Conoravirus ...

[Olaf Hart]

I am slowly coming to a radical place on reopening.

If we start with the premise that this thing isn’t currently amenable to curative treatment, and that our use of hospitals and high level intervention is effectively palliative, then we should step back to the 19th century and look at how things were managed then.

Society was used to a very high level of untreatable disease outbreaks, and established quarantine stations with their own hospitals to manage diseases, and hospital staff lived in the quarantine areas. Diseases still managed to spread sporadically outside the walls, but society, the economy, and the country largely continued on as normal.

As these conditions became treatable, we slowly closed the quarantine stations and used isolation facilities in community based hospitals with great success. This model clearly isn’t working here.

Here we have an effectively untreatable condition which is highly infectious and has a lowish death rate. The death rate is important, because if the virus killed most of its victims it would not spread as rapidly or effectively. We need to consider a different model of care to the one we use for treatable conditions.

Let’s not discount the effect of our current model on society, there is significant morbidity and mortality associated with shuttering up the economy, and we are already seeing some of the long term risks in a country which enshrines the right to bear arms...

So, I am coming to the position that admitting people with COVID19 to normal hospitals and shutting the economy is the wrong way to go, we really need massive quarantine facilities and high levels of testing. The big problem with this virus compared to most infectious diseases is the long silent prodromal period and asymptomatic carriers. This should be addressed by social distancing, masks and hand washing.

The idea is to get the community levels back to where we can contact trace, and then manage until we find effective treatment, or forever if we don’t...

[SemiSalt]

Two words for you, Semi. Small sample.

Not really that small. Lots of important real world problems present with data like this. Any way, looking at the two runs of 10 observations that I described above, the earlier one totaled 2946 and the latter one 1918. So we have seen a 35% drop. I think one reason it's hard to see is that the spikes squash the rest of the data down toward the x-axis.

The data is from Fairfield County with a population of almost a million. The data for Stamford, population about 125,000, is a lot messier, as you would expect. Total deaths in the city is 142 over about a month and a half.

[Olaf Hart]

https://www.buzzfeednews.com/article/ch ... oronavirus

[Jamie]

I am slowly coming to a radical place on reopening.

If we start with the premise that this thing isn’t currently amenable to curative treatment, and that our use of hospitals and high level intervention is effectively palliative, then we should step back to the 19th century and look at how things were managed then.

Society was used to a very high level of untreatable disease outbreaks, and established quarantine stations with their own hospitals to manage diseases, and hospital staff lived in the quarantine areas. Diseases still managed to spread sporadically outside the walls, but society, the economy, and the country largely continued on as normal.

As these conditions became treatable, we slowly closed the quarantine stations and used isolation facilities in community based hospitals with great success. this model clearly isn’t working here.

We have an effectively untreatable condition which is highly infectious and has a lowish death rate. The death rate is important, because if the virus killed most of its victims it would not spread as rapidly or effectively. We need to consider a different model of care to the one we use for treatable conditions.

Let’s not discount the effect of our current model on society, there is significant morbidity and mortality associated with shuttering up the economy, and we are already seeing some of the long term risks in a country which enshrines the right to bear arms...

So, I am coming to the position that admitting people with COVID19 to normal hospitals and shutting the economy is the wrong way to go, we really need massive quarantine facilities and high levels of testing. The big problem with this virus compared to most infectious diseases is the long silent prodromal period and asymptomatic carriers. This should be addressed by social distancing, masks and hand washing.

The idea is to get the community levels back to where we can contact trace, and then manage until we find effective treatment, or forever if we don’t...

So Ellis Island hospital and sanitarium type facilities?

[Ajax]

Olaf, that is a fascinating idea. I think it has real merit.
Everything old is new again!

[Olaf Hart]

That’s the general idea.

The possible flaw in this plan is that, as this thing is so infectious, it may be difficult to isolate.

The experience here in Tassie is very interesting, the island has a population of half a million, has had around 220 cases and 13 deaths, the numbers are pretty accurate because we have had high levels of testing.

The outbreak has always been kept under control by contact tracing.

Two thirds of the cases and 12 of the 13 deaths can be traced directly to a breakdown in isolation procedures in a district level hospital in the northwest of the state, which had to be closed down. We have now had four days of no new cases, so the strategy worked.

As far as I can tell, no one has been intubated and ventilated, 12 of the deaths have been elderly folks treated in district hospitals, where I have had some experience. They are not capable of safely maintaining a ventilated patient past the resuscitation phase..

So, in a small outbreak on an island which has always been under control, the main cause of spread has been breakdown in infection control systems in a hospital. I wonder how often this has happened around the world, but the data is hidden inside the static of much larger outbreaks.

So the question I have is if high level treatment is so ineffective, are we safer keeping these folks out of our hospitals and using dedicated facilities just for this outbreak?

[kdh]

Two words for you, Semi. Small sample.

Not really that small. Lots of important real world problems present with data like this. Any way, looking at the two runs of 10 observations that I described above, the earlier one totaled 2946 and the latter one 1918. So we have seen a 35% drop. I think one reason it's hard to see is that the spikes squash the rest of the data down toward the x-axis.

The data is from Fairfield County with a population of almost a million. The data for Stamford, population about 125,000, is a lot messier, as you would expect. Total deaths in the city is 142 over about a month and a half.

Sorry I lost my patience before, Semi.

I'm sure you don't think that I don't know that "lots of important real world problems present with data like this." I've spent my life thinking about real world problems with data associated with them.

My point is just that if data are noisy or spiky or however one might describe the result of using a small sample and more data are available, well, use more data.

I think focussing on counties is silly. Now that I've been completely blunt I'll get off my horse. Sorry for the rant.

[kdh]

OH, one of the Massachusetts islands in my cruising area, Penikese, used to be a leper colony. Perfect spot.

Is there really any hope of eradicating COV-2? Even with a vaccine it's hard to do. My assumption is that we'll have to find a way to live with it essentially forever.

[Olaf Hart]

OH, one of the Massachusetts islands in my cruising area, Penikese, used to be a leper colony. Perfect spot.

Is there really any hope of eradicating COV-2? Even with a vaccine it's hard to do. My assumption is that we'll have to find a way to live with it essentially forever.

I am looking out my windows at Quarantine Point on Bruny Island, Australia’s last vaguely intact quarantine station.

It last housed people when troops returned from WW1 and were quarantined for Spanish Flu.

It was a plant quarantine facility from the 50’s and was closed and handed over to the state by the feds in the nineties, some of the buildings have been dismantled but is still there..

And speaking or relics of the past, I am the closest Public Health Specialist ....

[Jamie]

One could argue, in the see-saw battle between microbe and medicine, that not having these types of facilities might have been a 70 year exception.

How many types of resistant antibiotics do we still have? I know that not applicable to viruses, but possibly another example of a medical "revolution" that may have been only temporary or partial.

[BeauV]

OH,

That is a really interesting suggestion. My paternal grandmother died in a "TB Sanitarium". My grandfather only took her there once she was really bad off. As a result, everyone in the family for two generations tests positive for TB, as do I. But, in many areas it slowed the transmission of the disease substantially.

If you think it's hard to keep American's at home with their Man Cave and Big Screen TV, you have no idea how ugly it'll get if we start "locking up" (which is the phrase they'll use) folks who are asymptomatic but exposed. I have sailing friends who think that the entire idea of a Q-flag and having to wait aboard their boat for "Clearance" is fundamentally illegal under our constitution. (Of course, they haven't read our constitution. But that doesn't slow 'em down.)

That said, I know of a LOT of people who have self-isolated. Our navigator, Lance, did that. Got home from a ski area (which is like a Petri dish for COVID-19) with a cough, fever, etc... his wife (a nurse) put him to bed in the "spare room" and wouldn't let him out. It took 5 weeks, but he's feeling pretty good now. He recounts it being pretty damned rough but his wife was making the call. Going to the hospital wasn't allowed. "You're sick as a dog, it's not the flu. If you additionally catch the flu in the waiting room or in a ward it'll kill you. You're staying home."


Jamie,

I agree. We humans will probably look at the period between the broad availability of antibiotics and sometime in the next decade as an astounding exception. Unless we find some fundamentally different ways to deal with diseases, infectious illnesses will become far more prevalent. But, I'm stating the obvious. I used to joke with my Admiral that we had lived in the golden age: Free love, Antibiotics could cure anything, and the Birth Control Pill. Then AIDS and Herpies put an end to that. (Well, reduced that.)

Viruses are going to be a massive problem, which isn't going away. As I think about the pattern of MERS, SARS1, and now SARS2, I feel there is a trend here. Wildly promiscuous travel patterns, primarily by air, has resulted in astounding velocity for these viruses. Sure, the 1918 flu managed to get across the Atlantic on a ship, but it was much more difficult.

Maybe this is the real reason Warren Buffett sold all his airline stocks. It will only take a few more, maybe a SARS3 and SARS4, and folks will stop flitting off to Paris (as the Admiral and I used to do 3 or 4 times a year). The Admiral and I actually had this discussion a week ago. She said: "I miss that little hotel near the river." and then, "But, I guess we're not going back anytime soon." An hour later in a doleful voice: "Do you think we'll ever go back?" All I could do was hug her and say no one knew.

It's fine for business folks to shift to video conferencing. Indeed, we should have shifted years ago. The software industry has completed the migration, mostly. This bug is causing all three Boards I'm on to shift. I doubt I'll fly to San Diego again for a Board meeting until things are a _LOT_ safer. I'm not up to 6 friends who have caught COVID-19 during air travel or in a face:face meeting at their destination. Massive trade-shows are gone for now. All those humongous trade show conference centers are sprouting tusks, the white elephants of real estate. Soccer stadiums, movie theaters, etc.. etc... etc...... It seems like there could be a massive impact on certain types of real estate.

[Olaf Hart]

I am with you on the individual freedom thing Beau, but it’s interesting, the countries which have closed this thing down are the ones that put population health concerns before individual freedoms, it’s always been that way with epidemics.

From this side of the world, the USA seems pathologically obsessed with individual freedoms at the expense of the common good, but I guess it looks different from inside the fishbowl.

Eventually the penny will drop as people understand that focusing on the common good rather than individual rights is the way to keep an economy open and functioning.

Taiwan has aced this thing with distancing, masks and self quarantine, and its economy has hardly missed a beat...

Australia and New Zealand have bottomed out the first wave, and are talking about starting a South Pacific “bubble” which allows travel within the zone. Both economies are opening up over the next week as they are comfortably in the contact tracing space.

The way the US is going, it won’t have a second wave, it won’t get through the first until it reaches herd immunity.

We were discussing tonight how it could be years before it’s safe for us to visit Denver.

And we haven’t even started to consider what we can do when this thing mutates and leapfrogs vaccines..

[SemiSalt]

We don't need a vaccine that confers long-lasting immunity. We can get along with a vaccine that confers 90-day immunity if we give it to everyone exposed to every live case.

I think we will get to a point where most of the US won't have to think about it, but places like NYC and LA and SF that have thousands of travelers passing through are going to continually reinforced for a long time.

[Ajax]

Being pathologically obsessed with individual liberties isn't the problem. Eschewing the responsibilities that accompany those rights, is the problem.

[Olaf Hart]

Being pathologically obsessed with individual liberties isn't the problem. Eschewing the responsibilities that accompany those rights, is the problem.

Good point

[Olaf Hart]

We don't need a vaccine that confers long-lasting immunity. We can get along with a vaccine that confers 90-day immunity if we give it to everyone exposed to every live case.

I think we will get to a point where most of the US won't have to think about it, but places like NYC and LA and SF that have thousands of travelers passing through are going to continually reinforced for a long time.

We have to give most vaccines before exposure, so we have to consider vaccinating the whole population.

If we have a low complication rate, it will end up a big deal because of the numbers.

[BeauV]

Being pathologically obsessed with individual liberties isn't the problem. Eschewing the responsibilities that accompany those rights, is the problem.

Bingo!

[LarryHoward]

I am slowly coming to a radical place on reopening.

If we start with the premise that this thing isn’t currently amenable to curative treatment, and that our use of hospitals and high level intervention is effectively palliative, then we should step back to the 19th century and look at how things were managed then.

Society was used to a very high level of untreatable disease outbreaks, and established quarantine stations with their own hospitals to manage diseases, and hospital staff lived in the quarantine areas. Diseases still managed to spread sporadically outside the walls, but society, the economy, and the country largely continued on as normal.

As these conditions became treatable, we slowly closed the quarantine stations and used isolation facilities in community based hospitals with great success. This model clearly isn’t working here.

Here we have an effectively untreatable condition which is highly infectious and has a lowish death rate. The death rate is important, because if the virus killed most of its victims it would not spread as rapidly or effectively. We need to consider a different model of care to the one we use for treatable conditions.

Let’s not discount the effect of our current model on society, there is significant morbidity and mortality associated with shuttering up the economy, and we are already seeing some of the long term risks in a country which enshrines the right to bear arms...

So, I am coming to the position that admitting people with COVID19 to normal hospitals and shutting the economy is the wrong way to go, we really need massive quarantine facilities and high levels of testing. The big problem with this virus compared to most infectious diseases is the long silent prodromal period and asymptomatic carriers. This should be addressed by social distancing, masks and hand washing.

The idea is to get the community levels back to where we can contact trace, and then manage until we find effective treatment, or forever if we don’t...

Isn't this effectively what Taiwan has done? Mandatory quarantine, at least for symptomatic patients in government provided facilities (I think I heard hotels) coupled with aggressive testing and contact tracing.

[BeauV]

I am with you on the individual freedom thing Beau, but it’s interesting, the countries which have closed this thing down are the ones that put population health concerns before individual freedoms, it’s always been that way with epidemics.

From this side of the world, the USA seems pathologically obsessed with individual freedoms at the expense of the common good, but I guess it looks different from inside the fishbowl.

Eventually the penny will drop as people understand that focusing on the common good rather than individual rights is the way to keep an economy open and functioning.

Taiwan has aced this thing with distancing, masks and self quarantine, and its economy has hardly missed a beat...

Australia and New Zealand have bottomed out the first wave, and are talking about starting a South Pacific “bubble” which allows travel within the zone. Both economies are opening up over the next week as they are comfortably in the contact tracing space.

The way the US is going, it won’t have a second wave, it won’t get through the first until it reaches herd immunity.

We were discussing tonight how it could be years before it’s safe for us to visit Denver.

And we haven’t even started to consider what we can do when this thing mutates and leapfrogs vaccines..

OH,

As Ajax said, our country not only wants a great deal of "freedom to" do whatever it wants, it wants a great deal of "freedom from" anyone holding them accountable for their actions or the consequences of their actions. There is this massive (pathological?) desire to always blame someone else for whatever has gone wrong. Most of our industries have been built by avoiding accountability. This goes back centuries. Of course, we're in good company. We learned it from the British.

When you ask an American where they're from they'll tell you something like Holland or Scotland, or they might say California or Montana. They almost never say the United States. We have a country that isn't really one country it's a federation of States, many of which don't get along or have very high regard for each other. Occasionally, a common enemy has sort of united us, but our geographic, religious, and economic self-interest takes over once the threat is gone. I wouldn't be surprised to see health checks at state borders, or at the least clusters of states; sort of like the S. Pacific bubble you mentioned.

Decades ago I read a science fiction novel about a future time when Washington, Oregon, and California were a country called Ecotopia. I think Ecotopia was the 3rd largest economy in the world and in an improbable twist, the military folks who were in the area agreed to join up, taking a significant number of nuclear weapons, ships, airplanes, etc... with them. The Marines from Camp Pendelton became the "Army" and the rest of the country really didn't want to fight about it; believing that they were better off without the nut cases on the west coast. Of course, this was before the massive trade with China developed. The rest of the country would care a great deal if the link to Asia was severed. But, the story struck me as reasonably credible. We have at least 4 or 5 regional clusters of states which would probably make perfectly good countries. Then we could simply sell off Washington DC as an amusement park (which it nearly is now) and save a lot of money. There's the W Coast, The Rocky Mountain states, The northern Mid-West, the North East, and the South. Although the W Coast cluster is screwing things up by colonizing Denver and bits of other states.

I get so tired of everyone assuming that there will ever be herd immunity. So far, we have no evidence of any sort of durable immunity, yet folks continue to ignore that fact and just assume it's a "reasonable assumption." It is not. There is no evidence of anyone having ever had durable immunity to a coronavirus that I can find. If I'm wrong, I'd sure love to know it as it's damned depressing. We know of quite a few coronaviruses, but none of them elicit immunity. The obvious example being the common cold. We get it every year, sometimes multiple times in a year. So, before we get all excited about herd immunity or a vaccine, don't we need to have some evidence that immunity can exist??

[Olaf Hart]

You are correct about long term immunity to Coronavirus, the common cold immunity fades after a year or so, and SARS immunity can last up to four years, but wanes rapidly.

The 2003 Coronavirus outbreak research supports the notion that these viruses disable our early immune response, and they trigger massive later immune responses that can be fatal. Developing early immunity, vaccines and herd immunity are open questions at the moment.

The potential benefits of herd immunity or vaccination, if they eventuate, will be lucky to only last out this outbreak.

The next one will start the whole mess again, which is one of the factors that started me thinking about how we dealt with these things in the past.

Clearly, we can’t shut down the world economy every time someone in China eats the wrong bat...

[Jamie]

I am slowly coming to a radical place on reopening.

If we start with the premise that this thing isn’t currently amenable to curative treatment, and that our use of hospitals and high level intervention is effectively palliative, then we should step back to the 19th century and look at how things were managed then.

Society was used to a very high level of untreatable disease outbreaks, and established quarantine stations with their own hospitals to manage diseases, and hospital staff lived in the quarantine areas. Diseases still managed to spread sporadically outside the walls, but society, the economy, and the country largely continued on as normal.

As these conditions became treatable, we slowly closed the quarantine stations and used isolation facilities in community based hospitals with great success. This model clearly isn’t working here.

Here we have an effectively untreatable condition which is highly infectious and has a lowish death rate. The death rate is important, because if the virus killed most of its victims it would not spread as rapidly or effectively. We need to consider a different model of care to the one we use for treatable conditions.

Let’s not discount the effect of our current model on society, there is significant morbidity and mortality associated with shuttering up the economy, and we are already seeing some of the long term risks in a country which enshrines the right to bear arms...

So, I am coming to the position that admitting people with COVID19 to normal hospitals and shutting the economy is the wrong way to go, we really need massive quarantine facilities and high levels of testing. The big problem with this virus compared to most infectious diseases is the long silent prodromal period and asymptomatic carriers. This should be addressed by social distancing, masks and hand washing.

The idea is to get the community levels back to where we can contact trace, and then manage until we find effective treatment, or forever if we don’t...

Isn't this effectively what Taiwan has done? Mandatory quarantine, at least for symptomatic patients in government provided facilities (I think I heard hotels) coupled with aggressive testing and contact tracing.

The disease never got a strong foothold in Taiwan because of the reforms put in place after SARS and then practiced with MERS, H1N1 and their early detection in December that something wasn't right in China. They screened everyone in-bound from WuHan and then China overall, put in place special e-immigration processes to avoid lines and then tracked with mobile phones. Taiwan has a very strong hospital system and public health system. I remember my interaction with the hospitals and administrators mostly with positive feelings. Occasional corruption/FCPA/HCC issues.

[Tim Ford]

My older sister, early 80's, is propagating this video on FB.

https://www.youtube.com/watch?v=IsuCa6V ... RtxAwsf5L8

I wrote her (my sister, not Judy) back:
- - - - - - - - -

This is a bit too tin-foil hat for me. A lot of her allegations and her work have been discredited and her publications retracted. I've worked with hundreds of researchers in my career and found them to be honest, dedicated scientists. Her conspiracy theories are dangerous and she's been part of the anti-vaccine voice for a decade. Which has absolutely zero empirical basis in epidemiology. The video leaves out some important info about her, especially the retractions, which are humiliating, sometimes career-endangering episodes for Principle Investigators. I would not promote this video, but hey, it's a free country!
- - - - - - - - - - - - -
(I hope I wasn't too harsh) would love to hear what Benno has to say about her.

[Panope]

Yesterday, recreational boating/fishing opened up in Washington state. I had been chomping at the bit to test another (small) anchor, so I got that done before the Summer algae/plankton bloom clouds up the water (bad for filming).

Also, today I got a message from my Boss that we (Cape George Marine) are ok to start back up with PPE and other measures. First day back will be on Monday.

I'm gonna miss all the free time for projects.

Steve

[Benno von Humpback]

My older sister, early 80's, is propagating this video on FB.

https://www.youtube.com/watch?v=IsuCa6V ... RtxAwsf5L8

I wrote her (my sister, not Judy) back:
- - - - - - - - -

This is a bit too tin-foil hat for me. A lot of her allegations and her work have been discredited and her publications retracted. I've worked with hundreds of researchers in my career and found them to be honest, dedicated scientists. Her conspiracy theories are dangerous and she's been part of the anti-vaccine voice for a decade. Which has absolutely zero empirical basis in epidemiology. The video leaves out some important info about her, especially the retractions, which are humiliating, sometimes career-endangering episodes for Principle Investigators. I would not promote this video, but hey, it's a free country!
- - - - - - - - - - - - -
(I hope I wasn't too harsh) would love to hear what Benno has to say about her.

Benno has an acute case of wacko fatigue. Virtually every high-visibility medical researcher has been named by someone a modern Mengele, a greedy creature of Big Pharma, or the Devil incarnate. If I were any good, I'd have people saying outrageous shit about me too.

The antivax movement is a magnet for scientific sociopaths and grifters, of which Dr. Mikovits is both, and its ambit has now encompassed the COVID-19 pandemic.

For David Gorski's angry dissection of the video, see https://respectfulinsolence.com/2020/05/06/judy-mikovits-pandemic/.

[Tim Ford]

Thanks Benno!

[Ajax]

I can say outrageous shit about you if it will make you feel better?

[Benno von Humpback]

I can say outrageous shit about you if it will make you feel better?

I'm sure you have already.

[Jamie]

Yeah Benno - look at your name - clearly involved with programs like the Boys from Brazil.

[Anomaly]

I can say outrageous shit about you if it will make you feel better?

I'm sure you have already.

We're here to help....

[LarryHoward]

I can say outrageous shit about you if it will make you feel better?

I'm sure you have already.

We're here to help....

Always