The earth when everything stops

The embed is from Bloomberg News, which does not let me resize the video. It is, howver, much larger on BN's page.



From, "Sweden’s Covid Expert Says ‘World Went Mad’ With Lockdowns." And of course, he is correct.
https://www.bloomberg.com/news/articles/2020-06-24/sweden-s-epidemiologist-says-world-went-mad-imposing-lockdowns

How deadly is the Wuhan virus really?

Is the Coronavirus as Deadly as They Say? -- Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude. 

Authors Eran Bendavid and Jay Bhattacharya "are professors of medicine at Stanford. Neeraj Sood contributed to this article."

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.

Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.

The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.

Coronavirus may have infected half of UK population — Oxford study -- New epidemiological model suggests the vast majority of people suffer little or no illness.

The new coronavirus may already have infected far more people in the UK than scientists had previously estimated — perhaps as much as half the population — according to modelling by researchers at the University of Oxford.

If the results are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, said Sunetra Gupta, professor of theoretical epidemiology, who led the study. The vast majority develop very mild symptoms or none at all.

“We need immediately to begin large-scale serological surveys — antibody testing — to assess what stage of the epidemic we are in now,” she said.

The modelling by Oxford’s Evolutionary Ecology of Infectious Disease group indicates that Covid-19 reached the UK by mid-January at the latest. Like many emerging infections, it spread invisibly for more than a month before the first transmissions within the UK were officially recorded at the end of February.

The research presents a very different view of the epidemic to the modelling at Imperial College London, which has strongly influenced government policy. “I am surprised that there has been such unqualified acceptance of the Imperial model,” said Prof Gupta.

However, she was reluctant to criticise the government for shutting down the country to suppress viral spread, because the accuracy of the Oxford model has not yet been confirmed and, even if it is correct, social distancing will reduce the number of people becoming seriously ill and relieve severe pressure on the NHS during the peak of the epidemic.
The Oxford study is based on a what is known as a “susceptibility-infected-recovered model” of Covid-19, built up from case and death reports from the UK and Italy. The researchers made what they regard as the most plausible assumptions about the behaviour of the virus.

The modelling brings back into focus “herd immunity”, the idea that the virus will stop spreading when enough people have become resistant to it because they have already been infected. The government abandoned its unofficial herd immunity strategy — allowing controlled spread of infection — after its scientific advisers said this would swamp the National Health Service with critically ill patients.

But the Oxford results would mean the country had already acquired substantial herd immunity through the unrecognised spread of Covid-19 over more than two months. If the findings are confirmed by testing, then the current restrictions could be removed much sooner than ministers have indicated.

Although some experts have shed doubt on the strength and length of the human immune response to the virus, Prof Gupta said the emerging evidence made her confident that humanity would build up herd immunity against Covid-19.

To provide the necessary evidence, the Oxford group is working with colleagues at the Universities of Cambridge and Kent to start antibody testing on the general population as soon as possible, using specialised “neutralisation assays which provide reliable readout of protective immunity,” Prof Gupta said. They hope to start testing later this week and obtain preliminary results within a few days.

Stanford University School of Medicine seems to be casting a skeptical eye toward such claims. Example 1 - John Ioannidis, a professor there.

His expertise is wide-ranging—he juggles appointments in statistics, biomedical data, prevention research and health research and policy. Google Scholar ranks him among the world’s 100 most-cited scientists. He has published more than 1,000 papers, many of them meta-analyses—reviews of other studies. Yet he’s now found himself pilloried because he dissents from the theories behind the lockdowns—because he’s looked at the data and found good news.

In a March article for Stat News, Dr. Ioannidis argued that Covid-19 is far less deadly than modelers were assuming. He considered the experience of the Diamond Princess cruise ship, which was quarantined Feb. 4 in Japan. Nine of 700 infected passengers and crew died. Based on the demographics of the ship’s population, Dr. Ioannidis estimated that the U.S. fatality rate could be as low as 0.025% to 0.625% and put the upper bound at 0.05% to 1%—comparable to that of seasonal flu.

“If that is the true rate,” he wrote, “locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.”

Example 2: Dr. Jay Bhattacharya (again) of Stanford Medical School. Dr. Bhattacharya brings bad news:

1) Only a small percentage of Americans, less than one percent in his study, maybe two or three percent nationwide, have had COVID-19. Herd immunity requires something like 70 percent or 80 percent to have antibodies. So the disease has a very long way to go before it has run its course.

2) There is no vaccine for COVID-19 on the horizon, and there may never be one.

3) The shutdowns that have paralyzed the developed world have, to some degree, slowed the spread of the disease, at tremendous cost. But that only delays the inevitable. There will never be a time when it is “safe” to stop the lockdowns. The disease isn’t going away.

4) Dr. Bhattacharya is also eloquent in describing the disastrous human toll, in lives and misery, that the shutdowns have inflicted around the globe.

On the other hand, Dr. Bhattacharya has good news, too. The fatality rate from COVID-19 is low–worldwide, somewhere between 0.1 percent and 0.5 percent, probably closer to the low end of that range. The typical seasonal flu is said to have a fatality rate of around 0.1 percent. So COVID-19 is probably somewhat worse than the average flu virus.

Here is the video in which he makes those points.

"I try to get more cynical every day . . .

" ... but I can't keep up." So observed Gerard Vanderleun a few years ago on the state of American politics. But it is not just politics any more. Consider this FB post, which I have personally verified (I deleted the person's name).

Now, why is that the rule? Having been a federal bureaucrat, I will say (in my view, authoritatively) that there is one and only one reason: money.

Understand that this listing decision was not originated by physicians, but by administrators. And the overwhelming desire of every bureaucratic administrator everywhere is this: get more money. Increase his/her department's budget.  Because that is the way that bureaucrats get promoted - not for managing programs or people, but by managing ever-larger budgets.

And the medical bureaucrats know very well that the amount of money they get from  the federal spigots turned on for the C19 epidemic will relate very directly to the number of C19 cases they report, especially the fatalities.

If you think this sounds cynical, I assure you: It is far from cynical enough.

Update: And the beat goes on:

The Big Apple’s new death toll is 10,367. That figures combines the 6,589 victims who tested positive for the virus plus another 3,778  who were never tested, but whose death certificates list the cause of death as “COVID-19 or an equivalent,” according to city Health Department data from March 11 through April 13.

Italics mine, to illuminate what is being done here. What exactly is an "equivalent" cause of death to C19? Why, something that killed them, duh. You know, like lung cancer.

I said on my FB page, "First, let’s kill the children."

 Serious question: How many people are we willing to kill to stop people from dying of Covid-19?  

More specifically: How many children are we willing to kill to do it? Read this and weep:

"Hundreds of thousands of children could die this year due to the global economic downturn sparked by the coronavirus pandemic and tens of millions more could fall into extreme poverty as a result of the crisis, the United Nations warned on Thursday. ...

But the U.N. report warned that “economic hardship experienced by families as a result of the global economic downturn could result in an hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year.”

The full UN report is here.

Our sanguinary calculus is real: If we do not do lockdown/distancing by shutting down the economy, people will die. And if we do lockdown/distancing by shutting down the economy, people will still die - and the UN says that "hundreds of thousands" of them will be children. But as Roger Kimball explains,

We have often been presented with a false dichotomy between saving the economy and saving lives. This is a false dichotomy because, as Geach points out, “the state of our economy is not just a monetary risk, it is a health risk.” For one thing, “when people lose their jobs, they typically lose their health insurance.” He notes that there were more than 10,000 “economic suicides” as a result of the 2008 recession. There is also a spike in cancer deaths, drug abuse, domestic violence, and other pathologies.

This is not a guess, it is fact:

Every 1% hike in the unemployment rate will likely produce a 3.3% increase in drug overdose deaths and a 0.99% increase in suicides according to data provided by the National Bureau of Economic Research and the medical journal Lancet. These are facts based on experience, not models. If unemployment hits 32%, some 77,000 Americans are likely to die from suicide and drug overdoses as a result of layoffs. Scientists call these fatalities deaths of despair.

There are protests around the country against long continuing the restrictions from this day on. The longer we are told to stay "safe at home" instead of going back to work, or finding a new job for the 22 million-plus Americans who have lost theirs in the last month, the more people will kill themselves or a family member, the more spouses and children will suffer abuse and injury, the more alcoholics will be made, the more people will suffer fatal non-Covid illnesses, the more drug addicts will be made - the list continues.

"At some point," [Princeton bioethicist] Peter Singer says, "we are willing to trade off loss of life against loss of quality of life. No government puts every dollar it spends into saving lives. And we can't really keep everything locked down until there won't be any more deaths.

We need to think about this in the context of the well-being of the community as a whole….We are currently impoverishing the economy, which means we are reducing our capacity in the long term to provide exactly those things that people are talking about that we need—better health care services, better social-security arrangements to make sure that people aren't in poverty. There are victims in the future, after the pandemic, who will bear these costs. The economic costs we incur now will spill over, in terms of loss of lives, loss of quality of life, and loss of well-being.

I think that we're losing sight of the extent to which that's already happening. And we need to really consider that tradeoff.

 The "false debate," in other words, is not the discussion that considers the enormous human cost of suppressing economic activity. It's the discussion that pretends there is no such tradeoff. (The 'False Debate' About Reopening the Economy Is the One That Ignores the Enormous Human Cost of Sweeping COVID-19 Control Measures)

And it will not take long for the American people justifiably to decide that the real point of these restrictions is not the health of Americans at all, but something politically sinister. And no podium appearances by Dr. Fauci or Dr. Birx is going to persuade them otherwise.

Just for the record

Found on Bookworm Room:

And FOFB, via Glenn:

The debate over immigration is over: restriction wins.

The debate over borders is over: they are needed.

The debate over globalization is over: the era of autarky begins.

The debate over Europe is over: it is a geographic expression, not a polity.

The debate over global warming is over: it is irrelevant.

The debate over international institutions is over: only nations matter.

The debate over the People’s Republic of China is over: it is a menace to the community of nations, not a member in good standing.

Crisis is clarity.

The coming crash and what it portends

If we continue on the present course, we will enter a depression that might make the 1930s a distant competitor. The number of jobless Americans could reach tens of millions.

WSJ: Rethinking the Coronavirus Shutdown:

Yet the costs of this national shutdown are growing by the hour, and we don’t mean federal spending. We mean a tsunami of economic destruction that will cause tens of millions to lose their jobs as commerce and production simply cease. Many large companies can withstand a few weeks without revenue but that isn’t true of millions of small and mid-sized firms. ...

The deadweight loss in production will be profound and take years to rebuild. In a normal recession the U.S. loses about 5% of national output over the course of a year or so. In this case we may lose that much, or twice as much, in a month.

Our friend Ed Hyman, the Wall Street economist, on Thursday adjusted his estimate for the second quarter to an annual rate loss in GDP of minus-20%. Treasury Secretary Steven Mnuchin’s assertion on Fox Business Thursday that the economy will power through all this is happy talk if this continues for much longer.

This is the first time ever that the US Government has deliberately shut the economy down, and the idea that it can just be turned back on like flipping a switch is delusional.

Consider: We will never be able to determine how many lives were saved from the virus. But we will easily know how many people died because of the economic crash to come - just count increased suicides and even some homicides, to say nothing of untold numbers of people thrown into permanent poverty.

The lockdowns and stay-at-home orders are saving lives now. But if they continue much longer, they will cost lives later and cause economic, literal suffering for years and years to come.

Also, The Atlantic, "Suicide and the Economy."

On April 12, 1937, the express train to New York roared across the New Jersey countryside. The train, a Pennsy Railroad electric locomotive the color of bull’s blood, usually passed through the station at Elizabeth at about 50 miles per hour. On this particular morning, it came to an unanticipated stop. As the express rounded the curve, my great-grandfather jumped down from the platform, where witnesses reported he had been pacing for 10 minutes, and lay down across the tracks.

When the engineer was finally able to halt the train 100 feet past the platform, Roy Humphrey had disappeared beneath its wheels. His last act: raising his head to look at the oncoming train.

Roy was one of at least 40,000 Americans who took their own lives that year and the next, the two-year span that suicide rate spiked to its highest recorded level ever: more than 150 per 1 million annually. 

Update: "US unemployment could surge to 30% next quarter and GDP might plunge 50%, Fed's Bullard warns"

Also relevant: "The luxury of apocalypticism -- The elites want us to panic about Covid-19 – we must absolutely refuse to do so."

The point is, there is such a thing as doing too little and also such a thing as doing too much. Doing too little against Covid-19 would be perverse and nihilistic. Society ought to devote a huge amount of resources, even if they must be commandeered from the private sector, to the protection of human life. But doing too much, or acting under the pressure to act rather than under the aim of coherently fighting disease and protecting people’s livelihoods, is potentially destructive, too. People need jobs, security, meaning, connection. They need a sense of worth, a sense of social solidarity, a sense of belonging. To threaten those things as part of a performative ‘war’ against what ought to be treated as a health challenge rather than as an End Times event would be self-defeating and utterly antithetical to the broader aim of protecting our societies from this novel new threat. To decimate the stuff of human life in the name of saving human life is a questionable moral approach.

Covid-19, from a reliable source

I received this from a man, Ken, I have known for many years. He is a retired Master Sergeant of the Tennessee Army National Guard. Since retirement he has been a senior director of emergency management in Tennessee. He said he got this "From a reliable friend in the medical field." Well, I trust Ken.

Here is the man's assessment.
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The virus is encircled by an oily, lipid layer that dissolved on contact with soap. Hence the push for hand washing. The virus enters the body through the mouth, nose, and/or eyes and needs cells with ACE2 receptors to attach. These are found primarily in the heart and lungs. ACE2 (angiotensin-converting enzyme) is a protein associated with both diabetes and HTN, both conditions which place an individual at a heightened risk; 40% of patients with HTN experienced severe infections.

The virus then attaches to healthy cells with that fatty, oily layer and hijacks the cells, making proteins to keep the immune system at bay. The immune system mounts a defense and sometimes attacks healthy lung cells. The lungs fill with fluid and dying cells. This can lead to ARDS which is most often fatal, basically an acute, lethal pneumonia. That's what killing people. It's not unlike the Spanish Flu. That flu attacked healthy individuals and created a "cytokine storm" and people drowned from the fluids in their lungs. We now know the virus is found in the bloodstream, GI tract, CNS, and possibly brain. It can cause damage to the lungs, heart, bone marrow, and liver, possibly nerve cells. Should you survive a severe infection because you're young and healthy, you can expect a 20-30% decrease in lung capacity. What this means is that a flight of stairs will wind you. You can expect lung scarring and damage. We do not know the long term effects as this is an entirely new virus. When a virus makes that first jump from one species to another, it is at its most lethal. That is what we are seeing with SARS-CoV-2.

A new study is out that shows the droplets can "hang" in the air for up to three hours. This may mean the virus is aerosolized which answers the question why it appears to be so contagious when it only has an R0 of 2.4. This study was conducted by NIH, Princeton and UCLA and is not yet peer reviewed. This study also showed the virus is viable on plastics for 3 days; on the glass of cell phones 9 days; and on cardboard for 24 hours.

Contrary to the other four coronaviruses that are endemic in our population, this one does not seem to be susceptible to heat and humidity as we had first hoped. The transmission of the virus will go down come summer, but that is a function of schools' closing for the summer break rather than a response to heat/humidity. There will be an uptick in cases once fall arrives due to the close quarters. This virus is not going away anytime soon. There are three courses a novel virus can take - 1. It can appear, be devastating, and disappear unexpectedly like both SARS and MERS. This one did not do that so this option is out. 2. It can cause a global pandemic and a lot of people will lose their lives or be disabled from the infection. May be happening. 3. It can become endemic in our population like the other 4 coronaviruses we see during cold and flu season and account for up to 30% of our "colds." This is highly likely.

Myths:

1. Keep your mouth moist (another version is to spray your nose with saline) and the virus can't "take hold." Staying hydrated helps your immune system. It does not do anything to the virus.

2. Keep your mouth moist and take sips frequently to "swallow the virus."

3. Drink a solution of diluted bleach and water. No. Do not ever drink bleach. Or take acetic acid or any number of the "natural cures" out there. If there was a natural cure, doubtful almost 6k people globally would have died.

4. Take vitamin C. Vitamin C was a great marketing campaign in the 50s by Linus Pauling. It's such a great campaign, it perpetuates today. It does absolutely nothing for the prevention or treatment of colds/viruses.

5. There are antibiotics for this virus. Antibiotics only work on bacterial infections. We don't know which, if any, antivirals work on this novel virus.

6. I'm young and healthy. If I get it, it won't affect me. There can be long term damage or even organ failure due to the virus. We will not know for many years the extent of the damage.

7. The flu shot will prevent the virus. The flu and this virus are completely different viruses. However, getting the flu shot does two things: decreases your chances of becoming ill from the flu and having a weakened immune system making you more susceptible to the coronavirus and keeps you out of the hospitals allowing providers the time and resources to care for victims of the pandemic.

8. Black people don't get the coronavirus. OMG. NO! This is not only racist, it's completely wrong. Africa has over 100 cases.

9. I should wear a mask. No. Just no. (I can elaborate at length why this is not a good idea)

10. Kids can't get the virus. Not only is this not true, it may be deadly. Yes, children can get the virus and many are asymptomatic. So far, thankfully, there haven't been any deaths in children under 9. Newborns have gotten the virus. We just don't know what the long term effects will be. If you can protect your children, do so.

11. Schools are closed; I can take my child to the museum, zoo, theater, etc. NO. The idea of social distancing is to stay home. Do just that. Stay home. If you do not, people will die. It's that simple.

12. Heat (or cold) will kill the virus. Nope. This nasty bugger is strong and kicking our butts. Neither a hot or cold bath or a hair dryer will kill the virus. (Seriously, WHO, who is using a hair dryer to kill the virus??)

13. Garlic. What? No, of course garlic doesn't prevent or treat the virus. I mean, look at Italy.

14. There are medicines to treat the virus. No, there are no specific meds to treat this virus. South Korea seems to have found a sweet spot with a combo of drugs, but we have no idea if that actually works, how effective it is, long term effects, etc. We are years away from a vaccine.

15. Essential oils. No. Always no.

And the big one - 16. "It's just the flu." Nope. At the worst, its 30x more fatal than the seasonal flu (Chinese/WHO figures) at its best, 10x more fatal (South Korea figures). This is NOT just the flu. Seasonal flu has a case fatality rate (CFR) of 0.6% annually. This virus, depending on which country you run the stats has either a 3.4% CFR or a 1.2% CFR. Both are substantially higher than the flu. For comparison, the Spanish Flu had a CFR of 2.5%.
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Read this, too: Influenza kills more people than coronavirus so everyone is overreacting, right? Wrong — and here’s why

Folks, this virus is bad news. Treat it that way.