COVID COVID-19 Coronavirus Containment Efforts

[mfb]

Some discussion how reliable numbers from some countries are.

Italy:

 

[kyphysics]

https://www.nytimes.com/2020/04/01/nyregion/coronavirus-new-york-update.html

Other developments on Wednesday:

• Confirmed cases in New York State: 83,712, up from 75,795.
• Currently hospitalized in New York State: 12,226, up from 10,929.
• In intensive care in New York State: 3,022, up from 2,710.
• In New Jersey: There were 22,255 cases, up from 18,696, and 355 deaths, up from 267.
• In Connecticut: There were 3,557 cases, up from 3,218, and 85 deaths, up from 69. Among the newly dead, Gov. Ned Lamont said, was a 6-week-old infant.
• The latest projections for the state put the peak of the outbreak at the end of this month.

Some numbers of the U.S. Northeast as of 4/1/2020 (yesterday).

When the deaths get into the hundreds (let alone, thousands) range for a state, it just feels scary for me. My state has less than 100 at this point, but we'll probably get there.

 

[kadiot]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

 

[atyy]

[response to deleted post deleted]

We are not given enough detail to understand Deborah Birx's statement. It is not obviously correct, since what is going on in Italy or Spain is consistent with China's numbers.

Deborah Birx recently made another bizarre statement that Singapore followed Trump's guidelines.
https://mothership.sg/2020/03/singapore-took-trump-guidelines-covid-19/

 

[wukunlin]

Ah indeed. Sorry for the tunnel vision.

 

[atyy]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

Well, I believe South Korea also has no lockdown, and they've been successful so far. I think the two successful cases so far are China and South Korea. China's problem was bigger because the outbreak started there and they mishandled things initially. Nonetheless South Korea also handled a great challenge. So it seems that depending on how out of control things are, both countries show the range of potentially successful policies.

Hopefully Italy will become another example of success, but it's too early to say at the moment.

 

[atyy]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents). Anyway, just for laughs (which is how most Singaporeans will understand this article):

S’porean mum discovers canes sold out at 2 stores as side effect of work-from-home
Kids all over the country quaking in fear.
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

 

[DrClaude]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

While there is no lockdown, there are many recommendations to limit contact and people are following them. Even if Sweden's approach succeeds, it won't necessarily mean that it would have worked everywhere. The overall low population density appears to be helpful here.

 

[bhobba]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents).
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

So was I at school, not so much at home, although other forms of punishment were used such as the handle of a feather duster. It was considered normal in Australia. But for some reason it went by the wayside here, but obviously not in Singapore. The only thing my parents disliked about it (as a child I just thought it normal) was at school when someone in a class would not own up to something they would cane the whole class. My mother had a very 'strong' talk to the principle about that practice - my son did nothing and you punished him.

Thanks
Bill

 

[wukunlin]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents). Anyway, just for laughs (which is how most Singaporeans will understand this article):

S’porean mum discovers canes sold out at 2 stores as side effect of work-from-home
Kids all over the country quaking in fear.
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

I'm more shocked that there are canes made specifically for that purpose. Most parent I know use whatever's at hand.

 

[gleem]

In the past decade, a lot of drugs have come on the market that are immunosuppressants: Humera, Embrel, Xeljzanz, Cosentiyx, Taltz, to name some well advertised drugs. And then there is the ever present prednisone that has been around forever. Those taking these drugs are often fairly young too. These people must be very concerned.

Not only prescription drugs have immunosuppressant effects. Over the counter drugs like aspirin and acetaminophen have been shown to affect the immunological response. https://www.hindawi.com/journals/mi/2015/349176/ reviews the immunological response and the effect on vaccination efficacy of many substances both pharmaceutical, environmental and nutritional.

So are we making ourselves as a population more vulnerable to infectious diseases?

 

[bhobba]

These people must be very concerned.

You think? I take Cosentyx a newer biologic and both me and my GP are really scared with this virus. Plus I have Diabetes. Join those together - and its up there with the angels, hopefully not down there with the other lot if I get it. Best to not dwell on it. Must practice my Cognitive Behaviour Therapy

Thanks
Bill

 

[atyy]

So was I at school, not so much at home, although other forms of punishment were used such as the handle of a feather duster. It was considered normal in Australia. But for some reason it went by the wayside here, but obviously not in Singapore. The only thing my parents disliked about it (as a child I just thought it normal) was at school when someone in a class would not own up to something they would cane the whole class. My mother had a very 'strong' talk to the principle about that practice - my son did nothing and you punished him.

Oh that's going to change my view of Aussies as easy-going people!

In school caning was not done for the whole class, just individuals. I don't think we do it in schools here anymore, just at home. For the whole class, the punishment was usually something like go and stand in the sun or stand on your chair.

 

[wukunlin]

In the past decade, a lot of drugs have come on the market that are immunosuppressants: Humera, Embrel, Xeljzanz, Cosentiyx, Taltz, to name some well advertised drugs. And then there is the ever present prednisone that has been around forever. Those taking these drugs are often fairly young too. These people must be very concerned.

Not only prescription drugs have immunosuppressant effects. Over the counter drugs like aspirin and acetaminophen have been shown to affect the immunological response. https://www.hindawi.com/journals/mi/2015/349176/ reviews the immunological response and the effect on vaccination efficacy of many substances both pharmaceutical, environmental and nutritional.

So are we making ourselves as a population more vulnerable to infectious diseases?

I wonder if that is in any way related to the decrease in body temperatures?

 

[wukunlin]

...deleted...

Yeah I realized it was unnecessary, deleting the post now.

[mod note: responses to the deleted content deleted. Thanks, @wukunlin ]

 

[russ_watters]

[response to deleted post deleted]

We are not given enough detail to understand Deborah Birx's statement. It is not obviously correct, since what is going on in Italy or Spain is consistent with China's numbers.

Deborah Birx recently made another bizarre statement that Singapore followed Trump's guidelines.
https://mothership.sg/2020/03/singapore-took-trump-guidelines-covid-19/

Birx's statement was:
"The medical community made -- interpreted the Chinese data as: This was serious, but smaller than anyone expected,” she said at a news conference on Tuesday. “Because I think probably we were missing a significant amount of the data, now that what we see happened to Italy and see what happened to Spain.”

My interpretation is that she's referring to the response in those other countries, not the statistics themselves. The early inaccurate data likely led most other countries to under-estimate the disease, partly resulting in slow/insufficiently aggressive responses. Point being, it should have been possible for basically every other country in the world to avoid the first-phase ramp-up that China had. My understanding is that only one country did: South Korea.

 

[peanut]

America reports one of the youngest persons to have died from COVID-19.

An infant girl in Connecticut who was just seven weeks old was brought unresponsive to a hospital. It was found out that she was infected with corona virus.

The death shatters the observation that only senior or older people are vulnerable to COVID-19. (NBC)

 

[atyy]

Birx's statement was:
"The medical community made -- interpreted the Chinese data as: This was serious, but smaller than anyone expected,” she said at a news conference on Tuesday. “Because I think probably we were missing a significant amount of the data, now that what we see happened to Italy and see what happened to Spain.”

My interpretation is that she's referring to the response in those other countries, not the statistics themselves. The early inaccurate data likely led most other countries to under-estimate the disease, partly resulting in slow/insufficiently aggressive responses. Point being, it should have been possible for basically every other country in the world to avoid the first-phase ramp-up that China had. My understanding is that only one country did: South Korea.

That was my interpretation too. But under that interpretation, her statement does not make sense. The early inaccurate data had been corrected quite a bit before Italy's ramp up. South Korea strengthens the case that Birx's statement makes no sense, since it was able to deal with it with the same amount of information. Italy did have enough time to to react and enough data to know that it had to react seriously.

I should also note that I have not seen similar statements from the Italian government yet. In fact, Italy has accepted help from China. It is by no means apparent that Italy would criticize China the way Birx, a representative of the current American administration, has done.
https://mothership.sg/2020/03/china-italy-help-covid-19/ citing this Twitter post:
"A China Eastern Airlines' A350 departed for Rome, Italy from Shanghai, bringing 9 Chinese medical experts and 31 tons of medical supplies, including plasma of recovered Coronavirus patients, to help Italy fight against the #COVID19 pandemic"

 

[Stephen Tashi]

Some discussion how reliable numbers from some countries are.

The mortality rate of a new disease doesn't indicate its net effect on the mortality rate of a population, especially in the case when the disease kills people who were likely to die of other causes anyway. In addition to posting links about Corvid 19 cases and fatalities, it would be useful to discuss comparisons with current death rates and historical death rates.

As far as I know, this page from a is non-political organization. In the section on Italy, it asserts that Italy has overestimated deaths due to Covid 19: https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

 

[russ_watters]

That was my interpretation too. But under that interpretation, her statement does not make sense. The early inaccurate data had been corrected quite a bit before Italy's ramp up. South Korea strengthens the case that Birx's statement makes no sense, since it was able to deal with it with the same amount of information. Italy did have enough time to to react and enough data to know that it had to react seriously.

"Enough time" and "enough data" are highly uncertain things. The data is thin and vague in some ways, overwhelmingly large and unwieldy in others, so it is perfectly reasonable and completely unsurprising that different countries/entities reacted very differently from each other. Yes, South Korea shows that it was *possible* to use a catch-and-contain strategy, but in order to accomplish that they reacted much faster and more aggressively than any other country I'm aware of.

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response. Being "right" makes South Korea the outlier - the one who's reaction doesn't make sense - not the rest of the world.

 

[russ_watters]

IMO, the situation with the cruise ship industry is one of the more head-scratching/shaking components of the crisis.
https://www.npr.org/sections/corona...th-covid-19-cases-to-stay-away-from-u-s-ports
https://www.businessinsider.com/trump-cruise-ships-zaandam-rotterdam-holland-america-2020-4

Passengers and cruise lines have been under-reacting to the issue for two months. From a strictly business-risk standpoint, the risk of a ship getting stranded over the virus has been obvious since the Diamond Princess incident started in the last week in January. Two months later, there are as best I can tell, dozens of stranded ships, with tens of thousands of passengers confined to a in a near-perfect virus-spreading environment. The cruise lines screwed-up.

And governments screwed-up: the US for example only shut down the cruise industry locally 2 weeks ago. Now, stranded ships are piling-up off the coast of Florida. Somehow, President Trump and the Coast Guard are not in alignment on what to do (I'm not clear how direct his authority is there...). The Coast Guard is refusing to let the ships dock and disembark and refusing to airlift passengers. IMO, this is morally and practically wrong. All countries should be taking it upon themselves to rescue their citizens in exactly the same way they did with the Diamond Princess and similarly, to regular tourists in foreign countries. We should let them dock and disembark as those arrangements are made. If those ships have American passengers, they should be removed and quarantined -- again, similar to how we did it with the Diamond Princess.

 

[kadiot]

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

 

[gmax137]

I think the mess with the cruise ships continues only because it is possible to say "no" to a ship coming into port. I have not heard of airliners being told "no you cannot land here." (of course flights are cancelled, but that doesn't happen when they are halfway to their destination).

I don't see any real difference; the craft should "land" and disembark the passengers. What happens to them afterwards is a different question than just saying they must remain aboard the petri-dish.

 

[BillTre]

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response. Being "right" makes South Korea the outlier - the one who's reaction doesn't make sense - not the rest of the world.

My understanding of the S. Korea situation is that they were strongly affected by the events of their SARS infections years ago. This lead them to:

• get ready for another epidemic
• take things seriously when the situation looked like a potential epidemic

The US medical experts are not stupid and could also learn from SARS. In response, they did things like set-up a pandemic response unit of some kind. The Trump admin. got rid of this (because Obama?) and made other "stupid" decisions that were not the actions recommended by the experts.

I guess this would be in the set of things you are calling "systems of logic, political philosophy, risk tolerance, institutional inertia, etc.".
I'm OK with that if you realize that it has a lot to do with the political philosophy and their lack of foresight and consideration of effects on people as a population rather than as economic entities.
To many medically trained people (in the same country), the available data did support an (more) aggressive response.
I don't think it is something that should be forgotten since they will be doing this over and over again if not called out on it and similar things.

 

[Vanadium 50]

Somehow, President Trump and the Coast Guard are not in alignment on what to do (I'm not clear how direct his authority is there...)

The President is Commander-In-Chief of the Coast Guard. So it's pretty direct. The real issue is that USCG officers swear to follow lawful orders, and it's less clear what the law allows. The problem is that these cruise ships are not US-flagged, and that limits American authority. This is the responsibility of the Bahamas or Malta or wherever.

Now, as a practical matter, Malta does not have the resources to sort this mess out. So it's going to end up on the US' lap one way or another. But one can understand the annoyance at the position of the cruise lines: we don't want to pay US taxes and fees, so we'll pretend we're Maltese, but if we ever get in big, big, trouble, we expect the US to bail us out."

 

[anorlunda]

Could the two Holland America cruise ships be sent to Guantanamo Bay? I don't know if they have the right facilities there to dock a cruise ship. Does anyone else know? But if it is possible, President Trump could order that without asking for permission or cooperation from anyone else.

 

[atyy]

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response. Being "right" makes South Korea the outlier - the one who's reaction doesn't make sense - not the rest of the world.

Well, you may have a point in that one not so traditional element they used was to use mobile phones to help with contact tracing. This has now been suggested by many. I just came across a new article on the strategy.

https://science.sciencemag.org/content/early/2020/03/30/science.abb6936
We conclude that viral spread is too fast to be contained by manual contact tracing, but could be controlled if this process was faster, more efficient and happened at scale. A contact-tracing App which builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society. We discuss the ethical requirements for an intervention of this kind.

 

[russ_watters]

The President is Commander-In-Chief of the Coast Guard. So it's pretty direct.

I don't think that's true. The USCG is essentially a civilian police force under the department of Homeland security. The President can transfer it to the Navy, but that's a rare and unpalatable order.

DHS is under the executive branch, but the pathway of orders is much less direct.

[edit] Hmmm...the wiki on it says the US Code lists it as a "US Armed Force", but I'm not sure there's a practical reality in that. The laws (both federal and international) under which the USCG operates are very different from that of the US Navy.

 

[anorlunda]

I don't think that's true. The USCG is essentially a civilian police force under the department of Homeland security. The President can transfer it to the Navy, but that's a rare and unpalatable order.

DHS is under the executive branch, but the pathway of orders is much less direct.

The commandant maintains operational command over the Coast Guard, unlike the chiefs of the other services, who serve only administrative roles. Thus, while the operational chain of command for the other services (per the Goldwater–Nichols Act) goes from the president through the secretary of defense to the combatant commanders of the unified combatant commands, command and control of the Coast Guard goes from the president through the secretary of homeland security (or secretary of defense, when the Coast Guard is acting as a service in the Department of the Navy) through the commandant.

Even thought the chain is different, the President is still at the top.

 

[Vanadium 50]

I don't think that's true.

It is. Ask any Coast Guardsman. Go Bears!
COC is President, Secretary of DHS, Commandant of the Coast Guard.

Could the two Holland America cruise ships be sent to Guantanamo Bay? I don't know if they have the right facilities there to dock a cruise ship.

The entry is mined. I hope the cruise ships have very, good navigators. Very good indeed.

 

[russ_watters]

Even thought the chain is different, the President is still at the top.

I understand that, but I think the difference matters. The military chain of command is required by law to follow lawful orders from the CINC, whereas non-military chains of command don't have that feature. It means the President can literally call a Navy captain and issue an order and the captain goes to jail if s/he doesn't follow it. For non-military, the President's only real power to give orders comes from threatening to fire the relevant cabinet member. Eventually he can get what he wants, but it can take a while and is politically unpalatable.

 

[russ_watters]

Could the two Holland America cruise ships be sent to Guantanamo Bay? I don't know if they have the right facilities there to dock a cruise ship. Does anyone else know? But if it is possible, President Trump could order that without asking for permission or cooperation from anyone else.

No he can't: that's an act of war.

The other related/relevant difference between the US Navy and Coast Guard is that as a civilian police force, they can perform police activities on US soil and in US territorial waters. The President can't order the Navy to force another country's civilian cruise ships into a US military port, and the Coast Guard can't do it either unless they happen to stray within the US territorial waters of Guantanamo bay (and under some unspecified legal authority).

There's also the state-federal separation of powers issue, which is part of why most of the Covid-19 responses are state led: the President doesn't have local law enforcement power, and can't do things like seize ports except by declaration of some national disaster/war. He could technically do that here, but again, that's a rare an unpalatable thing - you can probably count on the fingers of one hand the number of times something like that has happened in US history (for the Coast Guard specifically, the last time was WWII).

 

[Vanadium 50]

In this regard, the Coast Guard is no different than the Army. The President can call a USGC captain just like a USN captain. It would be odd in both cases, of course. One could actually argue it's a bit more direct, since DOD has a bunch of layers in the Pentagon.

 

[russ_watters]

In this regard, the Coast Guard is no different than the Army. The President can call a USGC captain just like a USN captain. It would be odd in both cases, of course. One could actually argue it's a bit more direct, since DOD has a bunch of layers in the Pentagon.

Again, I don't think so. He can ask, but they aren't legally obligated to follow orders from him. I disobey my boss all the time. He can fire me if he decides it's important enough, but he can't throw me in jail for it. The President can't even directly fire people except his cabinet heads and other direct staff.

[edit]
I'll concede the point. Given that the Coast Guard is under the UCMJ, the legal implications for the chain of command are probably the same as the rest of the military. However, due to its primary role as a civilian police force, what constitutes a "lawful order" in its day to day operation (both nationally and internationally) is very different for the Coast Guard than for the regular branches of the military.

I do have a bit of "on the ground" experience with this from my time in the Navy in the late '90s: I participated in counter-drug operations off the coast of Ecuador. Since the Navy is not authorized to conduct law enforcement (to do so against foreign ships would be an act of war), we handed over control of my ship to a small coast guard force to conduct interdiction. We essentially transferred the ship to the Coast Guard.

 

[Vanadium 50]

The President can directly fire or demote military (including the Coast Guard) officers. Officers serve at the pleasure of the President. 10 CFR 1116A is the statute. It does say "in time of war", but that seems to be a continuous state of affairs. (A court would have to rule on this re: the War Powers Act, but we both know that neither Congress nor the Executive wants the War Powers Act anywhere near a federal court).

But i tire of this. Just as the President isn't going to call the skipper of a destroyer, he's not going to call the skipper of a cutter. So this is theoretical and will likley remain so for a long time. I think the more relevant issue is that the cruise ships are legally, not US ships.

 

[russ_watters]

But i tire of this. Just as the President isn't going to call the skipper of a destroyer, he's not going to call the skipper of a cutter. So this is theoretical and will likley remain so for a long time. I think the more relevant issue is that the cruise ships are legally, not US ships.

Yes, sorry for the sidebar -- that makes it odd that the Coast Guard seems to be openly defying his wishes, but I guess if it wasn't an official order, there's no issue there.

I agree the most relevant issue is the legality of the use of the Coast Guard (or Navy) to intervene.

Perhaps we'll get back to the issue of Presidential powers when/if someone asks why the President hasn't implemented direct or national orders for things like stay-at-home/lockdowns...

 

[gmax137]

when/if someone asks why the President hasn't implemented direct or national orders for things like stay-at-home/lockdowns...

OK, I'm not going to ask "why the President hasn't..." because I think I know the answer.

But I do wonder, "when was the last time such an order was issued by a US president?"

EDIT: I'm going to say, it has probably never happened
https://www.npr.org/2020/04/02/8252...le-to-order-a-national-quarantine-experts-say

EDIT2:

Moss says the president would have to "either personally determine, or get the CDC director to state in writing, that the entire country is reasonably believed to have been exposed to the coronavirus," which Moss says would be "politically treacherous" and "turn the federal law on its head."

Not to mention, that if everyone had already been exposed, lockdown would be pointless, right?

 

[Mary Conrads Sanburn]

Presidential Message on National Financial Capability Month, 2020

ECONOMY & JOBS

Issued on: April 1, 2020​

During National Financial Capability Month, we recognize the importance of financial literacy to a free and prosperous society, and we commit to ensuring that all Americans have the resources they need to make informed financial choices and provide opportunities for a brighter and more secure future.

Small businesses are the backbone of our economy and workforce. As we continue to face the challenges posed by the Coronavirus pandemic, my Administration is working tirelessly to ensure that individuals and business owners have the information they need to overcome recent hardships. I am continuing to take concrete actions to protect the American economy and the hardworking men and women of our Nation. Last week, I signed legislation to provide historic economic relief to small businesses and workers, including $350 billion in job retention loans that will be forgiven if workers are paid. Additionally, at my instruction, the Small Business Administration (SBA) is actively working to respond to and assist small business owners in alleviating their financial burdens to help them and their employees recover from this pandemic. From providing targeted financial assistance to supplying helpful tips and best practices, the SBA is helping America’s small businesses navigate this pandemic and ultimately thrive.

Furthermore, to ensure that Americans have financial flexibility for the next several months, the Department of the Treasury and the Internal Revenue Service are moving this year’s Tax Day from April 15 to July 15. All taxpayers, individuals, and businesses will have this additional time to file and make payments without interest or penalties.

This month, as we continue to come together as one Nation, we will use every tool at our disposal to create an economic environment that will benefit all Americans. There are resources available to you and your family through the Department of the Treasury’s website that will help you make sound financial decisions in these uncertain times. Financial literacy is critical throughout all stages of adulthood, especially during crises and unexpected life events.

Throughout this National Financial Capability Month and in the months ahead, I encourage all Americans to seek ways in which they can further develop and enhance their financial skill sets and position themselves for success. Together, we will improve our personal financial literacy and help secure a brighter, more prosperous future for all generations.

https://www.whitehouse.gov/briefings-statements/presidential-message-national-financial-capability-month-2020/

 

[morrobay]

I don't think that's true. The USCG is essentially a civilian police force under the department of Homeland security. The President can transfer it to the Navy, but that's a rare and unpalatable order.

DHS is under the executive branch, but the pathway of orders is much less direct.

[edit] Hmmm...the wiki on it says the US Code lists it as a "US Armed Force", but I'm not sure there's a practical reality in that. The laws (both federal and international) under which the USCG operates are very different from that of the US Navy.

The Coast Guard is definitely a branch of the military and becomes part of the navy during time of war. It was under the dept. of defense while I was in 4 years. The transfer to homeland security just confuses things and was as unnecessary as that department itself. Sure the functions of the Coast Guard are different from the Navy but all the authority is derived from federal statutes. So maybe you could call it a federal police force IE interception of drug smuggling by sea across the border. But no way is it a "civilian police force"

 

[kadiot]

Amid Covid19 crisis, US insurance cos. warn tens of millions of Americans do not have health cover. I would understand this in PH but in America? What will happen to them past this crisis if they need treatment? Incomprehensible...

 

[jedishrfu]

Amid Covid19 crisis, US insurance cos. warn tens of millions of Americans do not have health cover. I would understand this in PH but in America? What will happen to them past this crisis if they need treatment? Incomprehensible...

The US has been in turmoil over healthcare for decades so this is nothing new. It will change when we catch up to the rest of the world with healthcare for all.

However, until that time let's focus on COVID-19 specific stuff in this thread rather than the political theater of the US Healthcare system.

 

[jim mcnamara]

@kadiot Let's not go down that road. All it will do is derail this thread. (veiled hint ).
Okay?

 

[atyy]

It's a few days behind now, but this presentation from UT Austin pointed to an interesting graph put together by Stephanie Jolly: https://www.wave3.com/2020/03/24/graph-comparing-ky-tenn-coronavirus-responses-goes-viral/

Up to March 22, the growth of cases in Kentucky is less than in Tennessee. This may be because Kentucky implemented social distancing measures earlier.

 

[atyy]

Kentucky is putting ankle monitors on Coronavirus patients who ignore self-isolation order
https://fox59.com/news/kentucky-is-...rus-patients-who-ignore-self-isolation-order/

 

[OCR]

Kentucky is putting ankle monitors on Coronavirus patients who ignore self-isolation order

Ankle monitors?. . . Ankle monitors?? . We don't need no stinkin' ankle monitors!

I really don't have a strong desire to go outside, anyway. . . .

.

 

[mfb]

"Enough time" and "enough data" are highly uncertain things. The data is thin and vague in some ways, overwhelmingly large and unwieldy in others, so it is perfectly reasonable and completely unsurprising that different countries/entities reacted very differently from each other. Yes, South Korea shows that it was *possible* to use a catch-and-contain strategy, but in order to accomplish that they reacted much faster and more aggressively than any other country I'm aware of.

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response. Being "right" makes South Korea the outlier - the one who's reaction doesn't make sense - not the rest of the world.

South Korea is a country that listened closely to experts.
Too many other governments were more concerned about their public image, about their re-election chances, about selling their private stocks before taking public action, and similar things, while too many people in these countries were more worried about their holidays than about the pandemic.
The reaction of South Korea made perfectly sense. It's just rare to see governments and most people listening to experts.

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

Note that "genetic material" doesn't mean virions (i.e. infection risk). Just some genetic material on its own isn't infectious.

 

[kadiot]

The Philippine government is planning to start the "mass testing" of COVID-19 Person Under Investigation (PUI) and Person Under Monitoring (PUM) on April 14, 2020.

1. Mass testing is not testing everyone. It is “risk-based” testing. Basically, you test people in increasing circles of risk: test the PUI, then the close contacts, then the community. It is not a shotgun approach because no country can test every single citizen for COVID-19. So we need to figure out our priorities for testing, and WHAT TEST to use. You CAN’T test 100M people, but you can test the MOST AT RISK.

2. Understand the limitations of testing. No TEST is 100% accurate. There are trade-offs. The probability that a test is positive when the disease is REALLY present is called the SENSITIVITY. The probability that a negative test actually means the disease is REALLY NOT there is called the SPECIFICITY.

3. A good sensitivity means that a test is able to detect disease MOST of the time if it is PRESENT in a patient. Having a negative test when the disease is PRESENT is called a FALSE NEGATIVE. In other words, the test failed to detect a sick person.

4. A good specificity means that a test is NEGATIVE MOST of the time if there is NO DISEASE in a patient. Having a positive test when the disease is ABSENT is called a FALSE POSITIVE.

5. FALSE NEGATIVES are harmful because you say that someone is COVID-19-free when he actually has COVID-19 so that patient will be free to spread the disease.

6. FALSE POSITIVES are harmful because you will put a patient WITHOUT COVID-19 in the hospital, possibly with REAL COVID-19 patients such that the patient can get COVID, or be isolated needlessly.

7. So how good are the tests? There are two tests we can use for COVID-19 – RT-PCR and antibody tests.

8. RT-PCR is considered the best test for diagnosing ONGOING COVID-19 infection. PCR itself is very sensitive and specific, >90% for both. HOWEVER, the TYPE of specimen and the stage of disease (how many days with symptoms) can affect how often a test is positive. So for RT-PCR, using a nasopharyngeal swab in a patient WITH disease, the probability of getting a positive test is only 63%. So you will actually MISS 37% of cases. This is why we can do a REPEAT test after 48 hours in a patient who is getting sicker of what looks like COVID, but was NEGATIVE on the first test. The DANGER of RT-PCR is a FALSE NEGATIVE and you can end up clearing someone who actually has COVID-19. This can happen in UP TO 1/3 OF PATIENTS so its not a perfect test.

9. RT-PCR is also a highly technical process that not only involves having the right machine and kits, BUT also the proper SAFETY INFRASTRUCTURE like a BSL2 laboratory. Many labs and hospitals HAVE RT-PCR machines but they do not have the biosafety infrastructure.

10. Antibody tests include PRNT (Plaque reduction neutralization test, the gold standard), ELISA (enzyme linked immunosorbent assay) and lateral flow IgM/IgG. The first two are LABORATORY based assays and the last is a point of care rapid diagnostic test (POC-RDT).

11. As much as we would like to use rapid lateral flow assays (IgM/IgG) because of convenience, NONE of the lateral flow assays have used the industry standard PRNT assay as a gold standard. In other words, we have NO IDEA how good they are despite their claimed sensitivity and specificity. The biggest danger is that because it takes 5 to 10 days to make IgM antibody, the test has a high FALSE NEGATIVE rate in those who just started having symptoms. And so you will get a FALSE SENSE OF SECURITY and end up passing the virus to other people and your family members.

12. The OTHER problem with the lateral flow IgM/IgG is that there are other HUMAN CORONAVIRUSES that cause the common cold, and some antibodies against these viruses may CROSS-REACT with the test, giving you a FALSE POSITIVE, which is bad for the reasons stated.

The BOTTOM LINE is NONE OF THESE TESTS ARE PERFECT. FAR from it. Tests INFORM your response, but they still need to be INTERPRETED in the right context.

To some lay persons like myself, we think that a positive is a positive, and a negative is a negative. To clinicians and scientists, they come with HUGE caveats in management. There are times they WILL NOT believe a test result because it is NOT CONSISTENT with the patient’s clinical picture. If we let ourselves be mislead by a test result without USING OUR BRAIN, people will DIE. And this also holds for doing public health strategies and mass testing.

 

[DennisN]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

While there is no lockdown, there are many recommendations to limit contact and people are following them.

Well, I believe South Korea also has no lockdown, and they've been successful so far.

Yes. It seems we are quite compliant in Sweden, both judging from the news and from my own experience. At my place in Malmö, I noticed early that the number of people being outside was getting less. Now there are very few people going outside. And those who are out are generally more careful with keeping distance. And the fact that so few people are outside has of course had a great impact on business, e.g. restaurants.

Another thing I have personally noticed is a new kind of unusual silence. I much more seldom hear the noise of human activity like cars driving, and the usual background noise has been replaced with the sound of birds singing and chatting, which is quite pleasant.

 

[chemisttree]

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

That’s because it’s airborne. Something we have known for some time but which our “experts” still refuse to publicly admit. We don’t have enough of the “spacesuits” for all healthcare workers dealing with this so the response is to refuse to admit it’s airborne. Problem solved.

We are all going to get this thing eventually. Let’s hope the system can deal with it when we do.

 

[zoki85]

We are all going to get this thing eventually. Let’s hope the system can deal with it when we do.

I hope not...