A Journal of the Plague Year (12)

March 28th, 2020

So here we are, the online companies delivering food, booze, and other essentials of life are set to make money and supply a vital service to the public at the same time. It’s not very often that the social attributes of the good are rewarded monetarily. But, hey, they deserve it.

I spent much of the day on WhatsApp video phone calls with friends. This may well be a significant new quantum of our social relationships in the future, nay, the present, until new rules of proximity have been developed.

Placed an order for two weeks food and other groceries…pick up next weekend. Wine and liquor to be delivered in a few days.

President Trump is postulating a quarantine for New York. Apparently, the zombie Democrats may be flooding out and infecting the rest of North America will liberal absurdity—but, too late, they’ve already done that.

If the American health care system cannot cope with the case load, then nobody can. According to the Society of Critical Care Medicine [here], the US has more critical care beds per 100 000 people than any other nation. And six times as many as Britain, with their National Health Service (the envy of the world). If the Americans are in trouble, so is everybody.

Here, a new paper [here] in bioRxiv is predicting the peak of new cases around mid-April and then a tail off. Check it out. That’s the good news.

Well, we don’t really know what the bad news might be. I’m having an early night tonight. One aside, this whole affair is making me sleep 8–10 hours a night. That can’t be bad.

And a friend finally arrived back from Portugal after multiple flights and country hopping. As he says: “I’m now under house arrest! But fine.”

Rebel Yell

A Journal of the Plague Year (11)

Today I’ve been busy trying to organize bookmarks in my browser in the right folders so as to make everything readily accessible for my preparation of the latest screed.

Also, Zotero for the academic publications to be saved for references.

First, an excellent source for the real meat of this thing with all the latest from bioRxiv.org {here], a preprint server like arxiv.org for physics.

Second, BoJo himself in the UK has been diagnosed with corona virus; rich and poor can be cut down. But we hope he’s going to be OK, he’s got a lot of work to do—no time for slacking.


And now…

In a situation like this, there is precious little time for partisan shenanigans, but you wouldn’t know it from the behavior of Pelosi and the Democrats in the US. Blame seems to be cast always on the politicians in office.

Actually, I’m going to go out on a limb here and cut the politicos a bit slack. Not much, but a bit. No country in the world has been prepared for this. Europe, America, the UK, Canada, wherever, no-one. Political leaders are always confronted with the Something-Must-Be-Done Syndrome. Whatever problem or fresh disaster occurs, whatever weird social deviance is suddenly de rigeur for the chattering classes, whatever new degeneracy deserves some special new “right”, our political leaders Must-Do-Something. When, most of the time, nothing need be done. Their skepticism really is justified much of the time.

But when it does need to be done, when it’s based in the scientific reality of the world and not the fevered imaginations of some deranged progressives, it’s suddenly very difficult.

An interesting article appeared today in the City Journal, (America’s Regulatory Framework Exacerbated Covid-19 Crisis) an American blog, concerning the lead up to this disaster in the US. As the preliminary phases of the epidemic began to show up on the radar of medical professionals, the warning signs were noted. I’ll just quote this passage in toto, as I can’t summarize it any better and the details are important…[CDC = Center for Disease Control]:

As has been widely reported, the CDC’s in-house testing design was flawed, thus compromising early testing results. Mistakes happen, but the impact of the test-design flaw was much greater than it should have been—owing to the U.S. bureaucracy’s tightly controlled process. Even had the CDC test worked perfectly, not nearly enough tests would have been available for wide-scale testing on the South Korean model.
The reasons: the American regulatory system, cumbersome even in emergency settings; and the specific choices made by regulators that proved to be tragic misjudgments. As Alec Stapp of the left-leaning Progressive Policy Institute has documented, after Secretary of Health and Human Services Alex Azar declared a public-health emergency on January 31, private laboratories had to obtain an Emergency Use Authorization to conduct their own testing. On February 4, the FDA approved an authorization for the CDC—and only the CDC. This created a testing bottleneck, with all testing in the nation routed through the government agency. By February 28, the CDC had processed only 4,000 tests. The next day, the FDA finally invoked the Clinical Laboratory Improvement Amendments to permit testing at some 5,000 highly specialized virology labs (among more than a quarter-million laboratories nationwide with some testing capability). The first Emergency Use Authorization granted to any entity other than the CDC was issued on March 12, to Roche. Throughout this period, the rollout of mass testing was limited by privacy rules in the Health Insurance Portability and Accountability Act (HIPPA); they were not waived until March 15.
Some of the holdups in the critical early U.S. testing effort read like paradigmatic illustrations of bureaucratic bloat. In Emergency Use Authorization applications in the face of an epidemic, the government was actually requiring labs to mail in CD-ROMs for agency review, rather than permitting online submission, owing to outdated rules. (Thankfully, they’ve since dropped that particular rule.)

That mailing in CD-ROMs in this day and age at the apex of a national emergency is not only so 20th century but shows the suffocating force of bureaucratic red tape—in an organization that is responsible for dealing with emergencies! So anyone thinking that more government control of the health care business is a good thing should think again.

In any emergency response operation, responsibility for much decision-making and action has to devolve to those on the front lines who are dealing with the actual problem. The bureaucracy is always worrying about what the clouds of parasitic lawyers might do if a decision later turns out to be not the best choice (which invariably happens in real emergencies). And the political leaders are always worrying about how this will look on the re-election prospects. “You told us it was a national emergency and only 300 people died!” —as the media-bitches will whine afterwards.

Perhaps Satan has a special room for some of the media.

Rebel Yell

A Journal of the Plague Year (10)

March 26th, 2020

Time to reflect a little on the hysteria surrounding the corona virus outbreak. Every day you can hear some frenzied journalist (especially in the US) rabbiting on about how many millions will die because a) President Trump, b) President Trump, c) President Trump. Actually, after a shaky start he seems to have come to grips with the issue quite well; would that we could say that about the political class in general. The attempts by Nancy Pelosi and the Democrats in Congress to insert billions of pork-barrel items into a piece of emergency legislation beggars belief. It’s nothing but venality to the n-th power.

Every day a new “study” appears filled with new prognostications and predictions for the future. Let’s put aside the predictions for the political future, or futures, and take a look at the science picture. The main subject of discussion has been a paper from Imperial College that modeled the likely outcomes in terms of cases and deaths based on certain prior assumptions:

We assumed an incubation period of 5.1 days. Infectiousness is assumed to occur from 12 hours prior to the onset of symptoms for those that are symptomatic and from 4.6 days after infection in those that are asymptomatic with an infectiousness profile over time that results in a 6.5-day mean generation time. Based on fits to the early growth-rate of the epidemic in Wuhan10,11, we make a baseline assumption that R0 = 2.4 but examine values between 2.0 and 2.6. We assume that symptomatic individuals are 50% more infectious than asymptomatic individuals. Individual infectiousness is assumed to be variable, described by a gamma distribution with mean 1 and shape parameter alpha = 0.25. On recovery from infection, individuals are assumed to be immune to re-infection in the short term. Evidence from the Flu Watch cohort study suggests that re-infection with the same strain of seasonal circulating coronavirus is highly unlikely in the same or following season (Prof Andrew Hayward, personal communication).

It was this paper that led to the change of course of the British government.

From this, and the use of the modeling algorithm, they can make predictions of outcomes after making various changes to attempt to modify R-naught and bring down the rate of infection. R-naught is not just a function of the virus, but a function of other things such as the different behaviors of the population like social distancing. Based on certain of these assumptions, this is where the prediction of nearly half a million deaths came from.

Another paper out of Stanford University claims that the prognosis is way over-estimated (can’t find the link right now), but a paper in The Lancet addresses a small study from China. Also, Tomasso Dorigo, an experimental physicist at CERN, thinks that the hype is turning physicists into crackpots.

Although it’s early days, some caveats need to be borne in mind.

First, computer models do not produce evidence of anything. Repeat that to yourself.

Second, computer models produce conjecture—not data.

The models are exactly that, they produce numbers (often displayed with very pretty graphs and diagrams) that are generated by an algorithm operating on a given set of assumptions. The numbers coming out are only related to the initial parameters and the algorithm in the software, which may represent the real world accurately—or not.

Third, data are generated by performing scientific experiments and making measurements and observations of the world around us. This is evidence.

Fourth, when the data match the output of the model then, and only then, can you say that the model may be a reasonably accurate representation of the real world. Note that any change in the parameters in the algorithm or any change in the logic path in the algorithm can lead to radically different computational outcomes. This happens all the time in modeling.

In computer science, the GIGO Principle is undefeated: Garbage In—Garbage Out. Computer models are fine as far as they go, but reality gives data.

Hence, suddenly, claims that the Imperial College model overestimates the numbers of cases. If the coronavirus has infected many more people prior to the panic, who then developed antibodies and they have never shown symptoms of disease, then the case fatality rate will be much lower than heretofore believed. However, we can’t know this until extensive antibody testing is done on the population—all the population not just sick people.

Even if that is true, the tsunami effect on the health care system is still just as real, but the time frame may be much shorter.

The less information we have, the greater the uncertainty. Both these views of the problem may be wrong (they can both be wrong but they cannot both be right!). Millions of tests must be done to make the enemy visible. If there are large numbers of people with antibodies, then they are immune and can get back to work and get the economies moving again, but this can only be ascertained by testing for the antibodies, not just the antigen.

All these discussions between scientists are perfectly normal and good—the science is never settled. That’s only in Al Gore’s fantasy world. Only journalists and politicians think they’re always right. And remember the words of the great physicist Richard Feynman—

…any scientist talking outside his field is just as dumb as the next guy.

When someone you’re talking to keeps dumping on President Trump, remember, he’s the guy making the political decisions—that’s what he was elected to do. After this thing is over, you’ll be glad there was an alpha-male in charge.

[Update: see science20.com article [here].  Could the predictions be out of line?]

Rebel Yell

A Journal of the Plague Year (9)

The Imperial Dirigible Service

“The New Normal”…How many times have we heard that before? In our city there were no new cases today, but we all know that the storm is coming. But forewarned is forearmed so emergency preparations are moving into full gear. The last time that a city emergency was declared was only last year and lasted six weeks due to excessive spring flooding. That time, however, did not involve the whole population being housebound.

Our local area of town seems ordered and low-key. Canadians tend to be a reserved and placid lot, which, as it happens, is a great attribute in times of stress. It must be the climate. When you’re alone in a cabin for a six-month winter, you learn quite bit about introspection, its uses and abuses. And for all our foreign fans, no we don’t live in igloos.

For those of you who want to really bone up on the medical research in real time, check out the JAMA Network[here], interviews with leading researchers in the US and the world with Howard Bauchner, Editor-in-Chief of the Journal of the American Medical Association.

One of the real-time effects of this thing is that medical research is, to a considerable degree, dispensing with much of the time-consuming peer-review process and other publication bottlenecks to get the latest findings on to the Web. The peer-review process has been under much scrutiny over the past few years, being accused of being too much of a “pal-review” process among other things. This is why sites like Retraction Watch [here] have been so active in the last few years keeping track of the faults in this process. It is important, but it’s become sclerotic and is in need of major rejuvenation.

The rapid spread of corona has shown in stark detail the unresponsive nature of many bureaucracies around the world. When decisions have to made in hours, a wait of a week for some bean-counter stifled in red-tape is not helpful [here]. The federal bureaucracy in the US, the Center for Disease Control, has been a part of the problem. As reported on NBC News:

As a result of the CDC’s being the sole organization to make and distribute the authorized test kits, the agency needed to strictly ration distribution. Because of the tight supply, the CDC initially set very restrictive criteria on testing individuals. To make matters significantly worse, by mid-February, the CDC had learned that many of its tests, for all the supposed focus on quality control, were inconclusive because of a flaw in one of its components and needed to be fixed. Meanwhile, no competing manufacturers were ready to meet the increasing demand.

As usual, in the US, the private sector is rapidly stepping up to the plate.

In the US, tests for the virus had to be sent out. Now they are being done in hospitals and private laboratories, which, prior to this event, did not have approval. There was no reason for this but hopefully this strangulation of private initiative will be greatly curtailed in the future. Especially when time is of the essence.

Further, as the New York Times from Reason (some actual reporting of facts, which must be new for the Times),

Seattle infectious disease expert Dr. Helen Chu had, by January, collected a huge number of nasal swabs from local residents who were experiencing symptoms as part of a research project on flu. She proposed, to federal and state officials, testing those samples for coronavirus infections. As the Times reports, the CDC told Chu and her team that they could not test the samples unless their laboratory test was approved by the FDA. The FDA refused to approve Chu’s test on the grounds that her lab, according to the Times, “was not certified as a clinical laboratory under regulations established by the Centers for Medicare & Medicaid Services, a process that could take months.”

So really, too much government control can result in disaster. Again, medical institutions should be run by doctors, nurses and medical professionals, not bean-counters, bureaucrats and MBAs. And certainly not politicians.

And of the future: maybe travel will be slower, and rapid airplane travel replaced by a more sedate Imperial Dirigible Service as depicted above. Mint Juleps served prior to dinner.

Rebel Yell

A Journal of the Plague Year (8)

There is some good news from Italy today; over the past three days, the daily increase in the number of cases has fallen from just under 7 000 to just under 5 000—hardly an occasion for great joy but moving in the right direction. The quarantine effects are just beginning to be noticed—as predicted, about ten days to two weeks after their implementation.

The daily increase in the number of cases is the essential measure. But this can only be known by testing the population, meaning that testing must be as extensive as possible. If antibody testing is available soon, then testing will enable us to determine who has been infected, and now has antibodies in the blood, and is now immune. These people can get back to productive activity and help out others.

Now, confined to quarters, can be a good time to catch up on some of the things we might have wanted learn. The mathematics behind the statistical analysis of disease and infection has been a subject of great interest to only a few people in the disaster business (as was I). Check out this talk on the nature of modelling and prediction  [here].

Also, an interesting video on the Science Paper That Has Changed US And UK Covid-19 Policy (from Imperial College) and why it happened… [here] You can read the paper  [here].

Also, Thunderfoot, a British science guy, does easily understandable videos [here].

And now, Prime Minister Modi of India has announced a three-week lockdown of India. All of it! 1.3 billion people. Nothing like this has happened in history before and ‘interesting times’ doesn’t even come close to describing it.[here]

As I submit this paltry screed for publication, the world case toll passes 417 000. We can only hope that our medical people can cope with it. After this, they will be remembered.

We’re in for a bumpy ride…

Rebel Yell

A Journal of the Plague Year (7)

One week ago, I asked the technician coming to do a small job on my Yamaha digital piano to may be put it off a bit. Well, one week later, the whole country grinds to a halt. Is this over-reacting? This is the subject of today’s missive from my digital scriptorium.

First, on the local front, everyone has stopped frantic messaging and has started swapping recipes for pantry cooking and the best sites for online games–symptomatic of a massive cool down. Local grocery stores will prepare orders for pick up, thereby significantly reducing unnecessary contact with essential staff. Our in-house volunteers pick up recyclables to take down to the building disposal. Doors and handles are cleaned and maintenance is done. So far everything is operational.

On the world front, as the picture above shows, events can reach unmanageable proportions quickly. One school of thought uses figures that relate to the overall death rate from corona which may be much lower than currently thought for a variety of reasons. (See Plague Journal (5)). The other school lays much more importance on the rate of change of numbers and the tsunami of seriously ill people affecting the health care system in a short time. The picture above illustrates the situation in Spanish hospitals in Madrid.

It seems to me that the most important issue is tactical: how will the health care system cope with the wave of severe cases that appears in any affected population. We know this from the Chinese experience and later from Italy. The number of new cases per day is the critical number to watch. If this is decreasing, then there is hope that the disease may be under control. However, we do not know really how many actual cases there are in the general population as testing is so sporadic and sparse right now. The latest news from Italy may have a sliver of hope.[here]

The next two months will be critical in that regard. This is a virus on a blitzkrieg, so tactics will determine our success or failure.

After this, the failure of the managerial “elites”, that shower of lawyers, economists and other people of nothing must be held accountable, and then replaced with people fit for purpose.  I don’t know exactly how that will happen, but happen it must.

No matter the medical results, the economic, social and political fallout will be bigger than anyone thinks right now. Personal relationships have changed; our relations with the ruling class, the media, and the irrelevant parasites that occupy our social airspace—all that will change.

Watch the interview via the Journal of the American Medical Association with Dr Michelle Gong from New York, Chief of Critical Medicine at the Montifiore Medical Center for news on the front line.

Also, the drug Arbidol (Umifenovir, in the West), an antiviral treatment for influenza, has been around for years in Russia and shows some promise for treatment [here]. Of course, it has not been approved by the US FDA; where would the US be without its own Soviet bureaucracy. Some studies in Russia and China have shown that it can be effective against some influenza types of disease. Some work must be done on this.

While the members of our society who have real value, the nurses, doctors, truck drivers, garbage collectors, sewer maintenance engineers, are keeping the world turning, let’s give a thought to the narcissistic, fatuous, useless hypocrites of the chatterati, the celebrities, social justice whiners, and other pustules on our body politic. They really have shown how utterly worthless they are when the chips are down.

To close today, a comment from an American scribe on the wretched media and political elites (h/t Kurt Schlicter):

Our elite has contributed nothing to this fight, except self-serving lies, cheesy power grabs, and terrible covers of the worst song ever recorded, “Imagine”. As usual, as always, our salvation comes from you, the normal American who sees a challenge and meets it. We had a paradise, and in paradise, you can indulge in silliness like multi-culti blather and meaningless virtue signaling. But things just got real. We have no time for that crap now. The elite who imagine themselves indispensable to the world that normal people built, run, and defend, are being revealed as useless and ridiculous just when things got serious. We won’t forget how much they suck when this ends.

I could not put it better myself.

Hang tight, we’re all in for a bumpy ride.

Rebel Yell

A Journal of the Plague Year (6)

Every day is an age. History seems to be made every week. Today it’s been almost impossible to keep up with all the emails from around the world. The street scene above will be the face of our towns and cities for sometime to come.

Until recently, I’ve never used Facebook and other social media due to privacy concerns and such. Now, I have completely rearranged my priorities by re-activating Facebook. Maybe social media will grow up and be concerned with the real world rather the fatuous half wits of Hollywood. I received immediate responses from old friends from Taiwan I met in Moscow some years ago. And Bob, the cable guy in Oregon. It’s interesting who remembers you. People you haven’t seen in years, but should have.

The local residents’ association has already circulated a list of all the grocery stores, pharmacies and businesses that will deliver and their opening times. We have special hours set aside for seniors.

In our apartment building, folks are coming together to help each other. Sometimes a real disaster does bring out the best in people. But it seems to me that it’s the best in ordinary people, not the chattering classes, politicos, pundits and “celebrities”. They become more repugnant every passing day.

On the international front, despite the dire straits that Italy finds itself in, no help has been forthcoming from the EU— that monument of bureaucratic futility. The only real help is coming from—wait for it—Russia and China. A fleet of Russian planes is heading to Italy with medical teams and supplies. Even Cuba has volunteered help, and gee, thanks Brussels, we never you cared. And an interesting Keiser report on Russia Today concerning the likely development in the economy and connections to the past. Many things like this have happened before.

The events that are hard to comprehend are occurring in Britain. First, the government makes absurd claims that “herd immunity” will provide protection. Herd immunity [here] is a long-term result of repeated exposures to viruses and bacteria that a population can adjust to. It’s a kind of strategic adjustment. Here, covid-19 is spreading at a rate that is a blitzkrieg. There’s no time for that nonsense. The increase in the daily case rate is now greater than that of Italy two weeks ago. And two weeks in this game is an age.

This thing is going to teach us all about many people who are overrated and all those who have been underrated. I hope we can show those who were underrated some more respect in the future. Here are some interesting views on that subject.

[Update: Interview with Italian doctor and JAMA (Journal of the American Medical Association), March 13th already history, back good background on the frontline emergency response].


Rebel Yell

A Journal of the Plague Year (5)

March 21st, 2020

On a slightly different, and not so technical, note today, I ventured out into the Zombie Apocalypse. Essential supplies required (a case of wine). We are confined to quarters for two weeks. Only allowed out for groceries and pharmacy supplies. The local grocery store was not busy at all, sparsely populated, no problem in the parking lot. No shortages of anything either. I did go with my mask and bleached rubber gloves ready for a Level 4 decon event. Maybe over the top, but you never know.

I asked the wine guy for a case of Cabernet Franc. “Sure, no problem, sir.” All the staff wore gloves (good), but not masks (umm..) and were doing continuous cleaning of the carts and doors; all places subject to touching by the great unwashed. Sound practice.

Only one other person (one of my neighbors) had a mask.
At the self-checkout, she said, “Soon been time for biking, eh?” “Sure thing, Cathy. Who’ll be out first?” She’s also an avid biker. No panics. Drove home. Washed gloves with hot water and soap. Opened a bottle. Had a drink.

It seems a different world in the rarefied atmosphere of the twitterati, the chattering classes and the constricted world of journalists of limited mentality. No wonder President Trump got a little annoyed with some half-wit journalist the other day—he has a real problem to deal with and a real job—not a job as a permanent media-bitch.

This is the reality of ordinary people. Once a real problem is realized, everyone seems to knuckle down, get serious and keep cool. Only the media act like a Benzedrine puff adder on a bad day. The CBC, Canada’s answer to Pravda TV, announced one of their spectacularly stupid actions. They are shutting down local TV news and sending everything through Pyongyang Central, aka Toronto. In any emergency situation, as anyone who has dealt with these situations will tell you, local news for local people is the best way to communicate information and get reliable feedback from the ground. It’s what binds people together, especially in such a diffuse and sparsely populated country as Canada. It’s just so typical of the fossilized liberal mindset of the CBC that sees Toronto as the center of the universe. It’s the very last thing we need, not that most people get their news from the CBC anyway; its credibility quotient is less than zero anyway. It’s just the total lack of understanding of the real situation. As Chris Selley pointed out in the National Post today:

On Wednesday, in a moment history may well note as Mother Corp’ rock bottom, CBC announced it was scuppering all its local television newscasts. Instead it would feed us all Canadians a mixture of national and local news from the same Toronto-based spigot.
Basically, CBC ended itself. It almost beggars belief.
Brodie Fenlon, editor-in-chief of CBC News, took to his blog to explain the decision — but didn’t, really. He talked of “staffing challenges” stemming from employees self-isolating and working from home. “Television is especially resource-intensive, and many jobs are difficult to do at home,” Fenlon wrote. “Our systems are overtaxed.”

Ah, the poor guys! (And femmes and trannies too!). Too many diversity boxes to tick. That must have tired them out. “Television is especially resource-intensive” they whined. If they want to see resource-intensive, go to an ER during this crisis, go see Hydro workers during an ice storm in the middle of winter, go see fire fighters in a forest fire or oil workers on a rig in a storm. These CBC clowns have no idea what a real job is. Real jobs are not sitting around in comfy studios driveling on about how oppressed some “gender studies ‘professor’” is on $100 000 a year.

Selley is right. After this thing is over, we’ve got to get rid of the CBC; it’s just Liberal Party propaganda financed by the taxpayer and it’s nothing but a retirement home for washed-up party gasbags and intersectional weirdos.

Time to kill it. Stone dead.

That’s it for today, time for some bourbon.

Rebel Yell

A Journal of the Plague Year (4)


Image Credit: Imperial College, London (my old school!)

March 20th, 2020

As I write, Italy seems to be approaching a moment of truth. The case load for hospitals in the Lombardy region appears to be near critical. MIT Technology Review is running a website “Radio Corona” with excellent interviews with some of the leading medical minds—check it out.

I want to address a few points here that fellow scribes have raised which I think display faulty reasoning. And there is confusion about the absolute numbers, relative numbers, and the rate of change of numbers, each of which have different importance.

Point 1.

Much is made of the numbers of cases and deaths due to Covid-19 as compared to the standard flu that occurs every year. As Dalwhinnie points out (quoting the illustrious Professor Briggs):

• In Wuhan itself, the City of Doom, some 2,446 souls departed their fleshly existence earlier than expected. Google tells us the city has between 11 and 19 million, depending on whether you count the entire metro area as “the city”.
• The city had 49,995 cases. The case rate was 0.26% to 0.45%, depending on what China called “the city”. The total dead rate was 0.01% to 0.02%. The case dead rate was 4.9%.
• People fixate on that last number, forgetting you first have to get the bug before you can die from it. But everybody now seems to believe they’ll get it with certainty. Review Bayes Theorem & Coronavirus!

Nothing is wrong with these numbers or with the application of Bayes’ Theorem to the problem. However, it’s right only so far as it goes. The city had a total case rate of nearly 50,000 (0.5%) which doesn’t sound that bad, given a population of nearly 15 million. But this is only weeks AFTER a total shutdown of the city was instituted when even the Chinese leadership realized something big was happening. This is not what would have happened had that action not been taken. Witness Italy now and figure how far they were (are) behind the Chinese curve.

Further, this massive case load was IN ADDITION to the normal hospital case load of any city anywhere. And thousands of doctors and nurses do not miraculously appear overnight to care for them.

Moreover, it was only after the lockdown that (more than a week I think) the rate of increase of cases began to fall off. The effects of pushing down the value of R-naught, the base reproduction number, to below one led to this. Case numbers continued to rise due to the appearance of symptoms in those who were already infected prior to the lockdown.

Point 2.

Even if a health care system can cope with greatly increased numbers at various times, a tsunami of new cases can rapidly overwhelm even the best system. Despite the fact that the Chinese government was criminally negligent at the beginning, at some point something snapped in the leadership when they realized that this thing will not go away or be suppressed politically. It was then that mass action started. Europe, and especially Italy, did not follow this path and is paying the price.  (CIDRAP, the Center for Infectious Disease Research and Policy, at the University of Minnesota is an excellent source).

It is not only hospitals and the medical workers that are affected, all kinds of supply chains and manufacturing are affected, especially in the West. Or they will be. As I alluded to in my previous missive, it’s not the absolute numbers at any time that count, but the rate of increase and the transmissibility of the thing.

Point 3.

Testing— Of vital importance, not only for those who are becoming sick, but for the general population currently unaffected, but possibly infected. This latter group is the source of further spreading. Tracking contacts and quarantine is the way to stop that and South Korea has shown that this works.

When an antibody test is available (apparently quite soon, maybe in a few days), this will enable us to detect persons who have been exposed to the virus and developed antibodies but have never become sick. Knowing this can give us a much better idea of the number of people who have been infected but never displayed sickness and the number who become sick (the afflicted). This greatly affects assessment of the case fatality rate.

If the health care system becomes overwhelmed at any time, the case fatality rate will rise as many sick people will get no treatment at all. Check out the graph at the top for possible scenarios.

So that’s it for today. This will not go away in a few weeks, we’re all in for a bumpy ride.

Rebel Yell

A Journal of the Plague Year (3)

Chloroquine: C18H26ClN3

March 19th, 2020

Meet your possible new friend—chloroquine. According to a paper from a few days ago, chloroquine (hydroxychloroquine, or in another form, chloroquine phosphate) can mitigate (apparently) symptoms of Covid-19 and also be effective as a prophylactic. Showing his usual dynamic leadership, President Trump has cut through much bureaucratic red tape that would usually hold up approvals to ensure that it is released and freely available.

What about possible side effects, you may ask? Well, chloroquine has been around for decades as a drug used to counteract malaria—years of experience have shown that it is safe.

However, my main point is that with the world-wide capabilities of the Internet, work done in conjunction with the Stanford University School of Medicine can be out and available in a matter of days. Although no guarantees, encouraging results. If not a silver bullet, maybe a bronze one?

Events are moving with amazing speed. Italy and Europe are now the epicenter of the pandemic and China seems to be on the brink of recovery. Chinese TV (CGTN) has some very interesting coverage[here]. Sure, it’s state media, but so is CBC. Get your news from around the world as do I. There’s no reason to doubt Chinese figures on the case load today—anyway, it’s all the data we have.

Yesterday, my fellow scribe, Dalwhinnie, posted about Professor Briggs, a noted statistician (who I follow regularly), who wrote an article on coronavirus—the Madness Has Arrived. And let me say up front, I have no argument with his figures or analysis. Bang on, as usual. But…

No matter how irrational the madness, however, the physical effects in society are real—the stock market crash, the death porn, the wailing and gnashing of teeth, a retail and restaurant crash etc.

Further, even if the case fatality rate is not much greater than standard flu (although it does appear so far to be about ten times greater), the transmissibility of the virus is really high leading to rapid spread. And, it seems that a person is highly infectious some time before they show any symptoms; again making it much harder to control.

This is why comparisons with absolute numbers, how many people die from regular flu, are not really relevant. They are built into our systems through years of experience. This new virus has no barriers of partial immunity in the population, and, coupled with the high transmissibility, makes it a particularly nasty beast.

The now infamous R0, R-naught, the base reproduction number, the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection, has to be brought down to below one. If greater than one, the epidemic will grow exponentially; if less than one, it can be contained. R-naught is not a function just of the agent (here corona virus) but a function of how easily the infection can be communicated, particularly as it seems to spread via droplets. Hence, the importance of social distancing and personal hygiene.

These effects are what can lead to a wave of patients that can overwhelm the capacity of the medical system to cope—and herein lies the great danger. The measures now being taken in the US should have been taken sooner, but at least they are happening now. President Trump seems to have got the message seriously. (As for the media—words fail me when trying to describe their appalling behavior. In this scientific age, we would be hard pressed to find a more ignorant shower of people.)

Acting rapidly can avoid the situation getting like that in Italy. And who is helping Italy out? Not the EU bureaucracy, but China.   Think about that.

Check also further real information [here].

Hang tight,

Rebel Yell