How Do Things Get Better? Part II.

In my last post, I talked about how immunity might help us cope by giving us a cohort of immune folks to help society run — and possibly even donate their antibodies — until herd immunity happens.

In this post, I will talk about some other hopeful trends I see on the horizon.

One trend I see is that hacking culture + desperation are attacking the twin shortages of ventilators and PPE.¹ A lot of folks in many walks of life are working on ways to hack, kludge, and gerry-rig our way out of this mess.

Regarding masks, there’s a lot of effort going into “good-enough” solutions. Folks are sharing research showing that any facial covering is better than no facial covering. Folks are sewing masks at home, while others are 3-D printing face shields. People are even doing extremely sophisticated materials and aerosol research on their own dime, and then mass-disseminating information with their findings. For example, just yesterday an article came out that showed that certain shop towels might make very good homemade masks.²

Similarly, there’s other research going on to figure out ways to stretch current supplies of PPE. Commercial ovens may start being used to re-sterilize masks. Others are looking into using things like UV lamps for re-sterilization.

Regarding ventilators, some groups of people are trying to create gerry-rigged low-cost ventilators in various ways, such as re-purposing cpap machines.

Meanwhile, many many MANY medical researchers are working on trying to figure out how this disease operates, and how to fight it.³ While ventilators are necessary, they are also a last resort. By the time a patient gets to the point of needing a ventilator, they have a 50% chance of death. The best thing is to keep a patient from getting sick enough to need one.

Perhaps over the next few months, one treatment or a combination of different treatments will emerge, and these will allow more patients to avoid becoming critical. That would be amazing.


¹ Obviously, the shortages in both areas are nothing less than travesties, brought on by inept, incompetent and often downright malicious government choices. These are horrible and horrifying, and one hopes that in the not-too-distant future, there will be a severe and profound reckoning for everyone who got us into this mess.

² Of course, price gougers are already selling those same shop towels on Ebay for 5 times the usual price.

³ Here is just one article that’s been called “promising.” I can’t claim to understand it myself. But it shows that researchers are leaving no stone unturned to look at different mechanisms by which we can fight this thing.

How Do Things Get Better? Part I.

Hi.

Now that we’re in the thick of things, a lot of folks are wondering, How long does this last? When can we return to normal? etc. etc.

I’m not a soothsayer and I can’t tell you the answer to that — that said, I’m pretty sure that, barring some miracle, the US is going to be on lockdown through the end of the summer at least.

But I can also see some scenarios that will at least allow things to improve.

Factor X: Immunity

The 64 Trillion Dollar Question is: Are you immune once you get the disease? Or can you be reinfected? Most illnesses confer immunity to survivors. However, there are a few that do not. Some survivors of Dengue Fever, for example, are able to get reinfected, and the disease is even worse the second time.

Most medical folks are pretty sure that Covid-19 survivors have immunity. But, there are some questions. There are anecdotal reports coming out of Asia of folks who’ve gotten the illness, left the hospital, and then tested positive again. Why would that be? Is it because the tests are unreliable? Are they testing positive because the test saw virus particles and antibodies? Or are they truly ‘sick’ and truly ‘have it again?’ We don’t know yet.

There are other unanswered questions about immunity. In the worst-case scenario, immunity would only last for a year or two, and would then fade. Or even worse: Covid-19 would mutate to Covid-21 in a year’s time, and just as with the flu, we’d all have to suffer through it all over again.

But I’m going to focus on some rosier scenarios for the time being.

Best-Case Scenario: Survivors are Immune, We Get Reliable Antibody Tests, and Survivor Antibodies are Helpful 

If it turns out that survivors are immune

And we get a shit-ton of reliable, mass-produced antibody tests

Then that will be a game-changer.

Data from Iceland and Vo in Italy are showing that as many as 50% of cases can be asymptomatic. Once we’re able to test the entire population, we could identify all the folks who had it and didn’t know it, plus all the folks who had it but weren’t able to get tested.

All those folks could go back to normal life, and they could help the rest of us, too.

The idea floating around is an “immunity passport.” A QR code, a bracelet, something that identifies you as immune. Once we have a portion of the population that is guaranteed to be immune, we also have folks that are uniquely qualified to do front-line work. They could work in hospitals and medical clinics. They could work with elderly and immune-compromised people. They could work in customer-facing roles or food delivery. They would be the folks who could be guaranteed to be safe, and that is very important thing.

Side note: for some period of time, immune people would also have special bargaining power. We’re already seeing workers at Amazon warehouses and Instacart go on strike. In this desperate time, they are much more at risk than normal, but they also have much more bargaining power and they’re taking advantage of it. Now imagine a bunch of low-income folks who have the immunity superpower. Imagine what kinds of salaries and benefits they could demand if they worked together? This would be a rare time where average folk might have something rich folks can’t buy — immunity. It would be a rare opportunity.

As immunity spreads, I have an image of some limited re-opening of a few bars and restaurants. Almost like speak-easies for the immune. You’d have to show your bracelet to get in, and the immune could party while the rest of us languish inside our homes. It could be a new and different class divide based entirely on luck, albeit a temporary one.

My brother tells me that this image is way too “Philip K. Dick” and is unrealistic. We’ll See.

The second opportunity in identifying immune folks is the possibility that their antibodies can help save patients. There is already research being done on this. If it turns out to be a helpful treatment, our society will by force turn away from an “I’ve got mine” society to one that’s more about working together communally. If rich folks are going to, literally, need the blood of the poor to survive, they’re going to have to start fucking sharing. Medicare for All sounds like a good start. After all, why should someone who’s been denied affordable healthcare for their entire life give away their very life’s blood to a stranger? Something is going to have to give, societally and culturally.

The third opportunity in immunity is of course the old standby, Herd Immunity. At a certain point, slowly or quickly, this disease will work its way through the majority of the population. At that point, the uninfected will be a lot safer, statistically, than they were before.

So these are all things that could make life easier and better while we wait for the Holy Grail, which is a vaccine or highly-effective, safe treatment.

I’ll talk about some other ways thing might improve in Part II.

 

 

Wear a Mask, Everybody

Like many of you, I was told not to wear a mask at the beginning of the outbreak, so I did not purchase N95’s prophylactically. I’ve been kicking myself for this. But it turns out that if everyone wears even a homemade mask whenever they go outside, the rate of spread seems to be a lot lower. Correlation is not causation, but…it sure does seem correlated.

I was going to write a whole essay on why we need to be wearing masks, but this person did a great twitter thread on it instead, so here you go. Click on the “March 25” link for the whole thing.

 

The Next Stage: Hiding Bad Data

A few weeks ago, when we didn’t yet have adequate testing, I started going to individual state public health pages. States are required to make weekly reports about flu activity, and most states also collect “syndromic surveillance” meaning flu symptoms even without a positive flu test. The lingo for this is “ILI” or “influenza-like illness.”

It was a lagging indicator to be sure, as it takes time to compile the data and write the report, but by last week it started to be clear that even without proper testing, things were looking bad in terms of Covid-19 cases in a large number of states. So then I knew.

I knew that as time went on, they were going to have to start hiding the data.

And that’s what appears to be going on. Here’s what happened when I attempted to access the syndrome data for Louisiana’s latest report:

LA lies week 10

Well, that’s ok, because even though they’re hiding the data now on the state website, it’s still visible on the federal fluview website. So here’s what they don’t want you to see — the spike in recent cases:

ILI Louisiana week 11

Bear in mind this is data for “week 11,” which ended March 14th. It’s now March 26th so the data is waaay out of date.

What about Florida?

Well, their reports are still visible, and at first glance they appear to be the same. The charts look similar, and they have the same number of pages. So they’re not hiding anything….or are they?

Here’s Figure 1 from Week 9:

FL week 9 figure 1

And here’s the “same” chart from Week 12:

FL figure 1 week 12

If you just look at the chart, it appears that the numbers of ill people are going down. But if you look at the fine print, they’ve changed the report. The reports for weeks 9, 10, and 11 were for “influenza-like illness,” but for week 12 it changed to “diagnosis of influenza or flu.” Hiding the Covid.

But wait there’s more! Let’s look at this series of graphs. Looks like things are improving since week 9, right?

Week 9:

FL figure 16 week 9

Week 12:

FL figure 16 week 12

Again, they changed the criteria of the report. If they’d kept it about “influenza-like illness,” then floridians could see what is probably a massive uptick in cases. But no, they just quietly decided to change the report instead.

The only place you can get a hint of what’s happening is here:

FL fig 12 week 12

See how “flu” is going down in elder care facilities, while “ILI outbreaks” are increasing? That’s (most likely) Covid.

How hard is Florida trying to hide? Well, I can’t say for sure, but when you go to the National FLU VIEW page, the only state with no ILI data is Florida.

So, to review — Louisiana is putting its latest syndromic surveillance data behind a firewall, while Florida is completely changing its reports to keep the information off the radar. Not good.

Just thought y’all should know. Maybe your state is hiding the data, too.

~Update~

This post is getting a lot of traffic, so I wanted to add some links for those who want to do their own research:

Florida Flu Review Week 9, includes lots of ILI data

Florida Flu Review Week 10, same format

Florida Flu Review Week 11, same format

Florida Flu Review Week 12, most ILI data now missing

Note: I have downloaded all of these reports, so if anything changes later, please let me know.

Feelings

As someone who has suffered on and off with disability and isolation for 10 years, I’m getting an awful lot of feelings right now about how easily the world is moving to accommodate disability and isolation when it happens to, you know, them. 

More on that to come. Just wanted to say: disabled folks are seeing this, and noting it, and being very angry, and very tired, about this.

The Next Wave

My next question is, can folks who have been infected and then recovered still be carriers?

Or do they *not* carry the disease?

There could be a whole job category for them. They could work in the factories making masks and so forth, or delivering food to vulnerable populations.

It’s Not Neglect, It’s Murder

One of the hardest things about being murdered is wrapping your head around the concept that someone is trying to kill you.

For example, let’s say your boyfriend, whom you love, currently has his hands around your throat. He squeezes, tighter and tighter. You’re in the kitchen, you could stab him with a knife but . . . that would be lethal force!

Is he really trying to murder you?

Like, murder-murder?

Or is he just . . . murdering you ever so slightly? Maybe you shouldn’t fight back yet? Maybe you’ll stab him to death and the cops will say accusingly, “You killed a man because you couldn’t tell when he was just kidding?

Right now, in America, facing this virus with no help from our federal government . . . we’re all that woman, in the kitchen, trying to figure out if it’s “just sorta murder” or if it’s really “murder-murder.”

Spoiler: It’s murder-murder.

Everything right now is just inchoate agony and questions. Why did our administration refuse tests from WHO? Why did they discourage testing for so long? Why didn’t they do sampling months ago? Contact tracing? Why did they allow flights from epidemic countries without quarantine? Where are our masks? Why did they tell us not to wear them? Where is our medical stockpile? Where are our respirators? Why was our pandemic response team disbanded? Where is FEMA? Where are our field hospitals? Where is the Army Corps of Engineers? Where is the National Guard?

For those of us still lost in the fog of war, thinking, “Well, we shouldn’t worry that it’s malicious, because Trump is perfectly capable of killing us through sheer incompetence” . . . well yes, that may be true, but it’s not what’s happening.

Let me remind you who this man is. Here’s something Trump has actually said, using his outside voice, on the record:

“You know what solves it?” Trump said of America’s alleged troubles during a 2014 interview. “When the economy crashes, when the country goes to total hell and everything is a disaster. Then you’ll have a [chuckles], you know, you’ll have riots to go back to where we used to be when we were great.”

And, lest we forget, here’s what his comrade-in-arms Steve Bannon said,

Lenin wanted to destroy the state and that’s my goal too. I want to bring everything crashing down and destroy all of today’s establishment.”

Trump is a serial rapist. He is a pedophile. He is a mafioso. He is a criminal. He put a hit out on his own ambassador to Ukraine. He is a Russian Asset. And he is currently, this very morning, committing genocide by putting people in concentration camps. It’s not neglect, it’s murder.

He is trying to murder us.

We need to work together, respond quickly and decisively, the way you would respond with a surgical team to cut out a Stage 4 Cancer. We need to put enormous amounts of pressure on our state and local government officials to mobilize. We need to put enormous amounts of pressure on Congress. And in the meantime, until we can get the resources of the government mobilized, we need to become our own rescue team. Share supplies, share information, share resources, evade the social media blackouts, help our fellow citizens.

Let’s get to work.


Any wisdom I have about this comes from reading and listening to Sarah Kendzior and Andrea Chalupa. You can listen to their terrifying podcast at Gaslit Nation.

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.