outbreak! (ebola, sars, coronavirus, etc)

oh

NEW from me and @AlbertSamaha: Smithfield Foods Is Blaming “Living Circumstances In Certain Cultures” For One Of America’s Largest COVID-19 Clusters https://t.co/Vke6w2uTpG

— Katie Baker (@katiejmbaker) April 20, 2020

How much is the push to open states just a drive for racial genocide under a different name?

94%

6% just pure stupidity

I'll admit to being 6% desperate to be able to go hang out in the bookstore no matter the cost to society

Smithfield has a point. I wonder why their workers don't all buy themselves single-family homes to live in?

Interesting practitioner's view of how Covid pneumonia differs from the usual type and why it's often so far along before its diagnosed:

https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html

that's really fascinating. also helps to explain why Johnson went in "as a precaution" instead of gasping for air like the proles

Read that and immediately tried to instacart a pulse oximeter but they were sold out by the time the shopper got there.

I think my phone (Galaxy S10) has a pulse oximeter. I used it a bit but had no idea how to interpret the results. "Is that... good? I dunno."

Wikipedia:

Normal arterial blood oxygen saturation levels in humans are 95–100 percent. If the level is below 90 percent, it is considered low and called hypoxemia.[1] Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed.

NB: a fingertip pulse oximeter won't measure 'arterial blood', but if you're seeing a number under 85%, you most definitely have a problem.

fwiw when my son (now healthy!) was in the NICU they wouldn't let him leave until the mean spO2 for the last 24 hours was > 95% and there were no dips below 90% longer than a minute.

I ordered a pulse oximeter weeks ago from amazon when I first started having symptoms. At the time the earliest possible delivery was mid April. Still haven’t gotten it, delivery has now been pushed back to June

if you really need something and you can afford at least a little mark-up, ebay >>>> amazon

I was having to contort my body in weird directions to avoid people who weren't giving space or converging on me at the Publix

felt like calling it the COVID Lean but idk what Young Dro is up to these days

probably bouncing right to left like the rest of us friend!!!

xp to myself

got 2 pulse oximeters for like $28 a piece and they were here in a week, there's a ton available but i can't account for their quality

also got a 4 pack of cottonelle for 9 bucks when we were running out and freaking out about not being able to find any, art of the deal

xp
Shoppin' the scene with a covid lean.

Nursing instructor John Campbell spoke about pulse oximeters as a means of determining whether pneumonia cases require hospitalization in late February and early March at a time I was mentally rehearsing how I'd care for my parents if they caught this. The takeaway I got is 94% and above is normal, 88% and below merited medical attention. Now with that Dr. Levitan article it sounds like we should be self-monitoring daily...

xxp I learned my lesson on that one. not ordering anything from amazon again

Some good news: in a large multi-national randomized study (704 treated, 704 controls), antiparasite medication ivermectin reduced deaths in hospitalized by 83%, deaths in mechanically ventilated by 66%. A single dose (150 mcg/kg) lower than those commonly used for parasitic diseases was used. Yes, its a preprint, but this seems a lot more promising than that hydroxychloroquine nonsense.

Patel, Amit, Usefulness of Ivermectin in COVID-19 Illness (April 19, 2020)

Just a correction, this study isn't randomized, it's a case-control study where patients in the intervention were matched to an individual registry of past patients on age/sex/comorbidities/severity. So, Level II-2 evidence, not Level I. Still, given low cost (US$0.12 in the developing world, $50 in the US) and established clinical profile, I think we'll be seeing a lot more on ivermectin.

i track some of the basic stats manually, even though i know there are multiple websites that will do it for me. so forgive the homemade look of this.

https://i.imgur.com/0lopjiL.jpg

i've been heartened by the declining growth rate of new active cases. it was down to a 3% growth today (749k to 772k), which is the lowest it's been, and it hasn't been above 10% daily growth since April 4.

but now i wonder how much of that is hidden by the plateau of tests. as Brian Schatz has been saying a lot recently, the steady escalation of tests has stopped. the green bars above are the daily number of tests. you can see that it peaked on April 4, and then has been hanging around 150,000 tests per day ever since. so it's not a surprise that the daily new positives are also on a plateau, either.

iirc the fraction of positive tests has fallen in NYS at the same time as the rate of testing has plateaued, which is difficult to explain without assuming the spread has slowed.

on a national scale, though, i suppose the improvements in new york are being offset by growth in new regions. given that NY and NJ represent so much of the national caseload, i was hoping that continuing improvement there would lead to an overall decline soon. i guess i'm anxious to get to the other side of the curve.

some of the projections for overall deaths seemed to feature an assumption that the distribution would be normal. but it could very well be heavy on the post-peak side, even before you start to consider the effects of various states and cities opening up prematurely. on the other hand, maybe those dumb unforced errors will be offset by advances in treatment.

https://i.imgur.com/y2CNC6q.png

I don't really look at testing/cases. The U.S. is not doing enough testing for those numbers to be meaningful imo. I look at hospitalizations and deaths. I would say we are plateauing in NYC, but it's still a high, unmanageable plateau, in terms of the strain on the hospitals. I think as the East Coast recovers a bit, the Midwest will be hit harder.

This is the most infuriatingly Japanese response to the corona virus - only white masks are acceptable attire in some schools and businesses

https://mainichi.jp/english/articles/20200420/p2a/00m/0na/014000c

is that because it's easier to verify that a white mask is clean (whatever that means) or is it a 'uniform' thing? maybe I should click the link.

A little of A and a lot of B

Looking at Karl's graph, there appears to be a fairly stable ratio between the number of tests and the number of positives. On days when tests rise, the positive results rise in tandem. On days with fewer tests, the positives dip right along in the same ratio.

To me this is not reassuring; it suggests that, if twice as many tests had been done on any day, it might have discover twice as many cases that day. Or not. The only way to break that pattern of constant ratio of tests-done-to-positive-results would be to conduct so many tests that the number of positive results stalled out, no matter how many additional tests were done. We are not there and it would help immensely if we achieved that state.

Agreed. We're gonna need... so much more testing.

@Karl, I'd either do a rolling average (3, maybe even 7?) because the reporting is so wonky over the weekend, you end up with almost a sawtooth pattern.

But more importantly, today is tracking to be the worst day yet so all that chatter about post-peak, etc. seems way premature... :-(

(also what is your source for these numbers?)

covidtracking.com

here's an updated version with rolling 3-day averages for both new tests and cases

https://i.imgur.com/54G6MUt.png

This piece is proposing a four day week to counter the economic impact of covid.

https://amp.ft.com/content/5c208540-831c-11ea-b6e9-a94cffd1d9bf

gimme

A four-day fortnight!

The Trump administration promised that by March 28th – nearly a month ago – there would be over 27 million coronavirus tests conducted in the U.S. It’s April 21st and we haven’t reached 5 million.

Where are the tests? https://t.co/eOi8O03XYJ

— Sheldon Whitehouse (@SenWhitehouse) April 21, 2020

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield said in an interview with The Washington Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”

“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” he said. Having two simultaneous respiratory outbreaks would put unimaginable strain on the health-care system, he said.

https://www.washingtonpost.com/health/2020/04/21/coronavirus-secondwave-cdcdirector/

^ Which is why we need a really strong planning effort all through the summer and fall to put all the necessary testing and supplies in place, along with contingency plans for extra beds and keeping health workers safe. Lead time is the main advantage we'll have then that we didn't have at the outset. But Trump squandered our brief lead time in January and February, and there's no indication he'll do better with his second chance.

So if one of these anitviral treatments work, are we good to go?

Do doctors often use antiviral medicine originally developed to fight HIV on other viruses? Seems like generally people just wait them out.

Antivirals won't stop anyone from getting or spreading the disease, but at least there would be a way to treat those who become ill with it. How effective a treatment they may be is the question, but most antivirals require swift intervention at an early stage of the progression to be much good.

Effective antiviral treatment isn’t really a “good to go” scenario I don’t think. Drugs may be expensive, difficult to manufacture, may be in short supply once an existing antiviral is shown to be effective, and it’ll still be highly preferable for people to not get sick in the first place.

My only pointed policy opinion about this at this point is that everyone who can plausibly work from home should continue doing so until they are vaccinated.

If there was a drug treatment that was effective, inexpensive, and easy-to-manufacture, there is no way that we would all keep this lockdown going, and that would be a good thing!

Not to the same degree, but filling office buildings with people from a vast commute radius who don’t really need to work from the office shouldn’t resume (1) ever but (2) at all prematurely.

I’m down with that, to some extent, but I think in-person work is valuable too.

If there was a drug treatment that was effective, inexpensive, and easy-to-manufacture, there is no way that we would all keep this lockdown going, and that would be a good thing!

If Ivermectin turns out to be an effective treatment, it's apparently cheap and easy-to-manufacture. It's what heartworm medicine for pets is!

ivermectin will not be the answer. I really wish the media would stop reporting these preprints because none of them have any idea how to interpret them

yeah, while I agree with you in principle silby, there are mental health benefits to getting out of your house and seeing co-workers in person (some of them anyway)

If everybody went to the office 2 days a week instead of 5 the environmental benefits alone would be *checks note* immense