Hiatus

Well, it looks like the stress of looking at stories about how many thousands of people are going to die has made my intermittent recurring shingles…recur. So I guess I need to take a few days off from the maelstrom.

Stay safe, folks. Don’t forget to:

  • Refill your meds (!!)
  • Buy toilet paper
  • Assume the Trump regime is lying and act accordingly:
    • Be more cautious than they’re telling you to be
    • Remember that they love the stock market more than people
    • Maybe avoid unnecessary gatherings for now

COVID-19: China Numbers Seem Accurate; Ideas for Getting More Accurate Public Health Numbers in Your Locality

When COVID-19 hit China, it took off like a wildfire, with thousands dead. It looked like the Case Fatality Rate (CFR) was about 2%, which was alarming. But there were a lot of reasons to think this situation might not reproduce exactly in other countries:

  • China was caught by surprise; we’re prepared (sort of?)
  • China might have been underreporting their total cases — if so, the real CFR would end up being a lot lower
  • China has one of the highest rates of smoking in the world, which might make the population more vulnerable
  • China was being so weird and secretive about some of their data that the world really didn’t know what to think

Well, now that the virus is well-entrenched in Italy, S. Korea, and Iran, I’ve got good news and I’ve got bad news: the China numbers mostly hold up. The disease spread, the CFR, they all seem to mostly match China. The good part of it is that this gives us more data that we can use to prepare. The bad part is that that data is…double plus ungood.

I’ve been crunching the numbers on the Johns Hopkins Coronavirus Map . Here’s the Case Fatality Rate by Country, as of today:

Feb 29, ’20 Case Fatality Rate by Country Total # Cases
Singapore 0 102
Germany 0 79
Korea 0.005 3150
USA 0.015 68
Japan 0.02 241
Hong Kong 0.021 94
Italy 0.026 1128
France 0.027 73
Iran 0.072 593

As you can see, there’s quite a wide range, but a lot of CFR’s are hovering around 1-2.5%. The average CFR for all countries is 2%; if you remove Iran and its very high numbers, the average is 1.4%. However, bear in mind that any CFR will be preliminary and low for the time being. You cannot know the true CFR until the disease has run its course and you divide the TOTAL deaths by the TOTAL number of people who got the disease, including those fully recovered; in the meantime, the numbers are always changing.

Some thoughts on this:

  • The higher the sample size, the more useful the numbers are. So Korea and Italy are more useful than Germany.
  • However, once you get too high, it becomes clear that no government can keep up with testing, and the numbers will likely get distorted again.
  • Singapore’s government is a high functioning government; they have had zero deaths so far, and by all accounts their rate of infection increase has slowed.
  • Iran’s government is a low functioning government; they have the highest death rate so far, and by all accounts their infections are totally out of control.
  • I repeat; I’m very worried about Iran. If China’s numbers are a model, Iran at this rate will have at least 1,500 deaths by the end of March.

What begins as an epidemiological problem is rapidly becoming a dysfunctional government problem, as anyone with experience in epidemiology or governments — or anyone who’s ever watched a disaster movie — could have foreseen.

Which brings us to the US. We are about to see in real time whether we’re a mostly-first-world country that’s fallen on hard times, or whether we’re more like a second or third world country that’s still talking about its past glories. We have a lot of policies in place that were supposed to only screw the poor — no sick leave! Expensive healthcare! Deductibles that reset Right About Now! — but it turns out that a broken healthcare system affects rich people too, because infectious disease control IS healthcare.

On top of the clusterfuck of the usual American healthcare issues, we have a truth-averse malignant narcissist in charge who would rather fudge the truth than see the stock market go down (more).

What we’re seeing the last 48 hours or so has been the push-pull between the Trump administration and government officials on the ground. Trump has a news conference to say everything’s fine? Gavin Newsom immediately has a news conference to announce community transmission in California. More “everything’s fine” from the administration? More news conferences, more community transmission, this time from Oregon, Washington…

So, while normal folks are out there looking for answers, they’re finding out that they’ve accidentally walked out into the demilitarized zone with the truth on one side, and crazy Twitter trolls typing “the FLU is WORSE,” and everyone is shooting at each other, and those ‘answers’ you were looking for are becoming ever more elusive.

If you are looking for answers the next few days, the closest you’re going to get are public health briefings from big blue states like NY, CA and WA. Another thing to do is see if your local government keeps a public health website on the number of flu and pneumonia cases / deaths. A lot of COVID-19 cases are going to be mis-reported as flu and pneumonia to start out. Moreover, some public health rank-and-file folks are going to be afraid of retaliation from the Trump administration, so they’re not going to publicize these numbers, but they will put them there, hoping the public can find them.

For example, here’s the State of Idaho’s chart keeping track of “Influenza-like illness.”

As you can see, the rate is ticking up slightly for our current week (“week 8”), while not at all going into alarming territory yet. BUT, if you look at the chart for your state / city, and it starts going up into “weird” territory while the government says everything’s “fine,” then you’ll know it’s not necessarily “fine.” (That said, compare to the year 2017-2018 for an example of a really bad flu season for reference.)

Good luck figuring out what the hell is going on in your personal corner of the woods.

In the meantime, stock up on toilet paper.

Covid-19 Update: Poop Gets Real

All right, y’all, the time for this to be contained — always a longshot — is officially over. Wherever it is you live, sooner or later, you may be impacted by this, and it’s time to get ready.

What does “get ready” mean?

Here’s a great post that will calmly and rationally guide you through some preparedness ideas by Virology Down Under.

Additional Thoughts:

Food and Supplies — Italy went from “no problem” to “OMG LOCKDOWN!!!” in a matter of days. There was a run on the shops. So, over the next few days and weeks, start stockpiling so you have enough food, etc. to survive a few weeks stuck in your home. Basically, prepare as if a hurricane / blizzard were coming, plus a few more days at least.

Medications — A lot of meds are manufactured in China. Supply chains are already starting to be impacted. So if you take regular medications — and especially if you have a severe medical condition — try to get an extra 2-3 month supply now. Today.

Financial — Have some extra cash on hand in your home if possible. On 9/11 I withdrew my rent money just in case. When the crisis passed I re-deposited it in time for my October rent.

Mental / Emotional — Poop’s gonna get real. The problem with this disease is that there’s up to a 30 day incubation period. So one way this is playing out in countries is that everything’s fine…fine…fine…HOLY SHIT! So, just, be aware. It’s going to be disorienting. I read recently that there is an “OMG” stage for these kinds of things, and you have to go through the OMG stage. One thing that can help make it easier is doing your preparedness shopping / organizing.

Mental, Part II — You’re about to find out just how shittily our government is functioning right now. Remember Katrina? Remember Maria? Well, we’re all about to face that level of gross neglect and incompetence. Trump has already stated — with his outside voice — that he doesn’t want folks to know about Covid19 cases because it might tank the stock market / his re-election plans. He already fired most of the people in pandemic prevention positions, like 2 years ago. This means you can expect the following:

  • Lack of transparency about new cases / locations of cases
  • “Everything is Just Fine” levels of denial to save his One True Love — the Stock Market
  • Underprepared, underfunded, understaffed and undersupplied disaster response
  • We will have to save ourselves. Look to your family, your community, your town. The feds are not equipped to deal with this. If they ever were, they sure as hell aren’t now.

Look, it’s not all doom and gloom. We have Netflix these days, and there have been no reports of water / power outages in China, so that’s hopeful for a long period of self isolation.

But, like, Get some extra toilet paper this week and stock up on supplies and get your meds refilled.

Love to all.

 

 

Covid-19: China’s Cooking the Books; Smoking May Contribute to Mortality; All Eyes on Singapore

Today’s installment of Sofi’s Armchair Epidemiology is all about ignorance. Specifically, our ignorance about China’s real numbers.

A few days ago, China made an announcement that they were changing how they counted COVID-19 cases. Previously, they were counting only the cases that were confirmed with a positive test. Since the tests they use have a lot of false negatives, and since hospitals were clearly too overwhelmed to test everybody, it was already clear that cases were being undercounted.

The new criteria they announced was that they would start counting both positive tests and positive symptoms — “ground glass” pneumonia showing up on scans, etc. And so, suddenly the number of positive cases jumped.

They made another announcement at the same time, though not as well-publicized. They have started dropping some patients from the count, specifically, patients who test positive but are asymptomatic. This is, of course, bullshit. We now know that asymptomatic carriers can still infect lots of people around them, so thinking that they “don’t count” is completely bonkers (that’s the scientific term for it). No doubt by dropping asymptomatic carriers from the rolls, the new total case number will look less alarming. There is no other reason to drop potentially infectious patients from the rolls.

Similarly confusing, the number of deaths doubled from what was expected in one day — theoretically due to these new inclusion criteria — but then the next day, 100 people vanished from the tally (“we realized we had double counted 100 people”). Considering how chaotic things are in Wuhan, the likelihood that they have an overcount is almost zero. Also, are deaths now being counted according to the old criteria (positive test) or the new criteria (positive test OR positive symptoms)? And what about people who die at home before they can be tested? Are they being counted towards the official tally?

Clearly China is massaging the numbers to to avoid a panic and financial meltdown. That is…not great. It also means that, without accurate numbers, the rest of the world can’t make informed decisions.

This leaves Singapore, because unfortunately, there is now an outbreak in Singapore as well.

Unlike China, Singapore has been doing an excellent job at transparently releasing information about their COVID-19 patients:

spore virus

Moreover, experts say Singapore’s been doing a good job at proper public health measures. So my take on things is that the next 2-4 weeks will give us real, actionable data, and also our best shot at seeing a country nip this in the bud. Singapore is highly regarded as one of the most technologically sophisticated countries in the world, which gives us the sense that if anybody can get this under control, it’s Singapore.

Here’s what the next 2-4 weeks should let us know in terms of data:

  • What is the actual Case Fatality Rate in a best-case scenario, i.e. a country with excellent health care that is not totally overwhelmed?
  • What is the reproducibility rate of the disease with proper containment protocols in place? (Note: the reproducibility rate is called the R0, pronounced “R-nought.”)
  • What’s the breakdown between mild/moderate/critical cases that test positive? (There will probably also be mild cases that don’t ever get tested, but it will be a start)
  • Will COVID-19 be less dangerous / will the male death rate be less skewed in a country with a lower smoking rate?

Which brings us to Item #3: Smoking. In China, the number of serious cases skews slightly male, but the male death rate is much higher than the female death rate. Some folks have theorized that this could be due to innate immune differences between men and women, but others are saying it’s due to smoking:

  • COVID-19 targets the ACE2 receptor
  • Tobacco use appears to affect ACE2 gene expression. From a new study: “We observed significantly higher ACE2 gene expression in smoker samples compared to non-smoker samples. This indicates the smokers may be more susceptible to 2019-nCov and thus smoking history should be considered in identifying susceptible population and standardizing treatment regimen.”
  • The male population of China has about a 49% smoking rate; the female population in China has about a 2% smoking rate.
  • By contrast, in Singapore the rate is about 18% men / 6.3% women.

Hopefully, Singapore’s advanced health system and lower rate of smoking will keep infections, critical cases, and deaths to a minimum. That is the best case scenario.

If Singapore can’t stop it, though, then…that’s not a good sign for the rest of the world. So let’s hope for the best case scenario and keep our fingers crossed.

My Prediction: Bloomberg will the Dem Nominee

“Why,” you might ask, “are you, Sofia, calling Bloomberg this early in the race?”

I have my reasons.

1. I was living in NYC when he ran for mayor. At first, people viewed his candidacy as a joke. Then he won.

2. He is ruthless about obtaining, using, and keeping power and money. He’s done some shady stuff like “golden handcuffs” charitable giving to consolidate power in NYC. He gave money to left-leaning organizations directly, and then they would endorse him when the time came. That’s how he got rid of term limits.

3. The political establishment do not want Sanders/Warren redistribution of wealth. They want a status quo candidate that protects their millions. But they’re also *slightly* uncomfortable with Nazis. So they’ll throw their support behind the strongest status quo candidate, which is Bloomberg.

4. Bloomberg has so f’ing much money that he’ll be able to win a lot of delegates just because other people will drop out due to lack of funds.

Now, do I think this is a good thing? It’s not….great, but it’s not the worst thing ever.

Pros of a Bloomberg Dem. Candidacy:

1. He has shit-tons of money, and he owns a tech company. The federal government is doing nothing to secure elections from hacking, because by now “doing nothing” = “ensuring another Trump win.” If anybody can fund and build a one-man election security committee, it’s Mr. 60 billion dollars.

2. Similarly, you know some super shady shit is going to go down on election day, from voter intimidation campaigns to broken voting machines to voters who are suddenly told they’re not registered. If anyone can afford to have boots-on-the-ground teams of rabid lawyers in all 50 states, it’s Bloomberg.

3. As Anand G. says, “Plutes gonna plute.” Rich people like Trump Because Money, but they don’t like him Because Fiery Nuclear Inferno. If all the Money people have a “safe” plutocratic thief to choose, they’ll definitely back Bloomberg.

4. Because of 1-3, we Might Just Beat Trump/Putin Maybe.

5. Bloomberg seems to genuinely give a shit about bad things that might affect him or his descendants, such as gun violence and climate change, and will probably be willing to put some big programs into effect to work on them.

Cons of a Bloomberg Candidacy:

1. He seems to be a shitty human being. He once found out an employee was pregnant and he said “Kill it.” (!?!?!?!?) His policies such as stop and frisk are widely regarded to be Super Racist.

2. He has been a Republican, an Independent, and now a Democrat. He has no ideology other than himself.

3. We’re not going to get a fairer tax system or affordable health care or real structural change under him.

Long story short: Bloomberg is a natural born killer whose greed and cunning might just make him the “he’s an asshole, but he’s Our Asshole” candidate we need right now. But after he wins, those of us who are poor or sick or whatever will be just as likely to die in a ditch as before. However, he is 1000% less likely to start World War III because his tummy is upset that day, and in this miserable time, I’ll take “avoiding the end of humanity” and be grateful I can die in a ditch in peace, un-irradiated.

Now, who would be his running mate? He’s going to want to appeal to more liberal voters and show that’s he’s not just a collection of stock portfolios in a suit. But there’s no way he’d actually pair w/ Bernie or, even scarier, somebody who really understands complex financial instruments and how they should be reformed — Elizabeth Warren.

So, he’ll signal he’s Not a Bad Guy by pairing with someone who is a not-white-man and not from the East Coast. I don’t think Bloomberg will pick a female veep because he’s too sexist. Cory Booker would be a great but New Jersey is too close to New York. So what about Joaquin Castro, a man who’s already worked in one centrist administration and knows how to play ball, plus he’s a LOT more visually appealing than keebler elf Bloomberg.

So that is my prediction: Bloomberg/Castro.

But what ticket would I love? Warren/Castro. Raise a glass, because the most qualified person BY FAR is a woman (again) and she’s not going to win (again).

Some Interesting Tools for Depression

Elsewhere on this blog, I’ve written/drawn about my mental and other health problems, and in particular about how I found out, 15 years into treatment, that I had a B-12 deficiency. What was so frustrating to me about this discovery was that:

  • B-12 deficiency has been a known cause of depression for 70 years
  • The test is simple
  • The treatment is simple, cheap, and has no side effects — it’s a water-soluble vitamin

and in particular,

  • NO ONE tested me for this over the course of 15 years!

And now, having experienced B-12 deficiency for a long time, I find I need massive amounts of B-12 shots just to get me back up to “normal.” **

In Applied Grace, I suggested a simple protocol that all mental health providers should use to Rule Out the Simple Stuff. But if your health care isn’t up to par, what then?

Enter: 23andMe.

There are a million different potential causes for mental health issues. BUT, a LOT of mental health issues have a genetic component.

Right now, you can get a test on 23andMe, and download the zip file with raw data. You can then upload that data to Promethease, Genetic Genie, and Found My Fitness (among others). They’ll tell you things like whether your body is bad at methylation and needs more B-12 and methylfolate. Whether you don’t absorb or process Vitamin D very well. And other useful stuff!

When I did these tests, I think I spent a total of about $30 after my 23andMe testing, and it was very useful. Some of the results even indicate things like, “probably responds poorly to __________ SSRI.” Wouldn’t that be great to know, before trying to take that SSRI!?!? Seems like the kind of thing it would be useful to know before going on medication, amirite?

So, this is what I recommend to all people struggling with mental health issues. Worst case scenario, you find out something else that’s useful, like a tendency towards diabetes or celiac. Best case, you’ve equipped yourself with the tools for a real change in how you feel.

Should actual “doctors” being doing this for everyone these days? Yes. Are they? Hell no.

So do it yourself, you’ll be happy you did.

 


** Pretty much the same exact story in non-cartoon form is told in a Wall Street Journal article this year. Long story short: chronic B-12 deficiency makes certain functions in your body deteriorate, which makes you need even more B-12. After a lifetime of deficiency you’ll end up in catch-up mode.

Lead and Fate

There’s an interesting article in Mother Jones, or more accurately a meta-article, which discusses the research that’s been done linking the decline in childhood lead exposure in the 1970’s and onwards to the decline in crime rates in the 1990’s, when those kids would have hit adulthood. It’s sobering reading.

I was born in Europe, which banned lead paint far before America, and I was past the whole eating-paint-chips phase of life by the time I moved here. So, by an accident of birth, I got to spend my most vulnerable brain development years safe from lead paint, while my age cohort peers in the US did not. This is especially true for kids in my age range who lived in substandard housing.

I was a smart kid. All the adults praised me and complimented me for being smart, as if it was an accomplishment, rather than an accident of birth. But now I see that, in addition to winning the genetic lottery for math ability, I also won a “right time and place” lottery for avoidance of lead. All these things I had literally nothing to do with, helped me to excel in school and get whatever success I’ve had in life.

America is a country with a strong mythos. It’s a fairy tale made by corporate backers, and then spun into the fabric of our society until its origins are obscured in the mists of time. The fairy tale says, You are more than just your circumstances, You can accomplish anything you set your mind to, Random misfortune is not going to defeat You, You can overcome anything with Pure Grit.

We’re fed these stories ad infinitum.

But if the quintessentially American truth – or should I say “truth” – is  about excelling in spite of adversity and not being defined by circumstance, the quintessential truth  keep coming back to is the opposite: how much of one’s life is circumscribed by random chance. How things that happened decades ago, in childhood, over which we had no control, can still limit our lives right now, today.

The can-do Americanism holds within it a darkness, which is the seed of judgement and rejection. If anyone can overcome anything, then your failure to overcome must be a character flaw. And if you’re just making bad decisions, then I don’t have any responsibilities to help you, as a fellow human being.

But being aware that random circumstances can have profound after effects creates the opposite feeling. There but for the grace of God go I. And with that feeling comes the responsibility to help our fellow humans, in whatever circumstance.

 

 

 

 

 

Got Student Loans? You Should be on REPAYE

I’m on REPAYE. One of the best things about REPAYE is that, depending on your income, the government might subsidize part of your repayment. This is important because, in a world where you still can’t refinance student loan interest rates, it’s the only “official” way to make your effective interest rate go down.

For the sake of simple math, let’s say your interest accrues at $300 a month, but based on your income you can afford $100 (they calculate what they think you can afford). The difference between what you can afford and what you accrue is $200. They will pay 50% of that. So every month, you don’t have to pay $100 in interest.

Now, the way they think you’re going to use it is by making your minimum payment, and then the extra $100 nobody paid gets added to your loan balance, and it goes up every year. At the end of 20-25 years, the whole amount gets “forgiven” and you have to pay taxes on that forgiveness.

BUT if your goal is to pay it down, then you could still use this to your benefit. Take advantage of the $100 savings each month, and pay aggressively. Your payments will go further because you’ll be accruing less interest.

One caveat is that their method of getting the subsidy is…odd. I think they send a statement to the government every month, and then the government sends in the subsidy, which gets applied to your account. In other words, you only get the subsidy when you pay $100 a month. If you make a big payment, you don’t get the subsidy that month. (Talk to your student loan servicer to double check this, it’s pretty complicated).

Long story short, you could take advantage of the subsidy most months, then make a few large lump-sum payments throughout the year. You would then be able to pay it down more quickly than you would without REPAYE.

If you apply for REPAYE now, you then have a year until they recalculate your income. If during that year you get a raise, then you could really take advantage of that subsidy. Your payments would only be x, but you could afford 2x or 3x, and make those payments without paying all that interest.

If however your income goes down, you can contact them to recalculate even if a year hasn’t passed yet. So it’s win-win.

One more thing to note: REPAYE is an even better deal if you have subsidized loans. For the first 3 years you’re on REPAYE, the whole “difference” between what you can afford and what you accrue is paid by the US government. So in the example above, you’d be getting a 200$ subsidy every month. If you have a mix of subsidized and unsubsidized loans, you could then put your extra money towards paying down the unsubsidized loan first.

Hope this helps.