“We know that there’s consequences. We might be fined, maybe even jail, but we’re willing to make a statement if this is going to help wake up some of the congressmen and the governor.”Jesse Arellano, owner of restaurant that opened in defiance of Colorado lockdown order
“To those politicians who decide to cave in to this coronavirus, they need to understand the consequences of their cowardly act.”PA Governor Wolf, threatening to withhold state and federal funding to counties “that put us all at risk by operating illegally”
“A bill has to come due for China. It’s not a question of punishing them, it’s a question of holding China accountable, the Chinese Communist Party accountable.”Peter Navarro, White House Advisor
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- Recent Developments and Headlines
- Numbers and Trends
- Risks of Infection Increase as States Reopen
- The Risks of Infection – Know Them – Avoid Them
- The Risks of Infection – Know Them – Avoid Them
- New Scientific Findings & Research
- Lockdowns vs. Reopenings
- Lessons From The Hong Kong Flu
- National Disgrace
- COVID Moonshot
A. Recent Developments and Headlines
Sources: New York Times Coronavirus Updates, New York Post Coronavirus Updates, Zero Hedge Coronavirus Updates, Drudge, Breitbart, Wall Street Journal, Coronavirus White House Task Force Briefing, NY Governor Daily Briefing, and Worldometers
- US Coronavirus Death Toll Tops 80,000 As States Push Ahead With Reopening
- Dozens of US states take more dramatic steps toward reopening
- NY Gov. Andrew Cuomo: Upstate New York Regions to Begin Reopening May 15
- Trump Says Coronavirus Outbreak “Overrides” China Trade Deal
- New study shows staggering effect of coronavirus pandemic on America’s mental health
- Study finds 42% of pandemic layoffs will become permanent job losses
- 52% Of Small Businesses Expect To Be Out Of Business Within Six Months
- As more PA sheriffs say they won’t enforce closure orders, Gov. Wolf threatens disobedient counties, calls them ‘cowardly’
- Trump Administration will provide states with $11B for coronavirus testing in ‘underserved communities’
- South Carolina reopens restaurants for ‘limited service’
- Iowa Governor says she will do limited quarantine
- Wuhan to test entire city after latest outbreak
- UN says 7 or 8 ‘top’ candidates for a COVID-19 vaccine exist
- WHO says 500,000 could die from AIDS thanks to disruptions in antiviral distribution
- German Paper: Lockdown ‘Huge Mistake’
- South Korea’s latest cluster swells to 80+; school reopenings delayed
- Wuhan reports first new cases since reopening
- Germany hits another reopening ‘speed bump’
- Iran sees spike in infections, reimposes lockdown in one hot spot
- Disneyland Shanghai reopens
- UK officially switches from ‘Stay at Home’ to ‘Stay Alert’
- Russia reports another record jump
- Spain sees new cases drop to 2 month low
- Meat Exports To China Soar As US Supplies Dwindle & Workers Risk COVID-19 Infection
- iPhone Sales Crash 77% In April, Hammered By COVID-19 Lockdowns
- A New Reality: Pandemic-Induced Layoffs May Be Permanent
- Americans Being Turned Away Trying To Buy Life Insurance
- Shanghai Disneyland Holds “Grand Reopening” As Guest Capacity Slashed, Social Distancing Enforced
- London’s Trains Packed With Commuters As PM Johnson Lifts ‘Stay Home’ Order
- As COVID-19 Spreads In Meat Plants, 200 USDA Inspectors Test Positive
- Disinfecting Drones Could Be MLB’s Solution To Reopen Stadiums
- Carnival Cruise Bookings Surge 600% After August Relaunch Announcement
- “It’s 99% Autonomous” – Delivery Robots Slated To Launch In Texas To Limit Virus Spread
- UK Prime Minister Boris Johnson: There May ‘Never’ Be A COVID-19 Vaccine
- India Uses Drones, Firetrucks To ‘Disinfect’ City As 100s Of Migrant Workers Clash With Police
- As Russia Now Has World’s 3rd Most COVID-19 Cases, Med Students Being Thrown To Front Lines
- White House Orders All Staff To Wear Face Masks ‘At All Times’
- Joint Chiefs Members Sidelined By COVID-19 As Alarm Grows Over White House Exposure
- Some 5,000 People Waiting Out COVID-19 In Frozen, Virus-Free Antarctica
- MLB Owners Approve Plan to Start Season in July
- Virus Returns to Wuhan
- Study: Virus Death Toll in NYC Worse than Official Tally
- Carnival Cruise Lines Flooded with Bookings; Return in August
- South Korea: Rise in Cases Linked to Gay Nightclubs
- Trump Demands ‘Freedom’ for Pennsylvania Citizens
- Fear of W-Shaped Recovery Grows
- IL Gov. Pritzker Self-Quarantining After Staffer Contracts Coronavirus
- 18 Attorneys General Call for Congress to Investigate China
- Businesses Can Safely Reopen Using Testing, Tracing, Innovation
- Georgia Records Lowest Number of Coronavirus Patients in over a Month
- U. of California System: Campuses Will Not ‘Fully Reopen’ in the Fall
- Report: Apple Plans to Move iPhone Production from China — to India
- Online Education Is Awkward and Ineffective for College Students
- UK Govt Lockdown: Enjoy a Game of Tennis, But Don’t Have a Drink in the Clubhouse After
- Lebanon Faces Grave Threat to Stability as Poverty Mounts
- Michigan Sheriff Won’t Enforce Whitmer’s Stay-at-Home Order
- Fauci on the Return of Football: ‘The Virus Will Make the Decision for Us’
- Democrat Governor of Wisconsin Refuses to Reopen Before May 26 Despite Declining COVID-19 Rates
- PA Gov. Wolf Threatens ‘Consequences’ for Counties Defying Lockdown Orders
- Michigan Judge Sides with Barber, Rejects Gretchen Whitmer Demand to Close Shop
- Elon Musk announces that Tesla will restart production despite a county order
- To reopen, Washington State restaurants must record information about customers
- Louisiana joins the ranks of states that are reopening some businesses
- A divide between red and blue states is driving a congressional dispute over aid
- Poll Finds That 9 Out Of 10 Brits Want Lockdown To Carry On
- U.S. Depression? The V-Shaped Recovery Fades Away
- “Contact Tracer” And “Disease Investigator” Jobs Spring Up Across The Country
- Businesses Discover Employees Would Rather Stay Home And Collect Unemployment During Pandemic
- States Largely Ignoring White House Reopening Guidelines
- Two men attack security guards after refusing to wear masks inside a Target store
- Inmates intentionally catch coronavirus to force their release
- Customers barricaded waffle shop entrance as cop arrives to cite owner for COVID-19 showdown violation
- Trump, an eye on re-election, accuses Democrats of reopening U.S. states too slowly
- ‘Partisan Tribalism’ Dominates in Poll of Americans’ Virus Views
- New York City Medical Examiner Doing Limited Coronavirus Testing on Dead
- Colorado restaurant illegally reopens with no social distancing and hundreds of customers
- Restaurant In Castle Rock Determined To Be Open For Dine-In, To ‘Make Our Stand’
- Nursing Homes’ Unclear Death Toll Has States Testing Corpses
- Virus rampages across vast Navajo lands, close-knot families
- U.S. Coronavirus Deaths Near 80,000 as States Expand Moves to Reopen
- Top scientist who battled COVID-19 says we will never live normally without vaccine
- One Idea for Speeding a Coronavirus Vaccine: Deliberately Infecting People — Debate is rising among scientists about whether a so-called human challenge trial is worth the risk
- France will still ban Islamic face coverings even after making masks mandatory
- Saudi Arabia Imposes Austerity Measures as Its Economy Founders
- Putin eases Russia’s stay-at-home orders as cases soar
- Farmers’ hopes for respite from Trump-era struggles fade amid pandemic
- UFC ushers in fan-free, mask filled era of sports
- Musk Emerges as Loudest Reopen Proponent With Tesla Threats
- NIH Chief Sees Likely Need for Multiple Vaccines to Fight Virus
- Fed Paper Says Companies May Automate More Jobs During Pandemic
- How coronavirus attacks the entire body — damaging the brain, kidneys and more
- Nursing home residents and workers make up a third of coronavirus deaths. In some states, they account for half.
- Norway to reopen high schools, bars and most of society by mid-June
- Boris Johnson reveals first steps toward easing UK’s coronavirus lockdown
- NJ residents are leaving an ‘inordinate’ amount of urine and feces in parks
- Pandemic upends life on isolated, idyllic Galapagos Islands
- Plastic piles up in Thailand as coronavirus sidelines pollution fight
- State AGs call for congressional probe of China’s coronavirus response
- NYC coronavirus death toll may be thousands more than official tally
- Uber lays off 3,500 workers in 3-minute Zoom calls
- De Blasio claims ‘historic’ gains in getting NYC’s homeless off subways
- Mysterious coronavirus-linked disease could threaten school reopenings
- Three New York regions cleared for coronavirus reopening by week’s end
- Europe begins to emerge from coronavirus lockdown
- Denmark slashes social distancing rules as coronavirus restrictions ease
- De Blasio says New York City could reopen in June
- New Yorkers will soon have to move their parked cars again
- Coronavirus sparks outbreak of online bullying against sick in Japan
- Palm Beach is new escape for New Yorkers looking to dodge coronavirus
- Partygoer sparks outbreak after joking she had coronavirus
B. Numbers & Trends
Note: All changes noted in this Update are since the 5/10 Update
1. Confirmed Total Cases, New Cases and Tests
- Total Cases = 4,252,325 (+1.8%)
- New Cases = 74,171 (-7.1%) (-5,695)
- New Cases (5 day avg) = 86,496 (-4.7%) (-4,231)
- Total Cases = 1,385,834 (+1.3%)
- New Cases = 18,196 (-10.5%) (-2,133)
- New Cases (5 day avg) = 24,546 (-5.6%) (-1,453)
- Number of Tests = 9,619,855 (+175,330)
[Note: A recent story in the New York Times citing administration projections of 200,000 cases per day by the end of May appears to be an astonishingly inaccurate report. The number of cases in the US have on average recently been decreasing, not increasing, and it is hard to imagine circumstances in which the number of cases in the US could increase from 20,000 to 200,000 cases per day over the next few weeks (which would be more than double the current number of worldwide new cases per day).]
- Worldwide Deaths = 287,137 (+1.2%)
- New Deaths = 3,403 (-3.1%) (-107)
- New Deaths (5 day avg) = 4,460 (-13.3%) (-681)
- US Deaths = 81,795 (+1.3%)
- New Deaths = 1,008 (+34.4%) (+258)
- New Deaths (5 day avg) = 1,399 (-17.9%) (-304)
[Note: A recent story in the New York Times citing administration projections of 3,000 deaths per day by the end of May appears to be an astonishingly inaccurate report. The number of cases in the US have on average recently been decreasing, not increasing, and it is hard to imagine circumstances in which the number of cases in the US could increase from 750 to 3,000 deaths per day over the next few weeks.]
- 5 Countries with Largest Number of Confirmed Deaths:
|Country||Total Deaths||Deaths Per 1M Population|
|US||81,795 (+1,008)||247 (+3)|
|UK||32,065 (+210)||472 (+3)|
|Italy||30,739 (+179)||508 (+3)|
|Spain||26,744 (+123)||572 (+3)|
|France||26,643 (+263)||408 (+4)|
- 5 Countries = 69.0% of Worldwide Total Confirmed Deaths (-0.1%)
- US = 28.5% of Worldwide Total Confirmed Deaths (+0%)
- 5 States with Largest Number of Confirmed Deaths:
|State||Total Deaths||Deaths Per 1M Population|
|New York||27,003 (+191)||1,388 (+10)|
|New Jersey||9,341 (+77)||1,052 (+9)|
|Massachusetts||5,108 (+129)||741 (+19)|
|Michigan||4,584 (+33)||459 (+3)|
|Pennsylvania||3,841 (+18)||300 (+1)|
|US||81,795 (+1,008)||247 (+3)|
- 5 States = 61.0% of US Total Confirmed Deaths (-0.2%)
- NY = 33.0% of US Total Confirmed Deaths (-0.2%)
3. Countries/States To Watch
- Sweden [Note: The World Health Organization has cited the Swedish approach as a model for reopening economies]
- Total Cases = 26,670 (+348)
- Deaths = 3,256 (+31)
- New Deaths (5 day avg) = 63 (-15.1%) (-11)
- Deaths per 1M population = 322 (+3)
- Below are 5 of the States moving quickly to reopen their economies (and OK never locked down).
|State||Total Cases||Total Deaths||Deaths Per 1M Pop|
|Georgia||34,002 (+494)||1,444 (+39)||136 (+4)|
|Florida||40,982 (+386)||1,735 (+14)||81 (+1)|
|Texas||40,855 (+965)||1,153 (+20)||40 (+1)|
|Ohio||24,787 (+706)||1,360 (+19)||116 (+1)|
|Oklahoma||4,613 (+24)||274 (+2)||69 (+0)|
|US||1,385,834 (+20,329)||81,795 (+1,008)||247 (+3)|
C. Risks of Infection Increase as States Reopen
1. Risks of Infection – Know Them – Avoid Them [Opinion By Erin S. Bromage, PhD]
[Note: Erin S. Bromage, Ph.D., is an Associate Professor of Biology at the University of Massachusetts Dartmouth]
- It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That’s what’s going to happen with a lockdown.
- As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I’ve said before, if you don’t solve the biology, the economy won’t recover.
- There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, as of May 3rd the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained.
- So throughout most of the country we are going to add fuel to the viral fire by reopening. It’s going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk.
Where are people getting sick?
- We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.
- But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks…. are these places of concern? Well, not really. Let me explain.
- In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with MERS and SARS (and this one), some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.
How much Virus is released into the environment?
- A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
- A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds.
- A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).
- If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.
- A Breath: A single breath releases 50 – 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.
- Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don’t have a number for SARS-CoV2 yet, but we can use influenza as a guide. We know that a person infected with influenza releases about 3 – 20 virus RNA copies per minute of breathing.
Remember the formula: Successful Infection = Exposure to Virus x Time
- If a person coughs or sneezes, those 200,000,000 viral particles go everywhere. Some virus hangs in the air, some falls into surfaces, most falls to the ground. So if you are face-to-face with a person, having a conversation, and that person sneezes or coughs straight at you, it’s pretty easy to see how it is possible to inhale 1,000 virus particles and become infected.
- But even if that cough or sneeze was not directed at you, some infected droplets–the smallest of small–can hang in the air for a few minutes, filling every corner of a modest sized room with infectious viral particles. All you have to do is enter that room within a few minutes of the cough/sneeze and take a few breaths and you have potentially received enough virus to establish an infection.
- But with general breathing, 20 copies per minute into the environment, even if every virus ended up in your lungs, you would need 1000 copies divided by 20 copies per minute = 50 minutes.
- Speaking increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.
- The exposure to virus x time formula is the basis of contact tracing. Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected. Anyone who shares a space with you (say an office) for an extended period is potentially infected.
- This is also why it is critical for people who are symptomatic to stay home. Your sneezes and your coughs expel so much virus that you can infect a whole room of people.
What is the role of asymptomatic people in spreading the virus?
- Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.
- Infectious people come in all ages, and they all shed different amounts of virus. The figure below shows that no matter your age (x-axis), you can have a little bit of virus or a lot of virus (y-axis).
- The amount of virus released from an infected person changes over the course of infection and it is also different from person-to-person. Viral load generally builds up to the point where the person becomes symptomatic. So just prior to symptoms showing, you are releasing the most virus into the environment. Interestingly, the data shows that just 20% of infected people are responsible for 99% of viral load that could potentially be released into the environment (reference here)
So now let’s get to the crux of it. Where are the personal dangers from reopening?
- When you think of outbreak clusters, what are the big ones that come to mind? Most people would say cruise ships. But you would be wrong. Ship outbreaks don’t even land in the top 50 outbreaks to date.
- Ignoring the terrible outbreaks in nursing homes, we find that the biggest outbreaks are in prisons, religious ceremonies, and workplaces, such as meat packing facilities and call centers. Any environment that is enclosed, with poor air circulation and high density of people, spells trouble.
Some of the biggest super-spreading events are:
- Meat packing: In meat processing plants, densely packed workers must communicate to one another amidst the deafening drum of industrial machinery and a cold-room virus-preserving environment. There are now outbreaks in 115 facilities across 23 states, 5000+ workers infected, with 20 dead.
- Weddings, funerals, birthdays: 10% of early spreading events
- Business networking: Face-to-face business networking like the Biogen Conference in Boston in March.
- As we move back to work, or go to a restaurant, let’s look at what can happen in those environments.
- Restaurants: Some really great shoe-leather epidemiology demonstrated clearly the effect of a single asymptomatic carrier in a restaurant environment (see below). The infected person (A1) sat at a table and had dinner with 9 friends. Dinner took about 1 to 1.5 hours. During this meal, the asymptomatic carrier released low-levels of virus into the air from their breathing. Airflow (from the restaurant’s various airflow vents) was from right to left.
- Approximately 50% of the people at the infected person’s table became sick over the next 7 days. 75% of the people on the adjacent downwind table became infected. And even 2 of the 7 people on the upwind table were infected (believed to happen by turbulent airflow). No one at tables E or F became infected, they were out of the main airflow from the air conditioner on the right to the exhaust fan on the left of the room. (Ref)
- Workplaces: Another great example is the outbreak in a call center (see below). A single infected employee came to work on the 11th floor of a building. That floor had 216 employees. Over the period of a week, 94 of those people became infected (43.5%: the blue chairs). 92 of those 94 people became sick (only 2 remained asymptomatic). Notice how one side of the office is primarily infected, while there are very few people infected on the other side. While exact number of people infected by respiratory droplets / respiratory exposure versus fomite transmission (door handles, shared water coolers, elevator buttons etc.) is unknown.
- It serves to highlight that being in an enclosed space, sharing the same air for a prolonged period increases your chances of exposure and infection. Another 3 people on other floors of the building were infected, but the authors were not able to trace the infection to the primary cluster on the 11th floor. Interestingly, even though there were considerable interaction between workers on different floors of the building in elevators and the lobby, the outbreak was mostly limited to a single floor (ref). This highlights the importance of exposure and time in the spreading of SARS-CoV2.
- Choir: The church choir in Washington State. Even though people were aware of the virus and took steps to minimize transfer; e.g. they avoided the usual handshakes and hugs hello, people also brought their own music to avoid sharing, and socially distanced themselves during practice. A single asymptomatic carrier infected most of the people in attendance. The choir sang for 2 1/2 hours, inside an enclosed church which was roughly the size of a volleyball court.
- Singing, to a greater degree than talking, aerosolizes respiratory droplets extraordinarily well. Deep-breathing while singing facilitated those respiratory droplets getting deep into the lungs. Two and half hours of exposure ensured that people were exposed to enough virus over a long enough period of time for infection to take place. Over a period of 4 days, 45 of the 60 choir members developed symptoms, 2 died. The youngest infected was 31, but they averaged 67 years old. (corrected link)
- Indoor sports: While this may be uniquely Canadian, a super spreading event occurred during a curling event in Canada. A curling event with 72 attendees became another hotspot for transmission. Curling brings contestants and teammates in close contact in a cool indoor environment, with heavy breathing for an extended period. This tournament resulted in 24 of the 72 people becoming infected. (ref)
- Birthday parties / funerals: Just to see how simple infection-chains can be, this is a real story from Chicago. The name is fake. Bob was infected but didn’t know. Bob shared a takeout meal, served from common serving dishes, with 2 family members. The dinner lasted 3 hours. The next day, Bob attended a funeral, hugging family members and others in attendance to express condolences. Within 4 days, both family members who shared the meal are sick. A third family member, who hugged Bob at the funeral became sick. But Bob wasn’t done. Bob attended a birthday party with 9 other people. They hugged and shared food at the 3 hour party. Seven of those people became ill. Over the next few days Bob became sick, he was hospitalized, ventilated, and died.
- But Bob’s legacy lived on. Three of the people Bob infected at the birthday went to church, where they sang, passed the tithing dish etc. Members of that church became sick. In all, Bob was directly responsible for infecting 16 people between the ages of 5 and 86. Three of those 16 died.
- The spread of the virus within the household and back out into the community through funerals, birthdays, and church gatherings is believed to be responsible for the broader transmission of COVID-19 in Chicago.
Commonality of outbreaks
- The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. (Ref)
- Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections).
So back to the original thought of my post
- Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint. We know that 60 people in a volleyball court-sized room (choir) results in massive infections. Same situation with the restaurant and the call center. Social distancing guidelines don’t hold in indoor spaces where you spend a lot of time, as people on the opposite side of the room were infected.
- The principle is viral exposure over an extended period of time. In all these cases, people were exposed to the virus in the air for a prolonged period (hours). Even if they were 50 feet away (choir or call center), even a low dose of the virus in the air reaching them, over a sustained period, was enough to cause infection and in some cases, death.
- Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.
- When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers – all day; customers – an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes more risky.
- Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floorplan office, you really need to critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk.
- If you are sitting in a well ventilated space, with few people, the risk is low.
- If I am outside, and I walk past someone, remember it is “dose and time” needed for infection. You would have to be in their airstream for 5+ minutes for a chance of infection. While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed.
- While I have focused on respiratory exposure here, please don’t forget surfaces. Those infected respiratory droplets land somewhere. Wash your hands often and stop touching your face!
- As we are allowed to move around our communities more freely and be in contact with more people in more places more regularly, the risks to ourselves and our family are significant. Even if you are gung-ho for reopening and resuming business as usual, do your part and wear a mask to reduce what you release into the environment. It will help everyone, including your own business.
1. The C19 Symptoms You May Not Know About
- As the pandemic spreads around the world, doctors are beginning to scope the coronavirus’s damage. Seen initially as a cause of viral pneumonia during the chaos of an explosion of cases in China, it’s now emerging as an enigmatic pathogen capable of harming the body in a myriad of unexpected, and sometimes lethal, ways. Clinical manifestations range from common cold-like symptoms and bronchitis to more severe disease such as pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. The illness may occur as a direct result of viral infection, as well as the body’s response to it. Here’s a snapshot of some of the symptoms Covid-19 causes, including some you might not have heard about.
- Blood — fever and inflammation may disrupt blood vessels, rendering blood cells more prone to clumping while interfering with the body’s ability to dissolve clots. That may trigger a clotting cascade that can lead to blood-vessel blockages in tissues and organs throughout the body. Life-threatening clots in the arteries of the lung, known as pulmonary emboli, may occur even after symptoms of the infection have resolved. Damaged blood vessels may become leaky and prone to bleeding. In children, inflammation of veins and arteries triggered by excessive immune activation may cause an illness similar to Kawasaki disease, an inflammatory disorder.
- Brain — dysfunction in the lining of blood vessels and associated bleeding and clotting disorders may cause strokes and bleeding in the brain. Patients may also experience headache, dizziness, confusion, impaired consciousness, poor motor control, delirium and hallucinations.
- Eyes — red, puffy eyes, sometimes referred to as pink eye, may result from infection in the conjunctiva, the tissue that lines the inside of the eyelids and covers the white part of the eye.
- Gastrointestinal tract — infection of cells lining the digestive tract may cause diarrhea, nausea, vomiting and abdominal pain. Blood-vessel blockages caused by abnormal clotting have been found to damage the bowel, requiring emergency surgery and resection.
- Hands — prickling or burning sensation in the hands and limbs may indicate Guillain-Barré syndrome, a rare nervous-system disorder that may be triggered by aberrant immune responses to viral infection. Other symptoms of the syndrome include poor coordination, muscle weakness and temporary paralysis.
- Heart — cardiac injury, sometimes leading to irregular heartbeat, heart failure, and cardiac arrest, may occur as a result of excess strain, inflammation of the heart muscle and coronary artery, blood clots, and overwhelming multi-organ illness. Infection, fever, and inflammation in people with existing heart-vessel blockages may cause their fatty plaques to break off, blocking or stopping blood flow in organs and tissues.
- Limbs — obstructions in large blood vessels may cause insufficient flow, or acute ischemia, in the limbs. Severe vascular complications can be lethal. At least one reported cases resulted in lower limb amputation.
- Liver — liver dysfunction may occur as a direct result of the viral infection, or more likely because of immune-mediated, systemic inflammation and circulatory blockages cutting blood flow to the organ.
- Lungs — the virus targets the epithelial cells that line and protect the respiratory tract as well as the walls of the tiny grape-like air sacs, or alveoli, through which gas exchange occurs to oxygenate the blood. Damage to alveoli and inflammation in the lungs can cause pneumonia, characterized by chest pain and shortness of breath. In severe cases, the lack of oxygen can trigger acute respiratory distress syndrome, leading to multi-organ-system failure.
- Kidneys — acute kidney injury may result from clots and impaired blood supply, or as a direct result of infection.
- Nose and tongue — while the virus can cause the sneezing and runny nose typical of a common cold, it can also disrupt the olfactory system, causing an abrupt full or partial loss of the sense of smell known as anosmia. Taste may also become distorted in a condition known as dyguesia.
- Skin — hive-like rashes, small red dots and purplish discolorations on the legs and abdomen are part of a complex category of so-called paraviral dermatoses that may result from the body’s immune response to the virus or from benign, superficial blood-vessel damage beneath the skin.
- Toes — purple rashes that resemble chickenpox, measles or chilblains may appear on the feet, especially of children and younger adults.
E. New Scientific Findings & Research
1. Lockdowns May Aggravate America’s Next Health Crisis: An Explosion Of “Deaths Of Despair”
- Doctors, scientists policymakers and even ‘non-experts’ posting on social media have argued that shuttering the health-care system to all non-emergency care risks sparking other public health crises from a spike in heart attacks and advanced cancer diagnoses, to so-called “deaths of despair.”
- In some areas, a spike in suicides has already been recorded since the start of the outbreak. And now, a newly published paper released Friday has attempted to quantify deaths that might occur because of the mental-health ramifications of widespread economic chaos caused by the crisis. The research – which hasn’t yet been peer-reviewed – found the isolation, grief and economic hardship related to C19 are conspiring to supercharge America’s already-burgeoning mental-health crisis, likely setting the stage for tens of thousands of suicides down the line.
- Specifically, the researchers tabulated that as many as 75k additional “deaths of despair” could be caused by the outbreak and the economy-crushing measures implemented to stop the spreads. “Deaths of despair” typically refer to suicides and substance-abuse-related deaths, according to Bloomberg.
- The research was carried out by the Well Being Trust and researchers affiliated with the American Academy of Family Physicians. One of the report’s authors said he hopes the research is eventually proven to be incorrect.
- “I hope in 10 years people look back and say, ‘Wow, they way overestimated it,’” said John Westfall, director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, who co-wrote the report.
- But the sizable spike in suicides, overdoses etc since the last major crisis (the financial crisis) is reason to be concerned.
- Even as the American economy rebounded after the last recession, suicides and overdoses cut into Americans’ life expectancy. Mental health experts worry that the economic uncertainty and social isolation of the pandemic will make things worse at a time when the health care system is already overwhelmed. The suicide rate in the US has already been rising for two decades, and in 2018 hit its highest level since 1941, Bloomberg reported, citing a piece published by JAMA Psychiatry (a prestigious medical journal) back in April.
- “There’s a paradox,” said Jeffrey Reynolds, president of a Long Island-based nonprofit social services agency, the Family and Children’s Association. “Social isolation protects us from a contagious, life-threatening virus, but at the same time it puts people at risk for things that are the biggest killers in the United States: suicide, overdose and diseases related to alcohol abuse.”
- Polls of life satisfaction taken since the outbreak began have reflected a rapid erosion as 33 million Americans have joined the unemployment rolls over the last months. NY Governor Andrew Cuomo said during a recent daily briefing that NY is seeing a spike in drug and alcohol abuse as people sit around all day with nothing to do and nowhere to go.
- “One of the main things people should take away from this paper is that employment matters,” said Benjamin Miller, chief strategy officer at the Well Being Trust and a clinical psychologist who worked on the paper. “It matters for our economic livelihood, and for our mental and emotional health.”
- But of course the tremendous levels of financial uncertainty coupled with the unique characteristics of this crisis make it pretty much impossible to model – any research is really an educated guess, at best.
- Still, the researchers believe it’s a useful warning, and something important for policy makers to keep in mind.
- “It’s useful to have a wake-up call,” said Ken Duckworth, chief medical officer at the National Alliance on Mental Illness. “Unemployment is going to have a very important impact on deaths of despair.”
- Benjamin Miller, chief strategy officer at the Well Being Trust and a clinical psychologist who worked on the paper, proposed several solutions that could be enacted to, uh, depress the number of suicides.
- His proposed strategies include investing more resources in helping unemployed people find meaningful work, and/or training the armies of contact tracers that de Blasio has now promised to hire to spot people at risk of self-harm.
2. If 80% of Americans Wore Masks, C19 Infections Would Plummet by More than 90%
There’s compelling evidence that Japan, Hong Kong and other Eastern locales are doing it right and we should really, truly mask up – fast
- It sounds too good to be true. But a compelling new study and computer model provide fresh evidence for a simple solution to help us emerge from this nightmarish lockdown. The formula? Always social distance in public and, most importantly, wear a mask.
- If you’re wondering whether to wear or not to wear, consider this. The day before yesterday (May 6), 21 people died of C19 in Japan. In the United States, 2,129 died. Comparing overall death rates for the two countries offers an even starker point of comparison with total U.S. deaths now at a staggering 76,032 and Japan’s fatalities at 577. Japan’s population is about 38% of the U.S., but even adjusting for population, the Japanese death rate is a mere 2% of America’s.
- This comes despite Japan having no lockdown, still-active subways, and many businesses that have remained open—reportedly including karaoke bars, although Japanese citizens and industries are practicing social distancing where they can. Nor have the Japanese broadly embraced contact tracing, a practice by which health authorities identify someone who has been infected and then attempt to identify everyone that person might have interacted with—and potentially infected. So how does Japan do it?
- “One reason is that nearly everyone there is wearing a mask,” said De Kai, an American computer scientist with joint appointments at UC Berkeley’s International Computer Science Institute and at the Hong Kong University of Science and Technology. He is also the chief architect of an in-depth study, set to be released in the coming days, that suggests that every one of us should be wearing a mask—whether surgical or homemade, scarf or bandana—like they do in Japan and other countries, mostly in East Asia. Among the findings of their research paper, which the team plans to submit to a major journal: If 80% of a closed population were to wear a mask, C19 infection rates would statistically decline by more than 90% when compared to a live-virus population in which no one wore masks.
- The mask debate, of course, has been raging for weeks in the US and globally. Pro-maskers assert that the widespread use of face coverings can diminish the spread of C19. Some anti-maskers, including various politicians and public health officials, have insisted that there is no proof of the efficacy of face guards. According to some activists, a blanket mask mandate places a limit on individual liberty and even one’s right to free speech. (Pro-mask advocates are fighting back with #masks4all and #wearafuckingmask Twitter campaigns).
- Representatives of the World Health Organization have also been sounding rather anti-mask, fretting that many people won’t wear masks properly, thereby risking infection, or that masks will give people a false sense of security and encourage risky behavior, such as partying up close and personal—none of which seems to have played out, as far as we know, in Japan or Hong Kong or other mask-wearing places. Adding to the brouhaha has been the shortage of medical masks for doctors, nurses, bus drivers, and the guy who delivers burritos to your door.
- The muddle over masks is what drove Berkeley’s De Kai to drop everything two months ago and help convene an ad hoc team of scientists and academics: a physician from London, a bioinformaticist from Cambridge, an economist from Paris, and a sociologist and population-dynamics expert from Finland.
- “I felt like this was pretty urgent,” said De Kai, who was born in St. Louis, and is the son of immigrants from China. “I saw the country where I grew up, where my family lives [now mostly in the Bay Area], about to face this pandemic without knowing much about something as simple as wearing a mask to protect themselves and others.” In part, this comes from a cultural difference between East Asia, where masks have been routinely worn for decades to fend off pollution and germs, and other parts of the world. This includes the U.S., where people are unaccustomed to wearing masks, and, in the past, have sometimes been insensitive, even stigmatizing East Asians, many of whom had chosen to wear them in public prior to the pandemic, and had continued the practice in the aftermath of the SARS and MERS outbreaks. (In part, this habit was meant to show other people that they were concerned about transmitting the disease—something we in the West would do well to emulate.)
- De Kai’s solution, along with his team, was to build a computer forecasting model they call the masksim simulator. This allowed them to create scenarios of populations like those in Japan (that generally wear masks) and others (that generally don’t), and to compare what happens to infection rates over time. Masksim takes sophisticated programming used by epidemiologists to track outbreaks and pathogens like C19, Ebola, and SARS, and blended this with other models that are used in artificial intelligence to take into account the role of chance, in this case the randomness and unpredictability, of human behavior—for instance, when a person who is infected decides to go to a beach. De Kai’s team have also added some original programming that takes into account mask-specific criteria, such as how effective certain masks are at blocking the invisible micro-droplets of moisture that spray out of our mouths when we exhale or speak, or our noses when we sneeze, which scientists believe are significant vectors for spreading the coronavirus.
- Along with the masksim site, the team is also releasing a study that describes their model in detail as well as their contention that masksim’s forecasts support a growing body of pro-mask evidence. “What’s most important about wearing masks right now,” said Guy-Philippe Goldstein, an economist, cybersecurity expert, and lecturer at the Ecole de Guerre Economique in Paris—and a masksim collaborator, “is that it works, along with social distancing, to flatten the curve of infections as we wait for treatments and vaccines to be developed—while also allowing people to go out and some businesses to reopen.”
- While all models have limitations and are only as good as their assumptions, this one is “a very thorough model and well done,” said William Schaffner, an infectious disease specialist at Vanderbilt University, who reviewed the De Kai team’s paper. “It supports a notion that I advocate along with most other infectious disease experts: that masks are very, very important.” Jeremy Howard, founding researcher at fast.ai and a distinguished research scientist at the University of San Francisco, also assessed the paper. “It’s almost overkill how careful they were with this modeling,” said Howard, who also coauthored and spearheaded a study last month (recently submitted to the journal PNAS) that reviewed dozens of papers assessing the effectiveness of masks.
- During a screen-share Zoom from his home office in Hong Kong, De Kai, who has not had to shelter in place (“because nearly everyone in here wears masks”), explained to me how the model works. (Check out the video where De Kai demos his interactive computation model below).
- On De Kai’s Zoom screen, a box pops up filled with dozens of blue dots, each representing a person who is publicly zipping and zapping about, doing their thing, and sometimes interacting with others. These blue dots denote the “uninfected, but susceptible.” As the simulation rolls along, one of the dots becomes orange, representing a person who has been exposed to the coronavirus. This orange dot then touches a nearby blue dot, which also changes to orange while the original orange dot changes to red. This means that dot-person is now infected. As the model runs and simulated “days” pass by, with the dots continuing to bounce around, some of the oranges and reds turn green, meaning they have recovered—or died.
- On the screen-share, De Kai first ran a simulation that shows what happens when C19 strikes a population in which no one wears a mask. The orange and red dots proliferate at a frightening speed; “susceptibles” becoming “exposed/infected,” then recovered or dead. “This is what you don’t want,” said De Kai. He changed the setting to simulate what would happen if 100% of the make-believe population wore masks; almost all of the dots would stay blue—with each of them surrounded by a white square, representing someone wearing a mask.
- Next De Kai added another tweak, modeling a situation in which 80% of a given population wore a mask. Here, most of the dot-people stay blue, with a few going orange, red, and green. “This is the goal,” De Kai maintained. “For 80 or 90% of the population to be wearing masks.” Anything less, he added, doesn’t work as well. “If you get down to 30 or 40%, you get almost no [beneficial] effect at all.”
- “I started to go out just to buy food in mid-March,” recalled economist Guy-Philippe Goldstein. “I was the only one wearing a mask, and people were making fun of me. They aren’t now, although there still aren’t enough people in Paris wearing masks.” This may be one reason why only a few states in the U.S. currently require people to always wear masks when they are out in public, although many states require masks for certain workers, for entering businesses, and on public transportation. Many cities and counties, including Denver and Los Angeles County, require them too. Whether you’re in a blue state or a red one, you don’t want to become one of De Kai’s red dots.
3. Scientific Research Finds Closing Borders Is Most Effective Way Of Combatting Coronavirus
Air travel is “the main explanation for the growth rate of COVID-19”
- Scientists in Brazil have found that the countries most affected by the coronavirus spread are the ones who continued to allow unrestricted travel across their borders, prompting further arguments that the most effective method of preventing the spread is tighter frontier controls.
- The research, carried out by the Federal University of Bahia in Salvador, suggests that screening and quarantining those coming into countries from outside could have been “a cheap solution for humanity”.
- The researchers based their analysis on records of 7,834 airports, using online flight databases documenting 67,600 transport routes in 65 countries.
- The scientists factored in a number of forces, including climate, socioeconomic factors, as well economic and air transport, in an attempt to ascertain how the size of outbreaks was affected in 65 countries which had more than 100 cases.
- The overwhelming factor was found to be air travel, leading to a conclusion that it is “the main explanation for the growth rate of C19.”
- The study notes that “The 2019 – 2020 world spread of C19 highlights that improvements and testing of board control measures (i.e. screening associated with fast testing and quarantine of infected travelers) might be a cheap solution for humanity in comparison to health systems breakdowns and unprecedented global economic crises that the spread of infectious disease can cause.”
- The data tallies with the fact that the US and the UK, which have the first and third highest air travel globally, have also suffered the most C19 deaths with 74,600 and 30,615, respectively so far.
- The US did not close its airports until late March, while Britain’s borders have remained completely open with little to no testing or quarantining of incoming travelers happening at all.
- On the other hand, nations like Austria, Denmark and New Zealand closed their borders within days of their first confirmed cases, and have experienced much fewer deaths.
- Austria in particular has enacted tight border controls, refusing entry to anyone without a medical certificate confirming they had tested negative for the virus, and placing a mandatory 14 day quarantine on those who do not have them. The country has suffered just 68 deaths per million of its population, with only 606 overall.
- Denmark closed its borders to all non-citizens in mid March, only excluding those with ‘credible purpose’ such as non-citizen Danish residents. The Scandinavian nation has recorded just 503 deaths.
- The UK, on the other hand has allowed some 18 million people to enter from outside the country with hardly any of them undergoing health screenings or being put into quarantine.
- Labour MP Stephen Doughty noted that “The fact that many of these people then likely arrived and travelled onwards across the UK with little or no adherence to social distancing, and with no checks or protections at the border is deeply disturbing.”
- The UK has seen 100,000 people arriving from foreign countries at UK airports every single week, all with virtually no health checks whatsoever.
F. Lockdowns vs. Reopenings
1. Is Herd Immunity the Only Viable Option?
- At present, there is no vaccine for the coronavirus. That means that one of the two paths to immunity is blocked. The other path is “herd immunity,” in which a critical mass of infection occurs in lower-risk populations that ultimately thwarts transmission.
- Herd immunity is the only path that is currently available. Let that sink in for a minute. The only way our species can effectively resist the infection is through the development of specific antibodies or sensitized white blood cells. In other words, the only way we can lick this thing is by the majority of the population getting the infection and thereby developing immunity to future outbreaks.
- That being the case, one would assume that the government’s policy would try to achieve herd immunity in the least painful way possible. (Young, low-risk people should go back to work if they so choose.)
- But that is not the government’s policy, in fact, the government’s policy is the exact opposite. US policy encourages people to remain at home and self quarantine until the government decides to lift the lockdown and allow some people to return to work. This policy assumes that the infection will have vanished by then, which of course, is extremely unlikely.
- The more probable outcome is that– when people return to work– there will be another surge in cases and another spike in deaths. We will have shifted the curve to a future date without having flattened it. We will have inflicted catastrophic damage on the economy and gained nothing. This is an idiotic policy that goes nowhere.
- After 6 weeks of this nonsense, many people are getting fed-up and demanding that the lockdowns be ended. In response to the public outcry, many governors are planning to restart their economies and lift the restrictions. What this means, is that, after wasting a month and half on a failed strategy, many states are ready to follow in Sweden’s footsteps with one critical difference, they’re not going to have a team of crack epidemiologists carefully monitoring their social interactions to see if a wave of new Covid cases is going to overwhelm the health care system. That means that things could get out of hand fast, and I expect they will. As we said in last week’s column, the lockdowns must be lifted gradually, that is crucial.
- “You have to step down the ladder one rung at a time”, says Senior Swedish epidemiologist and former Chief Scientist of the European Center for Disease Prevention and Control, Johan Giesecke. In other words, slowly ease up on the restrictions and gradually allow people to get back to work. That is the best way forward.
- There is also the question of whether herd immunity will be sufficient to fight off reinfection. This question was posed to Giesecke in a recent interview in which he was asked: “Why are you gambling that herd immunity will protect your people from re-infection?”
- Giesecke answered, “There has not been a single proven case of anyone getting a second infection from the virus….so far there have been no reinfections….If you have it once you don’t get it again….There will be herd immunity, that’s clear, and it will last over the period of this outbreak.”
- The interviewer then asked Giesecke why he was so certain that surviving the infection would produce herd immunity?
- “Because it’s a coronavirus,” Giesecke said, “and we know about 6 other coronaviruses, so why would this one be special? ….At present, 30% of the population of Stockholm is immune or has already had the infection. We do not have herd immunity today, but to go from 30% to 50% will only take weeks.“
- Giesecke candidly admits that he cannot be absolutely certain that infection survivors are immune, but he strongly believes that they are.
- Giesecke again: “When you (in the US and elsewhere) ease the lockdowns you will have more deaths…We will not have as many deaths because we will have herd immunity by the time the other countries start to lift their lockdown which means the virus won’t spread much more in Sweden, whereas you will have a higher number of cases and deaths.”
- If Giesecke is right, then Sweden is on the path to “normal” while the US is still chasing its tail, still following a policy that is clearly counterproductive. This needs to change. The safety and well-being of the American people should take precedence over the Hodge-podge of competing interests and conflicting agendas that have shaped the current policy. Now take a look at excerpt from an article at the National Review:
- “Spring is in the air, and it is increasingly found in the confident step of the people of Sweden. With a death rate significantly lower than that of France, Spain, the U.K., Belgium, Italy, and other European Union countries, Swedes can enjoy the spring without panic or fears of reigniting a new epidemic as they go about their day in a largely normal fashion.
- Dr. Mike Ryan, the executive director of the World Health Organization’s Emergencies Program, says: “I think if we are to reach a new normal, I think in many ways Sweden represents a future model — if we wish to get back to a society in which we don’t have lockdowns.”
- The Swedish ambassador to the U.S., Karin Ulrika Olofsdotter, says: “We could reach herd immunity in the capital” of Stockholm as early as sometime in May. That would dramatically limit spread of the virus.
- …Dr. Anders Tegnell, the chief epidemiologist of Sweden… heroically bucked the conventional wisdom of every other nation and carefully examined the insubstantial evidence that social-isolation controls would help reduce C19 deaths over the full course of the virus.
- As Tegnell told NPR in early April: “I’m not sure that there is a scientific consensus on, really, about anything when it comes to this new coronavirus, basically because we don’t have much evidence for any kind of measures we are taking.”….”To me it looks like a lot of the exit strategies that are being discussed look very much like what Sweden is already doing.”
- Sweden has about 2,641 reported C19 cases per million population. This is lower than the number in the U.S. (4,187 per million), the U.K., France, Spain, Italy, and also lower than in many other EU countries. It’s slightly above the number in Germany, which has been hailed for its approach to the virus….
- Sweden has 322 reported C19 deaths per million population. That is somewhat higher than in the U.S. (247 per million) but lower than the number in many other EU countries— and with no lockdowns….
- Unlike its Nordic neighbors and everywhere else…Sweden doesn’t have to worry about when and how to end social isolation. They don’t have to decide who to keep locked down and who to let out. They don’t have to get into civil-liberty arguments over involuntary restrictions or whether to fine people for not wearing masks and gloves.
- Now many countries and U.S. states are beginning to follow Sweden’s lead. But California and other states continue to pile up isolation-induced health costs and blow gigantic holes in their budgets with lockdowns that, nationwide, have generated more than 30 million newly unemployed.”
- Sweden is on the path to recovery while the United States is still trying to get out of the hole it dug for itself.
Also see: Sweden Bucked Conventional Wisdom, and Other Countries Are Following @ Coronavirus Crisis: Sweden Refused Lockdown & Other Countries Are Following
G. Lessons From the Hong Kong Flu
1. Hong Kong Flu Killed 100,000 Americans Without Any Lockdown – Why Is This Different?
By Jeffrey A. Tucker, Editorial Director for the American Institute for Economic Research
- In my lifetime, there was another deadly flu epidemic in the United States. The flu spread from Hong Kong to the United States, arriving December 1968 and peaking a year later. It ultimately killed 100,000 people in the U.S., mostly over the age of 65, and one million worldwide.
- Lifespan in the US in those days was 70 whereas it is 78 today. Population was 200 million as compared with 328 million today. It was also a healthier population with low obesity. If it were possible to extrapolate the death data based on population and demographics, we might be looking at a quarter million deaths today from this virus. So in terms of lethality, it was as deadly and scary as COVID-19 if not more so, though we shall have to wait to see.
- “In 1968/69,” says Nathaniel L. Moir in National Interest, “the H3N2 pandemic killed more individuals in the U.S. than the combined total number of American fatalities during both the Vietnam and Korean Wars.”
- And this happened in the lifetimes of every American over 52 years of age.
- I was 5 years old and have no memory of this at all. My mother vaguely remembers being careful and washing surfaces, and encouraging her mom and dad to be careful. Otherwise, it’s mostly forgotten today. Why is that?
- Nothing was closed by force. Schools mostly stayed open. Businesses did too. You could go to the movies. You could go to bars and restaurants.
- John Fund has a friend who reports having attended a Grateful Dead concert. In fact, people have no memory or awareness that the famous Woodstock concert of August 1969 – planned in January during the worse period of death – actually occurred during a deadly American flu pandemic that only peaked globally six months later. There was no thought given to the virus which, like ours today, was dangerous mainly for a non-concert-going demographic.
- [*Note: an earlier version said no schools closed. But a reader pointed me to an academic article that says “23 [states] faced school and college closures” but implies that this was due to absenteeism. This further underscores how aware people were at the time of the disease; the stay-open practice was a deliberate choice.]
- Stock markets didn’t crash because of the flu. Congress passed no legislation. The Federal Reserve did nothing. Not a single governor acted to enforce social distancing, curve flattening (even though hundreds of thousands of people were hospitalized), or banning of crowds. No mothers were arrested for taking their kids to other homes. No surfers were arrested. No daycares were shut even though there were more infant deaths with this virus than the one we are experiencing now. There were no suicides, no unemployment, no drug overdoses attributable to flu.
- Media covered the pandemic but it never became a big issue.
- As Bojan Pancevski in the Wall Street Journal points out, “In 1968-70, news outlets devoted cursory attention to the virus while training their lenses on other events such as the moon landing and the Vietnam War, and the cultural upheaval of the civil-rights movements, student protests and the sexual revolution.”
- The only actions governments took was to collect data, watch and wait, encourage testing and vaccines, and so on. The medical community took the primary responsibility for disease mitigation, as one might expect. It was widely assumed that diseases require medical not political responses.
- It’s not as if we had governments unwilling to intervene in other matters. We had the Vietnam War, social welfare, public housing, urban renewal, and the rise of Medicare and Medicaid. We had a president swearing to cure all poverty, illiteracy, and disease. Government was as intrusive as it had ever been in history. But for some reason, there was no thought given to shutdowns.
- Which raises the question: why was this different? We will be trying to figure this one out for decades.
- Was the difference that we have mass media invading our lives with endless notifications blowing up in our pockets? Was there some change in philosophy such that we now think politics is responsible for all existing aspects of life? Was there a political element here in that the media blew this wildly out of proportion as revenge against Trump and his deplorables?
- Or did our excessive adoration of predictive modelling get out of control to the point that we let a physicist with ridiculous models frighten the world’s governments into violating the human rights of billions of people? [Note: We would point out that C19 has killed almost 80,000 people, 80% of the H3N2 pandemic in only 3 months. The H3N2 flu occurred in the US between Sept ‘68 until the winter of 1969/1970.]
- Maybe all of these were factors. Or maybe there is something darker and nefarious at work, as the conspiracy theorists would have it.
- By way of personal recollection, my own mother and father were part of a generation that believed they had developed sophisticated views of viruses. They understood that less vulnerable people getting them not only strengthened immune systems but contributed to disease mitigation by reaching “herd immunity.” They had a whole protocol to make a child feel better about being sick. I got a “sick toy,” unlimited ice cream, Vicks rub on my chest, a humidifier in my room, and so on.
- They would constantly congratulate me on building immunity. They did their very best to be happy about my viruses, while doing their best to get me through them.
- If we used government lockdowns then like we use them now, Woodstock (which changed music forever and still resonates today) would never have occurred. How much prosperity, culture, tech, etc. are losing in this calamity?
- What happened between then and now? Was there some kind of lost knowledge, as happened with scurvy, when we once had sophistication and then the knowledge was lost and had to be re-found? For C19, we reverted to medieval-style understandings and policies, even in the 21st century. It’s all very strange.
- The contrast between 1968 and 2020 couldn’t be more striking. They were smart. We are idiots. Or at least our governments are.
- Readers have pointed out that this virus in the US came in two large seasonal waves in the Winter months, while Woodstock happened in August. Other countries had different patterns. Waves are clear in hindsight but not during; there was public awareness throughout.
- In 68/69, nothing was closed in either wave even though this was very deadly. Neither the organizers of Woodstock nor its participants (people not fatally vulnerable) gave a thought to it in January when it was planned. News reports later said that the flu was one of the many dangers that the event eschewed. For more on the medical and mortality aspects of this virus, see Multinational Impact of the 1968 Hong Kong Influenza Pandemic: Evidence for a Smoldering Pandemic
H. COVID Moonshot
1. Volunteer Chemists Use AI Algorithms to Discover an Antiviral
- It started with a tweet. Alpha Lee, co-founder and chief scientific officer of machine-learning company PostEra, read on Twitter that Diamond Light Source, the UK’s national synchrotron facility, had identified a set of chemical fragments that attach to an important coronavirus protein.
- Lee wondered if his company, formed just six months earlier, could help connect the dots from fragments to viable drugs to fight C19. PostEra uses AI algorithms to map routes for drug synthesis to speed the drug discovery process. But to do so, they would need some design ideas. So Lee asked the Internet.
- On 17 March, in collaboration with Diamond, the PostEra team launched the COVID Moonshot to crowdsource drug designs from medicinal chemists. Then PostEra applied their technology, pro-bono, to determine if and how those designs could be made.
- “We thought we might have 100 or 200 submissions,” says Lee, an associate professor at the University of Cambridge. “In fact, we got thousands.”
- Over 4,500 molecular designs from 280 contributors around the world flooded into the submissions site PostEra set up for the effort. Two chemical synthesis companies have stepped up to physically make the compounds, providing their services for free or at reduced cost, and two pharmaceutical companies, UCB and Boehringer Ingelheim, are contributing employee time toward the effort at no charge.
- “There’s an element of ‘we should do something’ from the PIs of the project, almost a duty, not wanting to leave key scientific equipment and great minds idle, and it has caught on” says John Spencer, a professor of bioorganic chemistry at the University of Sussex, who worked for 10 years as an industry medicinal chemist and is volunteering in the Moonshot. In addition to being involved in discussions and providing advice, Spencer has submitted around 100 ideas and sent compounds from his university laboratory for testing.
- If and when any drug candidates are identified via the crowdsourced project, the drug designs will be made openly available in the public domain without patent or any intellectual property restrictions. “In times like these, when the world is closing down, science should open up,” says Lee. “We are really optimistic that we can get a viable [drug] candidate out of this effort.”
- Currently, the chemical fragments discovered at Diamond are a far cry from actual drugs. The small molecules only weakly attach to the active site of a key coronavirus protein. A true drug compound requires additional chemical components to be potent, safe, and lasting in the body.
- Design ideas for such compounds are being submitted by academics, students, retirees, industry medicinal chemists, and more. “There are a lot of like-minded experts using a diversity of tools: some expert intuition, others machine learning, and others physical modeling,” says Lee.
- The PostEra team runs the designs through their machine-learning pipeline—algorithms trained on over 10 million chemical reactions scraped from patents of existing chemicals—to triage which designs can be made, and then generate recipes to do so rapidly. In a 2019 paper, PostEra’s algorithms outperformed human chemists in predicting the outcomes of chemical reactions.
- Lee estimates that designing ways to synthesize over 2,000 molecules might take chemists about three weeks. The PostEra algorithms did it in a weekend.
- Once the first batch of designs was triaged and complete, PostEra sent them off to chemical synthesis companies Enamine and Sai Life Sciences, who synthesized the compounds at no or reduced cost. “They’ve been super generous with their time,” says Lee. Incurred synthesis and testing costs are being funded through a GoFundMe campaign.
- Next, laboratories at the University of Oxford in the UK and Weizmann Institute in Israel began testing the compounds against the coronavirus protein, an enzyme called Mpro that is central to the virus’s ability to replicate. So far, there are several promising leads, says Lee. After testing against the protein in a dish, any strong hits will move into being tested against the whole virus, then against viral infection in animals. Lee hopes to identify a preclinical candidate in the next few months.
- “Knowing there’s a chance we’ll stumble upon some new discoveries, in an unprecedented manner, with a number of scientists from all countries, all levels—everyone is welcome, everyone has a voice—is invigorating,” says Spencer. “I sincerely hope that this is a sign of things to come.”
- If you want to get in on the effort, the Moonshot team continues to welcome design submissions through their website
I. National Disgrace
1. Nursing homes account for ‘staggering’ share of US deaths
- Residents of nursing homes have accounted for a staggering proportion of C19 deaths in the US, according to incomplete data gathered by healthcare researchers.
- Privately compiled data shows such deaths now account for more than 50% of all fatalities in 14 states, according to the Kaiser Family Foundation. Only 33 states report nursing home-related deaths.
- “I was on a phone call last week, where four or five patients came into our hospital just in one day from nursing homes,” said infectious disease specialist Dr Sunil Parikh, of Yale School of Public Health in Connecticut. “It’s just a staggering number day to day.”
- Despite early warnings that nursing homes were vulnerable to C19, because of group living settings and the age of residents, the federal government is only beginning to gather national data.
- In Connecticut, 194 of 216 nursing homes have had at least one C19 case. Nearly half the C19 deaths in the state – more than 1,200 people – have been of nursing home residents. The proportion is higher elsewhere. In New Hampshire, 72% of deaths have been nursing home residents.
- Parikh said limited testing and a lack of personal protective equipment such as masks hampered efforts to curb the spread of C19 in care homes. Due to limited testing capacity, most state nursing homes are still only able to test residents with symptoms, even though the disease is known to spread asymptomatically.
- “What I would like to see is the ability to test the entire nursing homes,” Parikh said. “This symptomatic approach is just not cutting it. Many states, including Connecticut, are starting to move in that direction … but I hope it becomes a national effort.”
- Nursing homes have been closed to the public for weeks but a bleak picture has nonetheless emerged. In New Jersey, Governor Phil Murphy called in 120 members of the state national guard to help long-term care facilities, after 17 bodies piled up in one nursing home.
- In Maine, a 72-year-old woman who went into a home to recover from surgery died just a few months later, in the state’s largest outbreak.
- “I feel like I failed my mom because I put her in the wrong nursing home,” the woman’s daughter, Andrea Donovan, told the Bangor Daily News. “This facility is responsible for so much sadness for this family for not protecting their residents.”
- Fifteen states have moved to shield nursing homes from lawsuits, according to Modern Healthcare.
- Nursing home residents were among the first known cases of C19 in the US. In mid-February in suburban Kirkland, Washington, 80 of 130 residents in one facility were sickened by an unknown respiratory illness, later identified as C19.
- Statistics from Kirkland now appear to tell the national story. Of 129 staff members, visitors and residents who got sick, all but one of the 22 who died were older residents, according to the CDC.
- By early March, most C19 deaths in the US could still be traced to Kirkland.
- “One thing stands out as the virus spreads throughout the US: nursing homes and other long-term care facilities are ground zero,” wrote Dr Tom Frieden, the former head of the CDC, for CNN on 8 March.
- That day, Frieden called on federal authorities to ban visitors from nursing homes. US authorities announced new measures to protect residents several days later.
- The CDC investigation into Kirkland was released on 18 March. It contained another warning: “Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to C19.”
- It was not until 19 April that the head of the Centers for Medicare and Medicaid Services promised to track all deaths in nursing homes. That requirement went into effect this Friday, but there is still a two-week grace period for compliance. During the period from 19 April to 8 May, 13,000 people died, according to an NBC News analysis.
- “This is really decimating state after state,” said Parikh. “We have to have a very rapid shift [of focus] to the nursing homes, the veteran homes … C19 will be with us for many months.”