An Over-reaction?

[Paul of Covington]

Flintlock76

When I left the trade medical offices were still heavy users of the fax function, why I don't know, but they seemed to prefer it that way. If they lost the fax they were in big trouble!

   A few years ago the agent who handles my retirement account mentioned that they were told to use fax rather than email because of security concerns.  The data being transmitted, being a picture, was harder to intercept.  (Or something like that.)

[Convicted One]

Flintlock76

When I left the trade medical offices were still heavy users of the fax function, why I don't know, but they seemed to prefer it that way.  If they lost the fax they were in big trouble!

I think that early on they had incorporated a visual imaging system to share x-rays from office to office that incorporated fax technology.  And they had a sizeable investment to amortize.

Of course, fax did monochrome fairly well, so why abandon the investment ?

[charlie hebdo]

David: The IDF has blockaded Gaza for years. Are they allowing medical supplies to enter now?

 

[daveklepper]

Who is leading the race to develop the coronavirus vaccine? Though regulatory processes and bureaucratic barriers are likely to be expedited, including the acceleration of clinical trials in humans, the world will need to be patient. By EYTAN HALON MARCH 22, 2020 21:55

As doctors battle night and day to save patients' lives in hospitals worldwide, the world's leading scientific minds are racing to produce the first vaccines for the novel coronavirus. Some of those leading the way have relied on knowledge from previous coronavirus outbreaks, while others have used vaccine platform technologies used to combat other epidemics, including Ebola.

Though regulatory processes and bureaucratic barriers are likely to be expedited, including the acceleration of clinical trials in humans, the world will need to be patient for the arrival of the vaccine. Dr. Mike Ryan, director of the WHO Health Emergencies Program, told BBC television on Sunday that it would take at "least a year" for a vaccine to become available, emphasizing the need for rigorous safety standards.

So, who are the developers leading the race for the highly sought-after vaccine? Moderna The first dose of the mRNA-1273 coronavirus vaccine, developed by the US National Institutes of Health (NIH) and Moderna’s infectious disease research team, was given to the first participant in their Phase 1 study on March 16. The trial of the vaccine, built on previous studies of SARS and MERS, is intended to provide data on the safety and immunogenicity of the vaccine, and is expected to enroll 45 healthy adult volunteers over six weeks. The Cambridge, Massachusetts-based drug discovery company emphasized that it is "still early in the story," with no approved drugs to date emerging from its vaccine program and no previous human trials. The current trials are being carried out at the Kaiser Permanente Washington Health Research Institute in Seattle.

Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, described the study as "an important first step toward" finding a safe and effective vaccine.

CanSino Biologics Authorities in China granted approval last week for Phase 1 clinical trials of a coronavirus vaccine developed by researchers at Tianjin-based CanSino Biologics and the Academy of Military Medical Sciences. Tests of Ad5-nCoV in animals, researchers said, showed that the vaccine candidate can induce strong immune response and demonstrated a good safety profile. Prescreening for the first human study has already begun, and is expected to enroll 108 healthy participants at Wuhan's Tongji Hospital. “Having committed to provide unconditional support to fight against the global epidemic, CanSinoBIO is determined to launch our vaccine product candidate as soon as possible with no compromise on quality and safety," said CanSino chairman and CEO Xuefeng Yu.

Migdale

MIGAL

Located in Kiryat Shmona, the MIGAL – Galilee Research Instute is working to adapt a vaccine initially developed to prevent the Infectious Bronchitis Virus (IBV) in poultry. Funded by the government, the institute hailed a “scientific breakthrough that will lead to the rapid creation of a vaccine against coronavirus" in late February, based on the genetic similarity between the avian coronavirus and the novel coronavirus. Human testing of the oral vaccine, the institute said, is expected to begin within eight to 10 weeks, and safety approval is expected within 90 days. "We are currently in intensive discussions with potential partners that can help accelerate the in-human trials phase and expedite the completion of final product development and regulatory activities," said MIGAL CEO David Zigdon.

INOVIO Pharmaceuticals Pennsylvania-based INOVIO announced the receipt of a new $5 million grant from the Bill & Melinda Gates Foundation on March 12 to accelerate the testing of its novel DNA vaccine for COVID-19, known as INO-4800. Currently in preclinical studies, INOVIO plans to advance into US Phase 1 clinical trials next month, backed by up to $9m. in funding from the Coalition for Epidemic Preparedness Innovations. The company says it aims to deliver one million doses of INO-4900 and handheld intradermal delivery devices to administer them by the end of 2020. "Our team of vaccine experts are working around the clock to advance INO-4800 and we look forward to attracting additional partnerships to expedite its development to meet this urgent global health need," said INOVIO president and CEO Dr. J. Joseph Kim.

CureVac Reportedly the target of an acquisition attempt by US President Donald Trump, German biopharmaceutical company CureVac announced that it is leveraging its mRNA-based drug platform to produce a vaccine against the novel coronavirus. The European Commission has offered up to €80 million of financial support to CureVac, which plans to launch clinical tests in June 2020. If proven, the commission said, millions of vaccine doses could be produced at low costs in the company's existing production facilities. "The combination of mRNA science, disease understanding, formulation and production expertise make CureVac a unique player to fight against any infectious disease, no matter whether they are seasonal or pandemic," said CureVac CTO Mariola Fotin-Mleczek. BioNTech German immunotherapy company BioNTech and American pharma giant Pfizer signed a letter of intent last week to codevelop and distribute an mRNA-based vaccine against the novel coronavirus. The partnership, originally formed in 2018 to develop flu vaccines, will accelerate BioNTech's COVID-19 vaccine program BNT162, which is expected to enter the clinic by the end of April.

Just one day earlier, the Mainz-based company announced a strategic development and commercialization collaboration with Fosun Pharma to advance its mRNA vaccine in China. Fosun Pharma will pay BioNTech up to $135m. in upfront and potential future investment and milestone payments. "We feel a duty to exploit our full technology and immunotherapy expertise to help address the COVID-19 pandemic emergency," said BioNTech founder and CEO Prof. Ugur Sahin, adding that the company is also working on a novel therapeutics approach for patients who have already been infected. Details, he said, will be disclosed "in the coming weeks.

[Flintlock76]

And it's not just photocopies anymore C-O, for the past decade, and maybe a little more, what we used to call "copiers" are now called "Multi-FunctionPrinters," or "MFP's."  Not only do they copy, they print, scan, and fax.  Sometimes when one function goes down the rest are still useable, but not always. 

When I left the trade medical offices were still heavy users of the fax function, why I don't know, but they seemed to prefer it that way.  If they lost the fax they were in big trouble!  

[Convicted One]

charlie hebdo

I think people actually engaged in essential work are given or must obtain a certificate. 

The Indiana law is pretty specific as far as the ruleset being self contained, and there is no mention of any requirement for any certificate in the stated rules.

Look specifically at section "J" of the document I linked to, it is disappointingly permissive.

Reading elsewhere in the document , the welfare of pets is an exclusion. Where I worked most recently is a resident cat. I could argue thatI was on my way to make the daily "welfare" check on the office cat, and be exempt.

[charlie hebdo]

I think people actually engaged in essential work are given or must obtain a certificate. 

[Convicted One]

Flintlock76

f I were still on the job doing copier repairs I'd be out there, especially now, and doubly-especially if medical offices were involved.

Yeah, I can see where the ability to make photocopies could be considered "core" to the operations of some essential businesses.

Indiana just announced that it's going to lock down to all but "essential" services at 11:59 pm Tuesday. There are a  multitude of exceptions, exclusions, and gratuitous interpretations to what is considered "essential".  Here is a link:

https://www.in.gov/gov/files/Executive_Order_20-08_Stay_at_Home.pdf

I could likely fiind enough wiggle room to justify whatever my personal preferences were.

Which begs the question, how are the local authorities going to be able to enforce this?

If I am a janitor or a wall painter, and claim that I am on my way to/from performing services at an "essential" business, I'm exempt. 

Not a lot there that can be enforced, so I guess the law is intended to control the sheep?

[Deggesty]

Quoting Convicted One: "What would the employer's defense be? Contributory negligence on behalf of the employee for following orders?" That sounds much like "All animals are equal, but some are more equal than others." 

 

 

"

[Flintlock76]

Let me put it this way.  If I were still on the job doing copier repairs I'd be out there, especially now, and doubly-especially if medical offices were involved.

I'd get more than the usual satisfaction I used to get knowing I'd made a difference in someones day.  Know what I mean?  

[Convicted One]

Well, according to one source at least,  worker's comp would not cover a workplace corona virus infection.

https://www.nolo.com/legal-encyclopedia/coronavirus-your-rights-in-the-workplace.html

Yet NIOSH has established guidelines recognizing legitimate threat of "take home toxins" in general. (not specific to corona virus, but relevant nonetheless)

So, merely my gut hunch, but I suspect an employer requiring employee attendance, despite the known risk of the pandemic, might have some exposure here.

What would the employer's defense be? Contributory negligence on behalf of the employee for following orders? 

[Murphy Siding]

charlie hebdo

I wouldn't hazard any legal opinion:; it's not in my bailiwick.  Maybe Euclid? 

Probably safer and less "unmutual" ** to follow the suggestions of public  healthcare people. 

** as in The Prisoner

 

Thanks. I needed a good pick-me-up this morning.

[daveklepper]

Hello, everyone.

At New York City Transit, our number one priority is to move New York safely and efficiently. Even in a crisis, that priority doesn’t change.

I wanted to take a moment to update you on our current situation, and how we are reacting to it in real time.

Most importantly, we are listening to medical and health experts, and executing on their guidance and direction. We are also in constant communication and coordination with all of our partners across all levels of government - state, city and federal.

First, it's important to note, public health experts have also said if you can stay home, you should stay home. If you’re able to work from home, please do so. If you don’t need to go out, please don’t. Please continue to follow their advice on all fronts: take care of yourselves, wash your hands for at least 20 seconds, use hand sanitizer, don’t touch your face, and if you start to feel unwell, contact your doctor.

For our part, we are taking every measure we can to help keep New York safe, healthy, and moving (but only if you need to be). Here’s more about what we’re doing, what's recommended, and how you can stay informed:

Right now, we’re staying open for those who need us—and for those whom we all need.

The subways and buses are how New Yorkers get around. That includes our medical professionals, firefighters, law enforcement personnel, child care workers, food service employees, and everyone else we need to keep New York safe and healthy. We continue to run trains and the buses so that these folks can get where they need to be. We are constantly evaluating our service levels to ensure we have enough capacity for those who need it.

We’re undertaking every practical measure to keep our system sanitized and safe.
Every day, we’re disinfecting subway cars, commuter trains, buses, work spaces and offices. The entire MTA fleet gets disinfected at least every 72 hours. In stations and on buses, we’re cleaning and disinfecting the surfaces customers touch at least twice a day.

We will keep you continually informed about what we’re doing and what you should expect.
We will be in constant contact with you about what we’re doing and how we’re responding as the situation evolves. We are keeping our website up-to-date and are providing real-time service status alerts and 1-1 customer support on our social media channels, and at 511. Inaccurate and unfounded rumors are common at moments like this – if you hear rumors about subway or bus service, please check our official feeds. We will be the ones to tell you if anything changes.

If you have any questions at all, please ask. We are available 24/7 on Twitter at @NYCTSubway, and @NYCTBus, and via phone at 511. Check new.mta.info/coronavirus and sign up for the City’s text alerts by texting COVID to 692-692.

Our top priority will always, always be keeping you and our employees safe. Please, take care of yourselves, your families, your neighbors, and everyone else. Thank you for riding with us (but only if you need to). It is an honor to serve you, and this city.

Sarah Feinberg
Interim President, New York City Transit

[daveklepper]

British ear, nose and throat doctors have called on adults who lose their sense of smell to isolate themselves for seven days, even if they have no other symptoms, as studies indicate that a loss of smell and taste could be a symptom of COVID-19, the disease caused by the novel coronavirus.

 

“We really want to raise awareness that this is a sign of infection and that anyone who develops loss of sense of smell should self-isolate,” said Prof. Claire Hopkins, president of the British Rhinological Society, according to the New York Times. “It could contribute to slowing transmission and save lives.”

 

Ear, nose and throat specialists and eye doctors were infected and dying in large numbers in earlier reports from Wuhan, China, the epicenter of the coronavirus outbreak, according to Hopkins.

 

Reports from multiple countries have indicated that significant numbers of coronavirus patients experienced anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, according to the Times.

 

The American Academy of Otolaryngology stated on Sunday that mounting anecdotal evidence indicates that lost or reduced sense of smell and taste are significant symptoms related to COVID-19. Some coronavirus patients have had a reduced sense of smell and taste without any other symptoms.

"There is evolving evidence that otolaryngologists are among the highest risk group when performing upper airway surgeries and examinations,” said a notice on the academy’s website on Friday. “A high rate of transmission of COVID-19 to otolaryngologists has been reported from China, Italy and Iran, many resulting in death.”

 

In Italy, doctors have concluded that loss of taste and smell is an indication that a person who may otherwise seem healthy is actually carrying and spreading the virus.

 

More than 1,000 Israelis infected with coronavirus

 

According to Dr. Clemens Wendtner, a professor of medicine at the Academic Teaching Hospital of Ludwig-Maximilians University of Munich, patients regained their ability to smell after a few days or week. The loss occurred regardless of how sick they got or whether they were congested and nasal drops or sprays did not help.

 

Studies on the newly realized symptoms have not been able to take place as physicians handling coronavirus outbreaks are overwhelmed, according to Forbes.

 

German virologist Hendrik Streek took daily samples from infected workers isolated in a hospital and interviewed them about the progression of their symptoms. He found that two thirds of those he interviewed described "a loss of smell and taste lasting several days," according to Forbes.

 

Both Streek and Professor of Infectious Diseases at the University of Milan, Massimo Galli, found that the loss of smell and taste usually occurred late in the course of infection.

 

According to Judy Stone, an infectious disease specialist, the only other infection they knew of with a loss of smell was Herpes simplex encephalitis, a rare neurological disorder characterized by inflammation of the brain, according to the National Organization for Rare Disorders.

 

Medical professionals are unsure what is causing the loss of the senses of smell and taste. Some virus destroy the cells or cell receptors in your nose, while others infect the brain via the olfactory sensory nerves. The ability to infect the brain may explain some of the cases of respiratory failure in COVID-19 infections and evidence shows that coronaviruses may invade the central nervous system.

 

SARS has been reported in the brains of both patients and experimental animals and, considering the high similarity between SARS and the novel coronavirus, an infection of the nervous system may be partially responsible for the respiratory failure of patients with COVID-19, according to a study by Yan‐Chao Li, Wan‐Zhu Bai and Tsutomu Hashikawa that was published in the Journal of Medical Virology last month.

 

Deputy Chairman of Iran’s Rhinology Association Dr. Ebrahim Razmpa told the Iranian ISNA news that there has been "a sudden, unexpected and unbelievable jump in cases of weak sense of smell and difficulty with vision" since the coronavirus outbreak reached the Islamic Republic, although it is still unclear whether the coronavirus or other factors caused the spike, according to Radio Farda.

 

As of Sunday night, 335,997 cases of the novel coronavirus had been confirmed around the world, with 14,641 dead and 98,333 reports of recoveries.

 

[daveklepper]

In Israel, Recovery is defined as complete lack of symptoms and testing negative as a carrier.  Is not this also the definition in the USA?

[Overmod]

It's less a legalistic issue than a practical one: if, as with colds, the primary infection risk is in droplets from sneezes/coughs or breathing, it makes sense to keep thr roughly 6' distance from the part doing the 'respiration'.

A far more alarming factor is how often I see the common sense of the distancing violated.  I visited four separate facilities yesterday where customers and staff were animatedly talking straight to each other at about 3' distance, none of them wearing masks or any other protection at all.  A number of people were walking around animatedly yakking into their phones.  As I mentioned yesterday it isn't unusual to see people waiting for 'limited admittance' into government facilities now practicing 'social separation' to be crammed close together, talking vociferously about the irritation and risk they are suffering ... and thereby probably increasing it dramatically if they should happen to be infectious, and perhaps (if they are inhaling strongly between comments) if not.

Please, folks, try to breathe through your nose and keep your head down and be quiet if you have to talk -- keep your breath away from others as much as you can.

Incidentally, as of March 9th there were at least two fully-documented instances of asymptomatic people shedding very large amounts of virus.  I wouldn't be surprised if, with the advent of much wider testing in the days since, the recognized incidence has not increased.

Cuomo mentioned a couple of days ago that at least some patients 'tested negative' in recovery -- whether this means negative for symptoms of COVID-19 or whether it means negative for shed virus remains unclear.  My own great concern is that I expect many who 'recover' to continue producing virus particles, albeit at a lower rate, that may continue to pose an infection hazard through both aerosol and contact transfer to at-risk cohorts, perhaps indefinitely.  That may mean widespread continued 'social separation' between the bulk of 'recovered' and perhaps immunized/antibody-treated people (the 70 to 98%) and any people at risk of ARDS or other lethal complications.  Ways of doing that and still bringing back many social institutions otherwise unsustainable are a current concern...

[charlie hebdo]

I wouldn't hazard any legal opinion:; it's not in my bailiwick.  Maybe Euclid? 

Probably safer and less "unmutual" ** to follow the suggestions of public  healthcare people. 

** as in The Prisoner

[Convicted One]

charlie hebdo

  Physical space refers to the three dimensional volume around us.  Since the virus is transmitted only between humans (assuming you don't have access to the fruit bats from Hubei that are the theorized source)  keeping a 2 meter physical space around one would include all objects, which would thus be an unnecessary precaution

How would you feel about substituting the word "liability" in place of the word "precaution"?

Suppose you  are an owner of a non-essential business, but you continue to require your employees to report to work.

A confirmed outbreak occurs in your business, and one of your employees dies from it. Are you  going to be sheltered by workmans comp, or are you staring down the barrel of a wrongful death lawsuit? Or both? Just a thought....many of these employers might be content to comply with the embargoed workplaces.

[charlie hebdo]

Social refers to living in various forms of contact with other humans.  Physical space refers to the three dimensional volume around us.  Since the virus is transmitted only between humans (assuming you don't have access to the fruit bats from Hubei that are the theorized source)  keeping a 2 meter physical space around one would include all objects, which would thus be an unnecessary precaution.  Social distancing refers to keeping a 2 meter space around you in relation to other humans only. 

[GERALD L MCFARLANE JR]

zugmann

 

BaltACD

There are too many asymptomatic carriers.

 

 

First documented case in our area was a asymptomatic doctor.   Typhiod Mary sort of thing.  Then we had a convneince store clerk.  

 

LAst week, our governor let businesses be open, but pleaded for people to be smart (yeah, I laughed too).  If youg o to restaurants:g et take out, don't hang around in bars - that sort of thing.  As I was coming home from work last friday, all the bars and restaurants were packed.  A few days later the order came to shut them down (except for take out).   People are stupid.  They don't understand medical stuff, and they don't understand statistics.  

 

After the 14 days from first exposure, if you are asymptomatic the entire 14 days then you are no longer a carrier, it's nothing like "Typhoid Mary".  There hasn't been a single case of a "Typhoid Mary" like carrier yet.

Also, "Social Distancing" is an oxymoron, you can't be social and distance yourself from people at the same time, they should rename it to "Physical Distancing", since that's what they want you to do.

I still contend it would be easier to isolate those most susceptible to COVID-19(the official name for this particular strain, no matter what everyone else writes) from contact with the general public than it is to get people to self quarantine or "shelter-in-place".  Witness the Mayor and Chief of Police announcing that anyone found not sheltering-in-place for other than an essential need will face more draconion measures such as a fine or misdemeanor(not withstanding the fact it's a civil order with no enforcement mechanism behind it).

To use the same example as above about the person going to the hockey game and not worrying about infecting someone after the game while dining.  I say isolate that person that would normally go out dining and let the other person enjoy their hockey game.  That's the difference between grinding the economy to a halt and letting it keep going with only minor inconvience.

Another statistic I read the other day.  Our state has 78,000 plus hospital beds available, and based on the numbers they claimed that maybe 15,000 people would've needed to be hospitalized had we not done a state wide "shelter-in-place' otherwise the medical system would've been overwhelmed.  Someone is using funny math if 15,000 hospitalized out of 78,000+ beds is going overwhelm our system, that's just under 20%...how is that overwhelming the system?   Yes, yes, I know about the inadequate number of resperators, etc., etc.,.  

I mean, we had a little over 660 some odd confirmed cases when the Governor ordered the statewide "shelter-in-place" vs the over 5,000 cases in New York.  Our Governor is just a little over zealous in my personal opinion. 

Still, I'd much prefer to get it myself and let my body do it's job by building up the immunities to it.  I already dislike all the changed they've made at my job to reduce contact with other people, it's our damned job, if someone doesn't want to do it, send them home.

[PJS1]

daveklepper

 So far, 37 people have recovered.  

How is recovered defined?

[daveklepper]

Some 945 Israelis have tested positive for the novel coronavirus, SAR-CoV-2, on Sunday morning, as numbers continue to increase.

 

 

The Ministry of Health reported that the majority of cases - 863 - are mild, 24 are moderate and 20 critical. One person died from coronavirus over the weekend. The 88-year-old Holocaust survivor was the first Israeli to die from the disease.

 

So far, 37 people have recovered.

 

 

The number of coronavirus patients in the country is expected to climb by even hundreds each day, according to Health Ministry director general Moshe Bar Siman Tov, as Israel expands the number of tests it takes each day.

 

 

When coronavirus first came to Israel, the Health Ministry tested around 750 people per day. That number climbed to 2,200 over the weekend. Some 3,000 people are expected to be tested on Sunday.

 

 

Bar Siman Tov said that Israel will likely test as many as 10,000 people per day in the coming days.

 

 

Magen David Adom is responsible for most of these tests. It has thus far opened four drive-through testing complexes, which allow Israelis to be swabbed and tested for the virus in their cars in two or three minutes.

 

 

 

The coronavirus outbreak has been harshly challenging the Israeli economy, as the government rolls out additional isolation and other restrictions to stop the virus from spreading.

 

 

On Sunday, the Israeli Employment Service reported that an additional 8,500 people registered for unemployment benefits on its website, bringing the total number of people who have registered in March to 511,965.

 

 

The unemployment rate in Israel has increased fourfold to 16.5%. Before the outbreak of the crisis, the unemployment rate was about 4%.

 

 

Acting Justice Minister Amir Ohana, in coordination with the courts, extended the state of emergency governing courts actions from Sunday until April 16. Those aspects of the courts, such as the High Court of Justice and emergency hearings in lower courts, which were still operating will continue to operate.

 
In addition to those out of work, several medical professional are in isolation: 3,030 as of Saturday night, including 814 doctors and 893 nurses. 

 

Yonah Jeremy Bob contributed to this report.

 

 

[charlie hebdo]

daveklepper

Aren't trial innoculations with a test vacine already begun? I have hopes it is successful, and that present disdancing prevention methods will be unnecessary, as we all get innoculations.

Or is this just a great hope?

 

Trials are just that.  Initial trials of many medications,  including vaccines end up on the ash heap.  They may be ineffective or have nasty side effects including death. So it's unlikely we will have an effective vaccine for public use in less than six to 12 months. There is no vaccine for the first SARS virus which took lives in 2003.

[daveklepper]

Aren't trial innoculations with a test vacine already begun? I have hopes it is successful, and that present disdancing prevention methods will be unnecessary, as we all get innoculations.

Or is this just a great hope?

[Overmod]

Mr. Shuman's point is a valid one, and has been mentioned here, perhaps most notably by charlie hebdo, for some time.  Both the 'outbreak' in Washington and some of the ARDS experience in Italy have demonstrated how promptly certain clones of SARS-CoV-2 can cause lethal progression in susceptible populations, and I for one see no particular reason why this may not be capable of inducing much the same type of ARDS, in the same populations via the same mechanisms, as occurred in the worst of the 1918 influenza.  I cannot find in the literature that we have an expedient method for treating this, or effectively addressing cytokine storm in a clinical setting, or addressing the particular problems that effective ventilation encounters with otherwise-naively-treated ARDS cases, or even for increasing the number of effective ventilators or developing proper logistics and training to provide them effectively where and when needed.  Meanwhile, I see as a peripheral and perhaps ultimately catastrophic piece of collateral damage that most of the medical conferences at which these sorts of things would be taken up and effective approaches hammered out have been cancelled.

In all of this, something profoundly lacking is the role of 3CLpro inhibitor prophylaxis in identified cases at risk of "viral pneumonia" promptly upon early diagnosis of infection, perhaps coupled with selective blocking (and subsequent active support of things like RAAS mediation) of the ACE2 receptor site that appears responsible for much of the hyperinfectivity of at least the dangerous clones of this virus.  (It fills me with nothing less than deep dread that the president of the American College of Cardiology seems to think that the virus somehow infects ACE rather than selectively attaching to its cellular receptors...)  Any even-minimally heroic strategy for addressing induction of ARDS hinges on reducing effective virus titer before either the observed kinds of cytokine storm or the rapid collapse of lung function become established, even if that action does not in itself arrest or dispel the development of ARDS in time.  And it may hinge on early and effective induction of functional immunity -- or effective resistance to establishment of infection, or progression to dangerous syndromes -- in a large population of potential 'responders' and people to be trained as effective paramedics.

With this amount of foreknowledge, it is almost amazing that we have to have active discussions in this country of how to 'triage' even relatively small saturations of people presenting with dangerous symptoms during (almost inevitable) outbreaks.  The good news in this, I suppose, is that we've had the dry run for a truly dangerous virus, as well as beginning to appreciate the awful economic and social consequences from a naive method of "preventing" rather than addressing the important issues involved.  Much of what we establish systematically represents knowledge and perhaps experience that might be incorporated into systematic methods for 'the next time' -- even the next time there's a flareup of dangerous symptoms or complications of COVID-19.  That this is not consciously being done coherently is a major failure, although laying it on "Trump" or witless figures in public administration is not any more useful as castigating Obama for failing either to preclude the nearly 14,000 recognized deaths in the 2009 H1N1 pandemic or for setting up just the kind of directed research into ARDS and other prompt causes of morbidity or lethality when experienced in a context that saturates existing cost-effective access to 'hospital treatment' that were proven then to be significant.  While it would greatly simplify the necessary efforts if supplied via a Government crash program, especially with the growing recognition of Cuomo with others that current social distancing methods may work medically for a while, but at a cost of billions per 'victim' saved, with no particular ultimate hope other than partial containment for a while, it becomes clearer and clearer to me that something proactive needs to be developed for the at-risk populations -- not just for those over the age of 60, critically important though that is.

 

[daveklepper]

Here is some serous thinking from a fellow MIT Alumnus more connected with the situation than I may be:

Gene Shuman <[e-mail]>

To:Anshuman Panda

Cc:[e-mail],[e-mail],sh-alum,[e-mail],[e-mail] 2 more...

 

Sun, Mar 22 at 7:43 AM

 

So this is a very good analysis, but it is missing one key fact.   Yes, the mortality rate

for covid is low. But in the best case scenario, even with a mortality rate of 0.5% or

something like that, still somethinglike 10% of all cases  need to be hospitalized, as

we can clearly see from statistics worldwide at thispoint.  This relatively low mortality

rate directly takes into account that we are able to save a lot of the milder cases with

direct medical intervention.  And if the medical system entirely shut down, the

mortality rate would *certainly* be several times higher than it is now. 

 

This to me implies that there is no choice except for at least mildly draconian

selfisolation/quarantine methods.  If we just let this happen on its own, and just

accept that we ware losing 0.5-1.0 of ourpopulation, our medical system will still

collapse.  *Without* a global pandemic, our medical systemis not healthy, I dont

think that anybody who has spent 3 hrs waiting to see a dr in an emergency room

can argue otherwise.  The point of all of these quarantine measure is to protect

the healthcare system. 

 

That is the missing fact here.  Italy's healthcare system is now in a complete

state of crisis.  We'll bethere very soon.  Yes, we're probably paying for this

with a great depressionera event.  But the mortalityrate of this situation will

be waaay higher than the 0.5-1.0-3.4%, whatever, number that we have if we

don't. Last I heard Italy's official mortality rate is like 5%.  And my understanding

is that is not the direct mortality rate of the situation, it has to be a in part a

function of their healthcare system not being able tohandle a massive influx, 

They also have an older population, relatively speaking so that doesnt help

either.  But I can say for sure, that right now what we're doing is 100% to

protect the healthcare systemfrom imploding, and that is a fact that needs

to be taken into consideration in this calculus.

 

Regards,

=Gene Shumzn

[Paul of Covington]

   Thank you, Dave.

[daveklepper]

 

Lockdown

 

Yes there is fear.

Yes there is isolation.

Yes there is panic buying.

Yes there is sickness.

Yes there is even death.

But,

They say that in Wuhan after so many years of noise

You can hear the birds again.

They say that after just a few weeks of quiet

The sky is no longer thick with fumes

But blue and grey and clear.

They say that in the streets of Assisi

People are singing to each other

across the empty squares,

keeping their windows open

so that those who are alone

may hear the sounds of family around them.

They say that a hotel in the West of Ireland

Is offering free meals and delivery to the housebound.

Today a young woman I know

is busy spreading fliers with her number

through the neighbourhood

So that the elders may have someone to call on.

Today Churches, Synagogues, Mosques and Temples

are preparing to welcome

and shelter the homeless, the sick, the weary

All over the world people are slowing down and reflecting

All over the world people are looking at their neighbours in a new way

All over the world people are waking up to a new reality

To how big we really are.

To how little control we really have.

To what really matters.

To Love.

So we pray and we remember that

Yes there is fear.

But there does not have to be hate.

Yes there is isolation.

But there does not have to be loneliness.

Yes there is panic buying.

But there does not have to be meanness.

Yes there is sickness.

But there does not have to be disease of the soul

Yes there is even death.

But there can always be a rebirth of love.

Wake to the choices you make as to how to live now.

Today, breathe.

Listen, behind the factory noises of your panic

The birds are singing again

The sky is clearing,

Spring is coming,

And we are always encompassed by Love.

Open the windows of your soul

And though you may not be able

to touch across the empty square,

Sing.

name of author available from me at [e-mail]

[54light15]

Want to see how stupid people can be? See what the woman does on an airplane. Unbelievable! 

https://ca.rogers.yahoo.com/news/five-examples-peak-madness-during-224851706.html 

[Overmod]

zugmann

LAst week, our governor let businesses be open, but pleaded for people to be smart (yeah, I laughed too).  If you go to restaurants, get take out; don't hang around in bars - that sort of thing.  As I was coming home from work last Friday, all the bars and restaurants were packed ... People are stupid.

Oh, it gets worse.  

We now have a standing order at our county clerk's office that only a few people can go in the DMV office at a time, and stay more than 6 feet apart.  This was being enforced by the armed guard at the metal detector -- another form of overreaction -- very strictly ... in utter disregard for the line of people packed cheek by jowl in front of Checkpoint Charlie, vigorously complaining in each other's faces about the delay and the problems.  More face-to-face discussion about restrictions on the type and number of permissible transactions.  No masks and no gloves in evidence ... but there was a hand-sanitizer dispenser on the wall, after you got 20 people forward in the line, and it still had plenty of 'product' in it when I got there.

The sensible rule is to limit talking, keep your distance, keep your face down and your nose and mucous membranes covered, don't touch stuff.  If you might need to cough, carry alcohol wipes or some kind of treated pad in a Baggie and cough into it, not your hand or your elbow or some random dry Kleenex.

Think of the gloves, masks and other PPE as the same rationale as 'adult vaccinations' -- so you don't give disease to others, not so you stave off picking it up as long as possible.  Booties, when those get established, are essentially the same thing -- keeping you from offset-printing virus on surfaces difficult to keep mopped 'enough' or from place to place silently as an implicit failure of trust.

When we start to get the fine-particle-filtering masks as a national resource, we'll be much farther along toward a reasoned solution.  It reminds me a little of the situation with an autistic child living on a property with large lakes: you can either try to fence everything around the hazards ... or you can fence the doors effectively.  Guess which is both cheaper and more assured of working under conditions of uncertainty?  But it also implies personal vigilance and a perceived measure of altruism to work...