COVID-19 tests: The non-fake news

Our system may not be the fastest, but it’s giving us trustworthy answers

Guest post by Dvorah Richman,

Federal officials recently testified before the U.S. House Committee on Oversight and Reform about government responses to the COVID-19 crisis. Committee members exhibited concern and frustration, and engaged in politicized finger-pointing, over what they said was needlessly slow development and distribution of diagnostic tests – particularly as compared to some other countries.

Some praised South Korea for testing more people in one day than the U.S. did in the past two months. Italy and the U.K. also got positive mention. One wonders whether these Oversight Committee members have any real appreciation for the system that they and their predecessors created.

In response to one question, National Institute of Allergy and Infectious Diseases Director Anthony Fauci said “the system is not really geared to what we need right now” and “the idea of anybody getting it easily the way people in other countries are doing it, we are not set up for that.” He added, “that is a failing.”

Committee members and the media seized on this widely misquoted and misinterpreted response as evidence of the government’s failure to provide needed tests. Some background about our system, and facts about the federal government’s actual actions, should correct at least some of the fake news that quickly dominated many articles, editorials and talking head comments.

For reasons rooted in our history, politics and system of government, the United States has myriad federal agencies, with myriad roles and essential healthcare responsibilities. State and local health departments also have critical healthcare roles. A maze of laws, regulations and policies operates at each level.

The private sector develops diagnostic tests, obtains Food and Drug Administration (FDA) marketing authorization when required (reflecting the agency’s determination about safety and effectiveness) and then markets the tests for clinical use by medical professionals. While medical professionals generally have discretion in their clinical use of devices and pharmaceuticals, many aspects of the practice of medicine are regulated under state law.

Two federal agencies, the FDA and Centers for Disease Control (CDC), have been front and center in the battle against this novel and deadly virus. Using emergency authority, flexible approaches and “enforcement discretion,” they streamlined many of the normally much more time-consuming processes.

The CDC promotes health, disease prevention and preparedness activities, with the goal of improving public health, in cooperation with state, local and other national entities. During a public health emergency, a primary CDC role is to develop a test for the pathogen and provide state and local public health labs (PHLs) with testing capacity. PHLs focus on the health status of population groups, perform limited diagnostic testing, disease surveillance, emergency response support and other functions.

The FDA is charged with protecting the public health by assuring the safety and effectiveness of various products, including medical device diagnostic tests. FDA reviews and authorizes marketing of such tests, which are designed and manufactured by medical device companies.

Laboratories also develop diagnostic tests. FDA’s authority over tests developed by laboratories (laboratory developed tests or LDTs) has been challenged for many years and, with some exceptions, the agency has exercised “enforcement discretion” in applying laws and regulations to LDTs.

Whatever the avenue, considerable expertise, time and resources on many levels are critical to developing, testing, validating and ultimately getting diagnostic tests that work as intended into the hands of medical professionals.

Considering our many laws, regulations, policies and longtime practices, the CDC and FDA have demonstrated flexibility during this unprecedented healthcare crisis. Congressional testimony noted that CDC scientists developed a diagnostic test for detecting the virus that causes COVID-19 within ten days of China’s disclosure of the genome’s sequence. The test was intended for use by PHLs.

Pursuant to emergency authority under FDA law, FDA issued an Emergency Use Authorization (EUA) to the CDC for its diagnostic test. The CDC began shipping this test to public labs. Shortly thereafter, performance issues unfortunately arose due to a problem in manufacturing one of the reagents. The CDC resolved the issue and began sending corrected tests to public labs. As of March 15, 84 state and local public health labs in all 50 states and the District of Columbia had successfully validated and were using the Center’s COVID-19 diagnostic test.

During this time, the CDC also granted a “right of reference” to performance data contained in its EUA to any entity seeking an EUA for a COVID-19 test, and FDA made templates available for EUA submissions.

On February 29, FDA issued an “immediately in effect” guidance that allowed certain qualified laboratories to use validated COVID-19 tests before FDA had completed its review of their EUAs. That same day, New York’s State Department of Public Health’s (NYSDOH) Wadsworth Center obtained an EUA from FDA for its COVID-19 test. On March 12, FDA used “enforcement discretion” and did not object to NYSDOH’s decision to authorize certain New York laboratories to begin patient testing after validating their tests and notifying the NYSDOH.

FDA has engaged with many test developers working on this issue. It issued its first EUA for commercial distribution of a COVID-19 test to Roche Molecular Systems on March 12. Since then, other medical device companies have received EUAs for their COVID-19 diagnostic tests. Labcorp, Quest and other commercial, healthcare system and academic labs are also providing patient tests.

On March 16, FDA issued revised guidance providing additional flexibility for states to authorize laboratory tests developed by qualified in-state labs for use in their states. Five days later, FDA granted the first EUA for a test that will provide results in hours, without having to go to a lab.

House Committee members asked why the United States cannot just use tests developed by South Korea, other countries or the World Health Organization (WHO). The simple answer is that federal laws and regulations require that medical devices (including diagnostic tests) must undergo FDA review and obtain approval or clearance before they can be marketed in the United States, unless that particular type of device is exempt. This applies to medical devices developed in the USA, and to those developed elsewhere. On the laboratory side, diagnostic tests (whether or not they receive FDA review and authorization) are also subject to scrutiny.

This process is intended to ensure that diagnostic tests work as intended, without false negatives that would put sick people back on the streets to infect others – or false positives that indicate healthy people are sick and thus use healthcare resources meant for those who are ill. While FDA Commissioner Stephen Hahn was reluctant to criticize other countries, he did note during a March 7 White House briefing that several countries have had “different levels of success” with their diagnostic tests and one unspecified country had “problems with the performance of several tests.”

The private sector is ramping up, and tests for COVID-19 are available in larger quantities. Ironically, some critics are now saying the federal government’s actions regarding diagnostic tests have been too flexible. Other test-related issues are emerging, including possible shortages of important chemicals, equipment availability and the capacity of U.S. labs to handle needed testing.

Our healthcare system has many moving parts, with critical, interfacing roles for government and the private sector. The system is already unleashing the creative powers of federal, state, local, university and private sector experts and innovators, who will develop, test and deploy diagnostic, preventive, therapeutic and curative technologies to tackle COVID-19. This is the American way.

When the dust settles, there will be time to assess problems and identify solutions, perhaps including new legislation, to address future crises. In the meantime, our various moving parts need to work collaboratively to address all aspects of this crisis – while maintaining, where feasible, a flexible approach in applying laws, regulations and policies that were not really designed to handle the monumental crisis at hand.

Ms. Richman served as in-house and outside regulatory counsel to FDA-regulated companies for over 35 years. Her work has focused on FDA laws, regulations and policies, primarily regarding medical devices and related regulatory and compliance matters. Her most recent position was VP, Chief Regulatory Counsel to Siemens Healthineers.

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203 thoughts on “COVID-19 tests: The non-fake news

  1. Why won’t the WHO call the coronavirus by its name, SARS-CoV-2?

    ‘Covid-19 refers to the disease. “The virus that causes the disease is SARS-CoV-2, which was named by the International Committee on Taxonomy of Viruses.

    https://qz.com/1820422/coronavirus-why-wont-who-use-the-name-sars-cov-2/

    I’m posting this not to discuss the academic arguments for and against but to reveal that this virus is closely related to the 2003 virus SARS. Something that isn’t obvious.

    This virus is closely related (I heard 96%) to the 2003 virus SARS. Something that isn’t obvious.

    Despite being promoted as an extremely dangerous global pandemic, SARS only killed 774 people worldwide.

    Wikipedia

    https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome

  2. False negatives are a major concern. The supposedly gold standard test used in China and other countries for SARS-COV-2 is the reverse-transcription polymerase chain reaction (RT-PCR) test. The test takes about 6 hours once the swab sample is at the laboratory and the tests are done in batches. So, there can be some wait from the time the swab is taken, delivered to the laboratory, batched, tested and results delivered back to the physician. Chinese scientists have indicated that this test is far from ideal with an approximate 31% false negative (Ref “Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases”, https://pubs.rsna.org/doi/10.1148/radiol.2020200642). As a result, the Chinese started using CAT scans to determine whether a patient had COVID-19. The first day Chinese data included patients identified by a CAT scan their total numbers of COVID-19 cases increased by 50%.
    Other tests that look for the antibodies produced by people with this virus can be much quicker to get results but again there will be false negatives.
    I think it is naive to think there wont be false negatives to any test.

    • The biggest problem is false negatives in towns and cities. What governments have failed to do is explain the problems of getting testing right and the problems when it goes wrong. Governments used to provide public information films which explained issues extremely clearly. During WW2 , Governments developed training films ; this skill appears to have been lost.
      A major issue is how deaths are described. If everyone whom has chest infection is described as having Corona Virus, then the mortality rates soars.

      One issue which may have been ignored is decline in statistical abilities of organisations which was a reason for the economic crash. The ability to obtain enough representative field data and combine it with thorough statistical analysis has declined. What we have is vast amounts of modelling to make for the lack of field data which can give orders of magnitude variation. Consequently, politicans have to make decisions based upopn the worst case. Next we need people who can make decisions in the time available. A WW2 Commando office said to me ” One needs to know the rule book because one needs to know when to throw it out of the window “.

    • It is not clear what the significance is of viral concentration in that particular area of that particular surface within the body, as it relates to the progression of the disease, or the status of the patient with regard to immune response and internal viral load.
      IOW…testing a nasal swab for virus is not the same as knowing how much virus a person has in their body.
      What we need is an antibody test.
      And a blood test for viral RNA is a more typical way of measuring the status of a patient.
      The nasal swab test is more of a qualitative test. It tells us who has virus on the surface of the nasal epithelium.

  3. Thank you for that. I particularly appreciate this bit,
    “While FDA Commissioner Stephen Hahn was reluctant to criticize other countries, he did note during a March 7 White House briefing that several countries have had “different levels of success” with their diagnostic tests and one unspecified country had “problems with the performance of several tests.”

  4. Remember the Bird Flu pandemic in 2008?

    A British Goverment parliamentary committee stated:

    “Up to 75,000 Britons will in die in an “inevitable” flu pandemic that could kill as many as 50 million people worldwide, a parliamentary committee warns today.

    The outbreak, most likely to be caused by a strain of bird flu, will be on a scale not seen for 40 years and cause “massive” disruption in the UK.”

    Not sure what the official figures were but Wikipedia says 392 worldwide. This Covid is a lot worse than that but…

    https://www.theguardian.com/world/2008/jul/21/pandemic.warning

    • Excess Winter Deaths in the USA average about 100,000 per year from all causes, including influenza. When Joe D’Aleo and I wrote our paper about Excess Winter Deaths in 2015, nobody cared.
      Now, we are supposed to be terrified by 582 deaths to date in the USA caused by the corona virus.

      In the UK in just England and Wales, Excess Winter Deaths (“EWD”) totaled 50,100 souls in Winter 2017-2018. That is THREE TIMES the average per capita EWD rate of the USA and Canada, in part due to excessively high energy costs in the UK, where fracking of shales is banned for no good reason. When we reported this startling statistic, nobody cared.
      Now, we are supposed to be terrified by 335 deaths to date in the UK caused by the corona virus.

      In 2016 I reported an extremely dangerous situation at a sour gas project close to Calgary that almost killed 300,000 people. When it was mentioned in the news media, nobody cared.
      Now, we are supposed to be terrified by 24 deaths to date in Canada caused by the corona virus.

      SO LET ME GET THIS STRAIGHT: WE ARE SUPPOSED TO PANIC WHEN A FEW HUNDRED PEOPLE DIE, BUT NOT WHEN A FEW HUNDRED THOUSAND DIE, OR ALMOST DIE. OK. GOT IT.

      “Cold Weather Kills 20 Times as Many People as Hot Weather September 4, 2015”
      by Joseph D’Aleo and Allan MacRae
      https://friendsofsciencecalgary.files.wordpress.com/2015/09/cold-weather-kills-macrae-daleo-4sept2015-final.pdf

      Corona virus data from: https://www.worldometers.info/coronavirus/#countries

  5. This is no fake news: it is the top 10 of a descending sort of the new CoViD-19 cases registered for yesterday, 23.03.2020, at the web site

    https://www.worldometers.info/coronavirus/#countries

    Country | Total | New

    USA 43,734 10,168
    Spain 35,136 6,368
    Italy 63,927 4,789
    Germany 29,056 4,183
    France 19,856 3,838
    Iran 23,049 1,411
    Switzerland 8,795 1,321
    UK 6,650 967
    Austria 4,474 892
    Canada 2,091 621

    This is a somewhat different view, when compared with e.g. W. Eschenbach’s ‘cases per million’.

    How many cases per million you have doesn’t matter much.

    What matters IMHO is rather:

    How many new cases do arrive per day at the hospitals?

    Sorry, but… simply to say, like does Trump: ‘It will soon become much better again’ will let you run in a predictable catastrophe.

    And if the US people can’t manage to follow isolation advises a bit better (see the beaches in California yesterday), then the situation will get even a little bit worse.

    Please, please

    Think about how many hospitals in the US outside of big towns are responsible for ten thousands of people around them, but have only about 20 bed-sized intensive care units, and… only one ventilator! Jesus…

    Do your best, people!

    Best regards from Germany
    J.-P. Dehottay

    • Apples to oranges. The US has more people than all those countries combined. That’s why you use per capita numbers.

      • Per capitia is wrong as well.

        Infections are local, concentrated.

        what matters is how many new cases arrive at the hospitals IN A GIVEN AREA

        some can handle the load, others will fail.

        So, per capita ? not the real story.

        You’ll see.

        remember when USA had 68 cases and ya’ll thought I was alarmist?

        told you to plan ahead.

        • Do tell us how smart you are.
          Only you can save us with your wisdom.
          Undeniably you have the knowledge. Can you save us Steven?
          Help us Steven?
          Everyone can sing your praises.

          • “hospitals IN A GIVEN AREA”
            That was in the Wild West days. We don’t use horses that much anymore.

          • sycomputing: “When will we see?

            WR: The time lag between testing and resulting deaths is about 8 or 9 days. So have a look at the graphics: https://www.worldometers.info/coronavirus/ The corresponding number for actual deaths is shown in the ‘case graphics’ at 8 or 9 days before now. If the rise in cases (= tested positive) in the last 8 or 9 days is five fold the today’s number of deaths will be five fold (assuming testing policy did not change and hospitals are not yet overfilled).

            You can click on individual countries in the list to see their country page and country graphics. Graphics (click on the line) show the number per date.

          • If the rise in cases (= tested positive) in the last 8 or 9 days is five fold the today’s number of deaths will be five fold (assuming testing policy did not change and hospitals are not yet overfilled).

            Thank you William, however, I’m not sure why positive tests should correlate 1:1 with deaths. E.g., if an inordinate number of those tested positive are relatively healthy they might live. Similarly, the reverse could be true. I think it depends on the individuals.

            Regardless, Steven would disagree with you that death rate is that about which we should be concerned:

            “Finally this is NOT about the death rate and never has been.”

            https://wattsupwiththat.com/2020/03/23/covid-19-tests-the-non-fake-news/#comment-2945338

            Thus, my query to him.

          • Testing is a morass.
            Some people are being tested in drive up centers.
            Some people are tested as a result of being a known contact of someone who has tested positive or been hospitalized, and some people are tested when they are hospitalized.
            The number of tests being done is not a function of how fast the virus is spreading, and therefore neither is the number of positive tests.
            And neither number is related to when people wind up in the hospital, or ICU, or in critical condition.
            It is simply false to speak of a lag between testing and death.
            There may be a statistical average time between symptoms in an individual and death, but that says nothing about an individual’s chance of dying or when, and has nothing to do with testing.
            At this point testing is spotty, and the number of available tests seems to be the primary driver of how many have been tested and how many “new Cases” are reported.
            New cases relates to testing, not the disease.
            We have no idea what the relationship is between positive tests and total number of infected, or when those infected became exposed to begin with.
            At this point these statistics are a hodgepodge of unrelated or vaguely correlated conditions, and some that are uncorrelated.
            If testing is increasing because we finally have tests, and so new cases being found is increasing…it may also be that the rate of new people being infected has already maxed out and began to decrease. And we will not be able to know that anytime soon.
            It also says nothing about how many people who test positive but have no symptoms were infected two weeks ago and will not get sick, and how many were infected two days ago and will be in an ICU in two weeks and die.
            And is says nothing about who is who in that group of positives.
            We need to know the immune status of people, not just who has virus in their nasal membrane.

          • sycomputing

            For persons having followed day by day since mid January the disease’s development in both
            – stat sites like Johns Hopkins, worldometers etc
            and
            – European newspapers and TV news

            the reason why death toll, let alone case or death toll per capita are less important than the new cases has to be found in the information we daily gathered.

            In all European countries heavily confronted with this CoViD-19: Italy, Spain, France (Germany is somewhat different), the major problems encountered by medical personnel within the hospitals was that they permanently were overrun by an increasing amount of new severe cases (an amount NOT AT ALL comparable with the average number of severe cases over land).

            In these three countries, the phenomenon became so harsh that medical personnel began to tell that they more and more had to give up old persons in absolutely critical state, because younger persons had more priority, and there were not enough intensive care places let alone the medical support devices like ventilators (I hope this is the right translation for ‘Beatmungsgeräte’).

            1. You don’t believe me, think I’m an alarmist reading alarmist news?

            No problem for me!

            2. You don’t think this can happen in the US (I speak about all these places ‘in the middle of nowhere’ and not about those in LA, NY, Houston, Seattle, etc etc) ?

            No problem for me!

            I feel no need to convince anybody here. All WUWT commentators are free to put my meaning into their waste bag!

            Good luck with your and Trump’s attitude.
            J.-P. D.

          • I feel no need to convince anybody here. All WUWT commentators are free to put my meaning into their waste bag!

            Na ja, Bindy . . . so you say while you spent many words above these attempting to convince me? Why do you continue to contradict yourself? A “responsible” Deutsche would pay better attention to rationales Denken!

            Don’t believe me? Ha! I am not for having any fear of your not of my believing!

            By the way, when are you Germans going to pay your NATO bill?!? A “responsible” Germany would be meaning to do that instead of putting that in the waste bag, no?

            Bah, undankbar Deutsche! Just like Slowakei!

          • Bindidon
            You said, “… the major problems encountered by medical personnel within the hospitals was that they permanently were overrun by an increasing amount of new severe cases …

            What, did European socialized medicine not plan ahead for epidemics, such as having reserve beds, masks, respirators, etc.? You have been telling us how much better the medical service is in Europe. Are you now telling us it is not robust and can’t handle other than the normal situation?

        • Yeah Mosher lost me, eventually the virus must move thru a reasonable portion of the population unless there is a vaccine. Once you have enough people immune it finds it hard to sustain cross contamination and it dies down to some sustain level. However those who are not immune are still at risk they just play the odds much like anti-vaxxers do.

          You can imagine a doomsday prepper hiding out until the things resume like normal. Then some person in some far flung country still with the virus hops on a plane arrives near the prepper and down they go.

          They are saying this danger will be around until we have a vaccine. Trying to avoid the first major wave is obvious but you aren’t safe until you have either had it or the vaccine.

          • You forget the mutation aspect. There are already 5 strains (haplotypes) in circulation. Some much deadlier than the others. Less than a year in the wild and 5 already? Let that sink in.

            Vaccines work best against genetically stable targets. Smallpox was the best target you could ask for. Seasonal influenza is the worst target. Where is covid-19 on that scale? We have no idea.

            Wrong tool for the job won’t get it done and it will give a false sense of security to people. A combination of treatments might buy us enough time for a vaccine but given the number of variants already in the wild I have my doubts.

          • Or an effective treatment is discovered (and the FDA deigns to let us have it). Many promising avenues being explored.

        • steve is an expert at remembering things that never happened.
          I can’t recall anyone calling him an alarmist on this issue.
          He’s beyond an alarmist when it comes to global warming, but that’s a separate issue.

          Regardless, while it is true that one of the critical numbers is how many patients per hospital, per capita is closer to that number than is absolute number. After all, for most first world countries, the number of hospitals tracks the number of people.

          • “He’s beyond an alarmist when it comes to global warming, but that’s a separate issue.”

            He’s not, really, he just likes to lord over people, thinking he’s the smartest person in the room. It’s all ego.

          • Actually, he IS an alarmist – just particularly gutless version, by pushing his alarmism down the road, as an amorphous terror, never provable, that enable whatever totalitarian solutions the ideological nutcases choose to impose.

          • MarkW
            Yes, hospitals are a profit making enterprise. If they build too many hospitals for the needed medical service, they will go out of business. If they don’t build enough, there will be an unmet need, and probably someone will step up to fill the vacuum. So, I would expect that there is a somewhat constant number of hospitals per million people. Thus, reporting new cases per million residents is a better metric of the demand on services than the total number of cases per country. Bindidon is wearing his socialized medicine rose-colored glasses.

        • Steven Mosher is correct. Some places in the USA will probably be swamped and short of ICU beds and ventilators, just like in Italy. But, people are also correct that in many places in USA, the shut downs could be premature or too broad. In South Korea, (where Steven is now?), they did not shut down in the ways we have. But, people are not stupid, and with Covid-19 mentioned in the media billions of times, they know to take precautions, stay home if they can, ask people to wear masks before entering their business, etc. After the pandemic is over, perhaps with wide-spread AB testing, we will have better estimates (from models!!) of how many in the USA got it, what percent were serious, what percent needed hospitalization or ICU or ventilators and what was the percent death rate. And then be able to compare it to normal flus and bad flus from the past in terms of how many (and what %) flu patients in 2009 between 30-39 needed to go to ICU, or got ARDS and compare. Covid-19 appears to cause a larger percentage of ARDS cases and have a higher base Ro and possibly longer infectious period, etc.

        • Mosher
          Per capita may not be ideal, but it provides a better representation than total deaths for political areas of widely varying populations.

          The issue is saturation of medical facilities for a CDC Health Region. That is, some cities may have a great many hospitals and those living in proximity will typically be sent to one of the local hospitals. So, the available beds and respirators for the proximate population are important. However, for rural areas with low population densities, there may only be a single hospital with respirators, and the important metric is the number of cases of COVID-19 that need medical intervention from the area that the hospital services. These rural areas will have a greater probability of having a small number of respirators. However, compensating for that is a lower population density, meaning less opportunity for transmission. By their lifestyle, ranchers and farmers practice a form of isolation that most urban dwellers can’t comprehend.

          I doubt if the level of detail you propose is available anywhere at this point in time. So, to best appreciate the progression of the disease, total infections or deaths at the country level is too coarse-grained and Bindidon’s use is inappropriate. Probably the best we can do at the moment in the US is at a state-level of aggregation.

          So, if you want to impress everyone with how prescient you are by telling us what should be done, try telling us what can be done in the absence of your ideal situation.

        • Actually, I usually take exception to your comments, Mosher, but this one seems dead on to me. In a given area is absolutely right. We’re not going to be medvacing thousands to other areas.

    • Excuse me, per capita the German death rate as of this mornning works our to be 51x to the US 57x rate, so big deal we are running second to you.

      • I’ve heard that Germany does not test those who die before having a test, and that is why the deaths attributed to COVID-19 are as low as they are. Is that accurate?

    • But… I just explained why the modus calculandi per capita is secondary here…
      When people don’t want to understand simple matters, they indeed don’t…

      Not my problem I could say!

      Good luck.
      J.-P. D.

      • No you did not, since we build hospitals on a per capita basis. Bigger populations have more hospitals. You are not explaining anything at all.

      • I think the issue, Bindidon, is that no one recognizes you as an expert, or even knowledgeable, on the US health care system.
        In fact it seems you have a lot to say and a critical opinion of something that, by all evidence, you know little if anything about.

        • Nicholas McGinley

          What the heck are you telling here?

          1. I have NO interest in getting recognized as the expert I have never been.
          2. I collect info about SARS-CoV-2 since about mid January, and that’s all.
          3. I have been since then by far nearer to the problems the guy created in Europe than you might ever be in your US.

    • Think about how many hospitals in the US outside of big towns are responsible for ten thousands of people around them . . .

      How many are there?

    • That’s a bit silly. The number of hospitals you have is directly related to the number of people you have, so infections per million is completely relevant. And infection rates outside big cities are very low because they are outside big cities.

      • Yes, and this should cause people to question leftist policies for bigger cities with higher concentrations of people. In addition, their open border policies increase risks for pandemics

      • Phoenix44
        And, because the outbreaks seem to occur in clusters, that means rural areas have the luxury of moving patients 100 miles to a different hospital if they become overloaded. I suspect that Europeans have little appreciation for the vastness of the areas west of the Mississippi where some places you can drive 100 or 200 miles between large cities.

        • Consider Wyoming, just over 100 miles from the town of Kemmerer north to the town of Pinedale and these are towns where you might find a doctor, never mind a hospital. Kemmerer: “2 monitored ICU beds”. Pinedale: Clinic. Halfway between in Big Piney is a clinic.

          Point is your chance of catching any disease, other than zoonotic (animal sourced) disease, is very low, practically non-existent. But your chances of finding a hospital bed aren’t much better. The ranchers tough out almost everything; heat, cold (bitter cold; it snows in June sometimes!), drought, storm and traveling idiots.

    • It is a terrible situation resulting from the fact that the Chinese government, in the first place, suppressed the news of this new pathogen, lied about it not being transmitted human to human and punished those who did their best to warn others.

      Many people will suffer and die from this disease needlessly due to Chinese Communist Party actions and inaction.

      That said, many countries already have control of the situation and new cases are coming down there. It appears that the peak is just passing in Italy, for example, and they will gain control shortly. Your message seems to be a call to panic, which does no good. I wish you would do something constructive.

    • In the US we have H1N1 influenza killing people, and nobody says a word about it. Same issues impacting the older population, pre-existing health conditions. H1N1 killing about 450 per week since January. But H1N1 kills children (~250 so far), unlike COVID-19. More die from the resulting pneumonia, about 3500 per week since January.

      http://r.axymbio.com/ruby/images/2020_deaths_flu_season.png

      Not sure how complete the testing is. Might be some COVID-19 cases are actually H1N1. Total guess. We have good testing for influenza, but do we test everyone?

  6. With the sequence available, designing a test takes literally a couple of hours. The biggest bottleneck has to do with the availability of sequence information for related strains that you either want to include or exclude in your sensitivity.

    For example, you might want to pick up COVID 19, but not SARS or MERS our regular coronavirus that causes colds. That’s simple as long as you have good sequence information for all those strains.

    What if you have one sequence, but there are 100 different slightly different isolates circulating in the population? That’s a problem if you are trying to detect some of the sequence that is naturally mutating because it’s not under selective pressure (a non-coding region for example).

    The arguments made by some of these critics are nonsensical. Why not use the German test? There are American companies that have their tests approved for use in Germany with a CE mark, but can’t market the same test in the US because it’s not FDA approved. Did the German test even seek FDA approval? Why pick that one over a dozen tests developed in the US that also lacked FDA approval?

    You could ask the same question of ANY test that gets a CE mark, without having FDA approval. Why not just accept it? Because we don’t. The US has a higher burden of proof of safety and efficacy. In most cases this means a delay in the US, while other countries are using it all along. But the classic case is the use of thalidomide to treat morning sickness in pregnant women. Europe implemented it, and the US delayed to wait for more evidence of safety and effectiveness. It turned out that thalidomide causes severe birth defects, which there US avoided due to the higher bar.

    Trump isn’t in a ministerial position, he’s not supposed to check the work of CDC scientists OR of the manufacturing staff. Instead he took early action to limit travel (and was heavily criticized as xenophobic for it). Now there are more than a dozen approved tests under Emergency Use Authorization, and even more that can be used now due to a rule change while they get through the EUA process. This is blazingly fast for so many tests to enter the market.

    It’s like bizarro world to hear critics say we should use any old test out there without standard evidence that it works while at the same time criticizing Trump for facilitating the availability of hydroxychloroquine that physicians have the option to prescribe based on plenty of evidence for its effectiveness against other Coronaviruses, and some early evidence of effectiveness against COVID19. The only consistent thread through all of this is TRUMP BAD.

    • Good comment, Ktm. The other issue in plain sight, is the different roles Dr. Fauci and President Trump find themselves. Dr. Fauci, while an extremely important Doctor, especially as head of the Advisory Group, has no responsibility for the many issues that the President faces and must deal with. The economy must be in sufficient health (with some time relief due to stored capacity) to adapt a winning strategy against a threat, such as Covid-19. The winning strategy is similar to a war, you must win the war and don’t worry excessively about every soldier. Every President had critics nipping at their heels as they went along dealing with whatever crisis, but only this President has actual, coordinated, viscous, media attacks against anything and everything associated with the President. One aspect everyone should remember is that Donald Trump grew up on the streets of New York City and he talks like it.

      • Ron
        You remarked about “… viscous, media attacks …” I completely agree. Most of the MSM ‘journalists demonstrate that they are rather thick. 🙂

  7. Dr. Anthony Fauci is a lifetime political and medical industry insider. During the H1N1 virus epidemic, he was a placid and uncritical mouth piece of the Obama administration, even as 100,000 were infected and 1000 were dead, including 100 children, before Obama took any actions. The archaic testing methods were not improved, the reserves of critical medical supplies were drawn down and never replenished, and Dr. Fauci offered no adverse comments.

    Today, as President Trump has taken early actions in January to stop travel to the USA by non-US citizens from China, quarantine US citizens returning from Hubei province, develop improved testing methods, and to protect the USA citizens from ‘all enemies, both foreign and domestic’, Dr. Fauci has suddenly discovered his critical voice for the current Trump administration. An inexplicably ‘curious’ evolution…. or overt political bias?

    • A little conspiracy theory- it seems that Fauci is pushing for double blind tests and says that chloroquinine is “anedotal” which is complete BS since there is plenty of info on it in South Korea, China and France. Instead he is looking for studies on it and another drug. One costs about 10 cents and the other is much more expensive. I support our Pharma industry and it seems he does too, but at the expense of the American people. He was completely bypassed by Trump.

      Bluntly, any scientist worth their salt will look at a compound that has been around since the 1930s and in wide use in the 40s with a solid database of what its issues are and also tested against SARS, HIV and others and demonstrated effectiveness against CV-19 in SK, China and France, along with several cases in the US, would bypass the double blind studies and and say to use it instead of his wishy-washy – if the Dr wants to use it off label they can. He is only saying this because he was bypassed by Trump.

  8. Speaking of fake news,
    look at these 2 daily new cases :

    Daily new cases by date of illness onset :
    https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-in-us.html

    Daily new cases from worldometers :
    https://www.worldometers.info/coronavirus/country/us/

    Daily new cases from CSSE (seems to have the same data source as Worldometers) :
    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

    According to the CDC, the daily illness onset cases is dramatically decreasing since the March 11 and at the same time, the new cases reported by Worldometers is still going exponential as of today March 23 ?

    Something is going badly wrong here.

    • “According to the CDC, the daily illness onset cases is dramatically decreasing since the March 11 and at the same time, the new cases reported by Worldometers “

      Different things. The daily illness onset is a lagging indicator. It is identified some days later. Those “dramatically decreasing” values are not final. They will be added to in coming days, as people enter the system and the date of onset is determined.

      • Stokes
        Being a lagging indicator is critical to appreciate when a pathogen is increasing. However, that lagging indicator suggests that things may be better than what is being reported. All bets are off if there is a second wave as China might now be experiencing. Basically, your remark about a “lagging indicator” is a non sequitur.

    • Dear Petit Barde, you got me intrigued by your message. I follow worldometers for a month now and suddenly there was something wrong compare to CDC data. In fact no, except for a few hours or a day difference.

      In the CDC data if you look at the map of the US, you can have the number of cases per state. If you look for example Vermont there 52 cases in Vermont. And 75 on Worldometers. But if you look at yesterday data on worldometers you realise that their were 23 new cases in Vermont so it was 52 the day before, I checked for several states with small numbers and either it is correct the day before or the difference is a few units only.

      Of course Looking at NY you have a difference of 15.168 on CDC website and 15.790 on worldometers but time data are actualised should mostly cover the difference.

      Now why is the CDC not up to date with the latest data ? I don’t know.

      Hope this help you.

      Have a good health for you and your dearest and nearest.

      • The CDC site is not the place to go if you want a running scoreboard of the status of the disease vs people match.

        • The CDC site has the disclaimer “State and local public health departments are now testing and publicly reporting their cases. In the event of a discrepancy between CDC cases and cases reported by state and local public health officials, data reported by states should be considered the most up to date.”

    • Thanks Nick and Renaud.

      Indeed, I am aware of the time lag between new cases and new illness onset cases.

      What seems wrong in the CDC site, is related to the statement :
      – “Illnesses that began during this time may not be reported **”

      “** Does not include cases among persons repatriated to the United States from Wuhan, China and Japan; does not include U.S.-identified cases where the date of illness onset has not yet been reported.”

      And more precisely, the number of days to which it refers :
      – 6 days, see the CDC graph.

      The aforementioned CDC statement should refer to 12-14 days not 6 days.

      Cheers

      • The way CDC reports is quite correct and more useful towards their mandate of protecting the public than how things are presented on Worldometers or in the news.

        The most useful metric we *could* during a known viral outbreak track to inform policy and response is arguably “date of infection”. It would be the best measure of the prevalence of the virus in society and the rates and trends of transmission. But without a time machine and a microscope, that’s impossible to know.

        However, a sick person can tell us when their symptoms first began. That’s as close as we’re going to get to the actual infection date, and that’s what CDC rightfully presents as the most critical data to pay attention to.

        Of course, this means that you actually have to have someone sick enough to go to a doctor or hospital, report their illness, and get tested. A sick person would generally wait a few days, but not much more than 4-5, before they went in to get checked. Add a 2-3 days to get the test and this explains CDC’s grey uncertainty bar and their caveat — as well as why their graph stops -3 days ago (to give time for testing to confirm the virus).

        CDC also doesn’t report death on their summary page for good reason. They’re worried mostly about controlling the spread of disease right now, today. Sick people clog up hospitals. Dead people don’t. So unless you’re dealing with something off-the-charts like Ebola or Marburg viruses where it’s obvious very early on that literally half the people infected are going to die, the case fatality rate can wait (you won’t be able to calculate it accurately for a long time, anyway).

        With symptom onset currently estimated a 2-14 days after infection (say we eventually conclude it to be ~6 days), and with the “spike” in illness onset in the US March 11, CDC’s data suggests the height of this virus’ transmission could very well have peaked back around March 5th-6th. It’s worth noticing the CDC has been much more conservative in its guidance around widespread business closures, school closures, public gatherings, etc.

        The “infected” stats being trumpeted by the media and politicians are only reporting on the *activities* of the virus hunters now (like Michael Mann chasing trees around Siberia). It’s a proxy for, well, nothing. We’re very likely putting a massive effort into finding the last remaining traces of a virus that has mostly ran its course and, despite the obvious data bias, getting excited whenever our tests confirm it even existed. But the CDC has no reason to discourage this behaviour, since it’s collecting valuable long-term data for them to analyze. But they are also paying attention to the correct numbers — and doing it correctly.

        So…

        Date of infection — would be super useful, but is almost impossible to know
        Date of illness onset — best proxy we can realistically get, requires testing to confirm virus and patient interviews (creates a lag)
        Date of death — only used to determine the case fatality rate and severity of the illness, which won’t be accurately known until long after we’ve moved on to the next hysteria
        # people testing positive — only measures the activities of virus hunters (useless, except for scaring people and selling newspapers)

        • NOTE: the CDC graphs were updated, the “spike” on March 11th is no longer the peak as they must have back-filled data this morning while I was writing, some of which must have been outside of their 6-day uncertainty bar… perhaps making Petit_Barde’s point. 🙂 As presented right now, without a few more days of illness onset data, it would be hard to even estimate when in the past (or if?) the peak of viral transmission was.

    • Keep in mind that the number of test kits and tests has greatly increased over the last week and will continue increasing. This puts a bump in the data and I haven’t seen any data on the effects of testing on the number of confirmed cases. Once the number of new cases from testing predominates, rather than diagnoses, hospital admissions, and deaths, the figures will give a more accurate picture of the epidemic process.

      Testing also needs to be done scientifically, much like a political poll, to ensure we can measure how the disease is expanding where. Samples of some fixed number of representive people, perhaps by census districts, evenly spread across the country is very important.

    • It seems the CDC aknowledged their error and corrected it.

      Now, the statement refer to 12 days (see the horizontal bar on daily illness onset diagram)
      and this is indeed consistent with the daily new cases.

  9. Bureaucracy is our enemy. The democrats love it as it gives them all sorts of ways to control everything.

    We need to make one department responsible, they have the authority and responsibility to act against COVID-19. The other departments need to be reduced in size as responsibility is transferred from them to the one in charge.

    Last I checked there were dozens of agencies responsible for giving aid to those in need like low income housing, food stamps, educational loans and vouchers, etc. Time to wipe out most of these and replace it with a single agency and a single set of policies.

    If you want to be nimble you need a structure that reflects that goal. A maze of old fashioned out of date bureaucracies is not the structure.

    • “Time to wipe out most of these and replace it with a single agency and a single set of policies”

      Absolutely! Eliminate fragmentation of hundreds of little agencies and create one HUGE bureaucracy! Or maybe that’s not such a good idea. It will simply become ossified onto its goal and the *next* emergency that comes along is going to find one big useless federal agency.

  10. “Two federal agencies, the FDA and Centers for Disease Control (CDC), have been front and center in the battle against this novel and deadly virus”

    No. These two were fighting each other over the virus.
    That is why the US is in the desaster like this now.

  11. Congratulations and thanks to Willis gor his Covid19 analysis using the cruise ship as a well defined and well contained sample.

    Now we find that John Ioannidis, Professor of Medicine & Epidemiology at Stanford says that the field data are utterly unreliable and that therefore fatality rates like 3.4% reported by the WHO are meaningless.

    He says that there is only one well controlled and well contained clinical sample and that is the cruise ship Diamond Princess. The death rate there is 1%. But it is distorted because so many of those aboard were elderly. The real rate, adjusted for a wide age range, could be as low as 0.05 per cent and as high as one per cent.”

    The genius of Willis corroborated yet again. Thank you Willis. Glad to have you here at WUWT.

      • Dear Allan,

        It is always a pleasure to read you. However I challenged you on that 1% from South Korea.

        You are right tests are around the 350,000. In fact it is 333,142 as of today and 15,440 tests are waiting for results.

        On these 333.142 tested, 9,037 have been diagnosed positive and 120 persons have died so far, so the rate vs. Positive case is 1,33% ! However all the persons recently diagnosed, let’s say in the last week, I guess none have died so far. I believe nobody died on their first day of the flu?

        For me there is another way to calculate the fatality: it is about the death over total persons for whom the sickness is over (2 outcomes possible: either death unfortunately, either cured).

        The total number of people cured as today is 3,507 so that fatality rate is 120/ 3,627 so it is 3.3%!

        Of course that fatality rate is reducing it was 4% on the 20th of March and 12% on the 13th. But I don’t think it will go down to even 1.5%, that means that of the remaining 5.410 active cases as of today “only” 15 persons will died so bringing the total of 135 deaths for 9,037 cases as of today.

        A proxy might be that since the 17th of March, 2,106 persons have been cured and 39 persons have unfortunately died. So that will give a rate of 1.8%. and over 2 weeks time it is 1.9% .

        I believe that South Korea will end around 2% more or less 0.2%. (cases in ICU is worrying in South Korea and/but has not changed for 10 days at 59, but is this reliable?)

        Now in order to gain control of the situation and to reassure every citizens you effectively need to tests, tests, tests. So far only 2.7% of the tested have turned positive and the daily rate for the last 13 days is between 0.8% and 1.8% with an average of 1.0%, economic safety and people being free of worriness is at that cost.

        • But even in South Korea it’s possible that around half of all cases have gone undetected. These will be the mild or asymptomatic cases. Deaths on the other hand are unlikely to go undetected.

          • But could be overcounted. The Italizns are saying g that anybody who dies having tested positive is counted as a coronavirus death. But the real rate may only be 14% of those.

        • What percentage of S Korea has been exposed to Corona Virus ? What percentage tested, are positive, need hospital treatment, intensive care, ventilators and have died ? What is the age distribution of those tested positive and die ? What about co- morbidity ? How does the Corona Virus compare to 1957 and 1968 flu epidemics? Have any treatmnets found to reduce infection and mortality rates?

        • I agree with what you wrote, but add one important proviso: the age of the people dying matters.
          Italy is the 6th oldest nation in the world – this is absolutely a huge factor in the high death rate there – but not the only one since health care system overload is a factor also.
          South Korea is the 40th oldest.
          Preliminary China data was showing 0.2% mortality rates for 20-49; other studies are showing 0.1% in the same age group. But it is early – it is also likely that the elderly don’t survive as long before dying when severely ill with nCOV – and New York is saying 50% of hospitalized are under 50.

          • Japan has the oldest population in the world, yet has few bad morbidities and deaths. So something else appears to be involved other than just age.

          • CG
            I suspect that there is always a natural immunity in a genetically diverse population. However, nobody is addressing it directly or estimating what the percentage might be. It is referred to obliquely by observing that something like 80% are asymptomatic or mild.

    • 10 diamond Princess Deaths now. That’s 1.4% All DP patients received the necessary medical care. If the capacity of hospitals is exceeded patients will not receive sufficient care. There are young fit people who are experiencing severe symptoms. This is a serious situation for us in the UK and Europe and all of you in the US.

      Willis ignores the problem of a huge surge of sick people in the hospitals.

    • “He says that there is only one well controlled and well contained clinical sample and that is the cruise ship Diamond Princess. The death rate there is 1%. But it is distorted because so many of those aboard were elderly. The real rate, adjusted for a wide age range, could be as low as 0.05 per cent and as high as one per cent.”

      Death rates are too complicated to draw any conclusion from the diamond princess.
      Further Death rates will be LOCAL, because of the factors that drive death rate
      1. Co Morbidities
      2. Quality/Availability of care.

      Finally this is NOT about the death rate and never has been.

      • Of course it is. Imagine the death rate uß 0%. We would be doing very little. Imagine it is 50%. We would be facing utter collapse.

        Everything we do or don’t do is based around the death rate.

        • Phoenix44
          I think that Mosher just likes to sound profound. This is the second time he has made the absurd claim about death rates not being important. He has been challenged about the claim and has just ignored the challenges.

  12. “Anthony Fauci said “the system is not really geared to what we need right now” and “the idea of anybody getting it easily the way people in other countries are doing it, we are not set up for that.” He added, “that is a failing.”

    Trying to reframe this as politicized, fake news… is fake news. It was a systemic failing, unfortunately a deadly one. The fact that Dvorah and a few others above feel the need to scribble so many paragraphs of wordy’splainin’ is a pretty good tell. The failing wasn’t caused by Trump but it was certainly made worse by his week of insistance that testing was going great when nothing could have been further from the truth.

    • Some of it could have came from false confidence over SARS. I was thinking at first this is similar to SARS and will fizzle our.

    • A prudent course of action would be to advise everyone in the country (whatever country) who takes ACE inhibitors and ARBs to switch while they still have time to something else that doesn’t up-regulate ACE2 expression in the lungs, if they can do so safely with their doctor’s approval. There is enough evidence that this is a potential problem that increases risk for severe infection and death. Even mealy mouthed Fauci acknowledges it as an unusual and potential problem and thinks the data in the Italian deaths need to be looked at quickly. Well it’s already in – at least 52% of Italians who died used ACE inhibitors or ARBs, but in actuality that number may be larger due to incomplete data. It’s not conclusive by any means, but any prudent person who seeks to minimize personal risk of severe illness or death would be foolish not to eliminate that potential risk from the equation if they can do so safely.

        • If cardiologists and cardiology societies were smart, they would encourage the public to changeover to other drugs, where possible, until this thing blows over. Instead they’re doing the opposite. I hope they get sued into oblivion and are held criminally liable.

          • I can see it now – cardiologists trying to explain to prosecuting attorneys why they denied injured or deceased patients who requested non-ACE2-upregulating treatments for hypertension, that while not the best treatment would have been sufficient for the patient’s condition while eliminating ACE2 upregulating risk. I’m not an attorney, but even I can smell blood in the water.

        • FWIW, I don’t have current data, but as of 2008, ACE inhibitors were the 4th highest prescribed pharmaceutical category, and a certain ACE inhibitor was the 2nd highest prescribed drug in the US. So that tells us ACE inhibitors are big business in the US. Not so much in Japan and Taiwan where calcium channel blockers are preferred. Those countries also have low incidence of severe illnesses and deaths, even while being so close to the epicenter.

      • I take an ACE inhibitor (Lisinorpil) and asked my doctor to switch me to a calcium channel blocker after reading the Lancet article. He refused stating that there was insufficient clinical evidence at this point to change treatment. Several major US medical organizations share this view including American Heart Association, the American College of Cardiology, and the Heart Failure Society of America.

        https://www.jwatch.org/na51158/2020/03/18/patients-with-covid-19-should-continue-ace-inhibitors-and

        I am still considering my options. It is not an ideal time to be trying to get in to see a new doctor, nor to be spending time in doctor’s waiting rooms.

        Stay healty.

        • A doctor that doesn’t abide by his patient’s wishes when a suitable alternative treatment is available needs to be held accountable if something goes wrong. These people are not being smart at all.

        • Likely a sexy pharmaceutical sales rep for big Pharma visits him every few months. Believe me that most of these reps are women and attractive.

          • What you describe sounds like an inequitable situation and calls for the hiring of ugly men and fat lesbians.

        • ACE inhibitors are notorious for side effects. You could tell your doctor you have them and want to go to a channel blocker.

        • I can tell you of at least three specific cases of which I have direct and detailed knowledge, of someone switching a hypertension medicine, and having a stroke within hours to days of the switch.
          Keep in mind why we take those meds: It is because HBP is the silent killer.

          And change must be carefully considered and done very gradually, particularly if you have been taking it for a long time.
          For example, some of these drugs take an extended period of time before they exert the intended effect. It is like deciding to change your locks while a 900 pound gorilla is standing outside your door.
          Make sure you know everything about both drugs, how to manage a changeover from one to another, and the risks thereof, prior to doing anything, if you want to make sure you are not trading an unknown risk of a small chance of a bad outcome, with a sizable risk of an extremely bad outcome.
          Changing a blood pressure medicine is risky and the danger is of a stroke or congestive heart failure.
          The risk of being on lisinopril and getting COVID-19 is vague and uncertain and may not exist.
          Consider also, that with high blood pressure making the odds of a bad outcome much worse with COVID-19, do you really want to risk being in a transition period and possible have poorly controlled blood pressure if you become infected?
          Think carefully, and do a lot of research.
          In the year 2020, bad information and acting rashly in response to rumors and hearsay can get you killed.

        • So if someone is on an ACE inhibitor, and this has, hypothetically increased the number of those receptors, and that person hears about this and stops taking their ACE inhibitor…do those receptors rapidly go away?
          Or has that person now made their situation worse in at least two ways: Their hypertension may for a period of time not be well controlled, and the ACE receptors may no longer be blocked by an inhibitor which is bound to them and preventing the virus from using them?
          I would say it is almost impossibly unlikely that stopping an ACE inhibitor will make those receptors go away.
          Also there is no real evidence that the virus needs any help or is assisted by the relative number of those receptors.
          In fact it is known that there are at least one other major set of receptors that the virus uses to gain entry into a cell, and who knows how many others?
          This appears to me to be a classic case of a little information being a dangerous thing, and Fauci seems to me to be telling it like it is: An internet rumor is not a suitable basis for medical advice, let alone a solidly based reason for switching a medicine.
          And what he said WRT to well controlled blood pressure was something I was talking about here just a few days ago: How could well controlled blood pressure be a risk factor for anything? Uncontrolled yes. But we know that controlling it has removed it as much of a risk facotr in all cause mortality.
          It is one of the single largest contributors to increases in longevity in recent decades.
          And ACE inhibitors are specifically known to be excellent for controlling blood pressure.
          Also, one in three Americans, over 100 million, have high blood pressure, and my guess is so too do a similar proportion of Italians. The stat for older people is no doubt far higher than one in three.
          IOW…listing it as a comorbidity may be spurious and a red herring.
          If most old people have something (HPB), and the risk (of dying from COVID-19) is higher for old people, then the two (HBP and dying) will be correlated, whether or not there is a cause and effect linkage in any slight degree.

          • Standard treatment of heart failure includes ACE or ARB. The current protocols have improved function and life span greatly. If you are taking these drugs for heart failure, stopping is the worst thing you can do.

            Induction of receptors takes time, and after stopping, it will take time for adjustments. On the basis of experience with CNS sensitising drugs, I would guess 1-4 weeks. This is also the timeframe for the period over which doses of ACE/ARB’s are gradually raised. eg, start and increase at 3-4 week intervals.

          • The Lancet item suggesting a potential link between ACE inhibitors and increased risk of COVID-19 infection is more that just an “internet rumor”. As Dr. Fauci acknowledges there is a plausible (not proven) mechanism by which treatment with an ACE inhibitor which which is known to increase expression of ACE 2 (in some patients, not necessarily all) could increase risk of CIVID-19 infection.

            Since well controlled hypertension is not normally associated with increased morbidity / mortality (as Dr. Fauci also acknowledges) concern that the ACE inhibitors used to treat hypertension, rather than hypertension per se, could be a factor in increasing COVID-19 risk is warranted. There is no doubt that diabetes and hypertension are highly correlated with increased COVID-19 mortality – numerous studies from multiple countries confirm this. Correlation does not imply causation, but is often suggestive.

            I don’t know if / how quickly ACE 2 levels decline to a baseline level after stopping treatment with ACE inhibitors. If ACE 2 levels do decline over time, I see that as an argument in favor of switching to an alternate hypertension treatment sooner rather than later since the potential for exposure to COVID-19 is likely to increase over time.

            I have not seen anything to suggest that ACE inhibitors “bind to” the ACE 2 receptors.

            I am an ops research analyst and see this as a standard decision making under uncertainty problem – but without sufficient data to estimate risk and expected values. If the hypothesis that ACE inhibitors increase COVID-19 risk is correct, and tens (hundreds?) of millions of people continue to use them during the pandemic, that could lead to a lot of avoidable deaths – BAD. If a lot of people abruptly stopped using ACE inhibitors (or switch to an alternative treatment that is less effective for them) and wind up with uncontrolled high blood pressure that would likely result in a lot avoidable deaths from stroke and heart attack – BAD, and potentially worse than continuing current treatments. However, for people whose blood pressure can be controlled effectively with alternate treatments (fairly easy to monitor), switching seems to be a prudent alternative to explore, but not currently supported by several influential US medical organizations. I am more than a bit irked by my doc for not supporting this option.

            We need more info in order to allow informed decisions. I am very concerned that the traditional clinical trial approach may not provide answers quickly enough given the current situation. I would love to see a comparison of COVID-19 morbidity / mortality for hypertensives treated with ACE inhibitors vs treated with other drugs like calcium channel blockers, but I have been unable to find any. If anyone has seen this, please post a link.

            Stay healthy everyone!

      • Very true. Its remarkable how similar the side-effects of ACE inhibitors are to CV symptoms, even down to loss of taste. And if ACE inhibitors increase ACE on cells, you are providing increased doors for the virus to enter.

        But the cardiac mafia won’t hear it.

        • Btw … To me, Dr. Freeman is a hero!

          Because I had been researching sources for my meds, I was the first American to get to his office in Hobart, Tasmania, AU after he set up the website FixHepC.com … and therefore one of the first Americans to be cured by using generic drugs. I was able to get my hands on generic Sofosbuvir and generic Daclatasvir for a total price of US$1,150.00 … and that combo in the US was priced at US$156,000.00.

          • And just over two days later, the website gets knocked down ….
            _____________________________________________________________________________

            Sorry! We got blindsided
            You are receiving this email because at some time in the past you registered on either FixHIV.com or FixHepC.com. Please unsubscribe if you find this irrelevant.

            About 12 hours ago GoDaddy LLC, the registrars for the FixHepC.com and FixHIV.com domains deleted the DNS records for these domains for an alleged breach of their Universal Terms of Service.

            As a result, our websites disappeared from the Internet and, any email sent to us at these domains will either bounce back to you simply disappear.

            If you were visiting FixHepC.com you will now find us at FixHepC.com.au.

            Similarly, if you were visiting FixHIV.com you will now find us at FixHIV.com.au.

            The old email addresses will not work, but like the websites, they will work if you add .au to the end.

            If you are in the thousands of people who have received their medication that’s basically it. We’ve moved to the same name + a .au at the end.

            If you have high blood pressure, diabetes or cardiovascular disease please skip to the end for something that might just save your life.

            If you are in the few hundred people who were caught up in the recent Indian export shutdown please read on.

            If you have received an email with a tracking number your medication is already on its way and the only impact on you is where to find us and how to email us.
            If you have not received an email with a tracking number please do not panic.
            India is expected to resume shipping essential items like medication tomorrow so any further delay in shipment should be brief although both we and DHL have backlogs to clear.
            You are welcome to request a full refund and please be assured that when we asserted we offer a 100% money-back delivery guarantee we were describing how we do business.
            Our servers have not been hacked and your personal details will be protected from any public view from now until eternity.

            We are available, at the new websites on chat and on email – just add the .au.

            Lastly, we wish to share the probable reason we got deleted. It happened just after we published this article.

            https://fixhiv.com.au/73-of-italians-who-died-of-covid-19-had-hypertension-and-were-taking-either-an-ace-or-an-arb/

            73% of the Italians who have died were taking 2 specific types of blood pressure medication. These happen to be the 2nd and 3rd most profitable medications in the world. While there is no proof these medications are the cause we are trying to gather the data at https://fixcovid19.com and it kind of looks like some people would prefer we did not.

            Please accept our apologies for the inconvenience.

  13. It is maybe too late for US to contain coronavirus. In our country – Slovakia government from patient 5 applied those rules.
    Closed borders, exception only for business trucks.
    All incoming into country are going into 14 days mandatory quarantine.
    Stay home.
    Allowed only needed shopping.
    Allowed go to work.
    Do not group.
    Closed all non essential shops, bars.
    Using any kind of face mask outside, in public transport, shops is mandatory.

    After 1 month we have 168 people positive. Most of them returned from abroad (Italy, Austria), rest is domestic contact with those people.
    For comparison, our neighbor Czech republic in same time went to over thousand positive. Germany from zero to 25 thousand.
    It looks that R0 here is kept under 1.
    We do not have curfew, staying home is only advised. If I want I can go for hike, or just for walk outside.
    I think most important of those rules are face masks. While it gives you only moderate protection from virus. It is very efficiently preventing you to spread virus. So chance to contract virus goes from maybe 80% when both people are unprotected to maybe 5% if both are protected by face mask or respirator.

  14. If all 40,000+ cases showed up for treatment it would be disaster.

    But 98% of US cases are asymptomatic, i.e. no doctor, no hospital, no death, not in the data.

    So, 2% of 40,000 = 800. That’s not going to tax the medical system.

    Just like the climate change scam assuming RCP8.5 for all their hysterical predictions – that never came to pass.

    • But 98% of US cases are asymptomatic

      Really? The US has really bucked the trend then. In the rest of the world around 81% of cases are mild/asymptomatic while at least 5% require hospital treatment. Hence the need for ventilators.

    • The numbers based on 72,314 cases of COVID-19 confirmed:
      * 80.9% of infections are mild (with flu-like symptoms) and can recover at home.
      * 13.8% are severe, developing severe diseases including pneumonia and shortness of breath.
      * 4.7% as critical and can include: respiratory failure, septic shock, and multi-organ failure.
      * in about 2% of reported cases the virus is fatal.
      * Risk of death increases the older you are.
      * Relatively few cases are seen among children.

      https://www.worldometers.info/coronavirus/coronavirus-symptoms/#mild

  15. From my perspective the poster is a bureaucrat that is defending a system that sucks. She is positing that tests should be 100% accurate and is waiting in the sidelines with her company to get a patent. I can understand a system that protects people from drugs that are ineffective or potentially dangerous. I don’t see how that applies to tests. A test that is 80% accurate is better than no test at all. You can always retest with a more accurate test if necessary. She begs to differ. I don’t trust bureacrats or politicians. They’re all in it for the money.

    • Yes and no. Rather depends on how inaccurate the test is. If it gives 90% false readings (positive and/or negative), for example, it’s not only next to useless but extremely dangerous as it fails at it’s intended job. On the other hand a test that is mostly but not 100% accurate would be better than nothing. Don’t let the perfect be the enemy of good.

  16. Dvorah Richman, regulatory counsel to the FDA for over thirty years. Make your own judgment about that, but my reaction is to invoke Mandy Rice-Davies rule (well-known in the UK, you can look her up.)

    ‘Well, she would say that, wouldn’t she!’

  17. As I’m watching Gummint in Australia shut down great swathes of the economy with each passing day and resorting to the printing press I become more convinced this is more of an economic problem than a medical one. The acid test for their go hard go lockdown to flatten the curve lies with China and will Covid19 rear up again?
    https://www.msn.com/en-au/news/world/life-after-lockdown-has-china-really-beaten-coronavirus/ar-BB11B9OE

    In particular-

    “Now the leadership has put a very heavy emphasis on resuming economic activity,” said Victor Shih, a politics professor at the University of California, San Diego.
    “One way to resume economic activity without panic is to cover up cases while still doing the government’s best to trace and contain them,” he said. “There is a risk it will lead to another outbreak but for now that seems like a risk the government is willing to take.”
    Still, sceptics of the positive statistics also acknowledge the difficulty of continuing the restrictions. Many citizens have lost months of income while others are tired of putting their lives on hold.
    One internet user wrote: “Why bother with data! Wuhan’s lockdown for so long is irrational in itself. People need to live!”

    There’s a massive global fallacy of composition that we can all print our way out of this but if the IOUs are to represent real incomes from real output in the long run then as a retiree I know it will all fall to our children and grandchildren to repay or else we’re simply going to create massive stagflation. The jury is out as to whether what we’re doing with shutdown and isolation is really in the interests of the greatest good for the greatest number and we still believe in a Magic Pudding rather than face up to the unpleasant truth. All eyes on the China success story now.

    • Dr Wolfgang Wodarg, a German pulmonologist (lungs) who understands viruses, responding to questions said,

      I consider the border closures, the cancellation of major events, the closure of schools and kindergartens and the quarantine measures that go beyond the scope practiced in previous years to be medically and epidemiologically unjustifiable. They are not indexed, are based on a falsifying application of an insufficiently validated test and, due to the neglect of important principles of evidence-based disease control, lead to the grossly negligent damage to liberties, property and health.

      https://publikumskonferenz.de/blog/2020/03/18/loesung-des-corona-problems-panikmacher-isolieren/?utm_source=Nachrichten-Fabrik.de&utm_content=link (last paragraph)

      • “due to the neglect of important principles of evidence-based disease control, lead to the grossly negligent damage to liberties, property and health.”

        They’re working on getting at the true stats-
        https://www.msn.com/en-au/news/australia/coronavirus-breakthrough-at-sydney-hospital/ar-BB11Crew
        Meanwhile contrary to the intent of Section 92 of our Federal Constitution that did away in 1910 with various State customs duty collectors at State borders various State Premiers are announcing closure of State borders with police on duty-
        https://www.abc.net.au/news/2020-03-22/wa-sa-set-to-close-borders-amid-coronavirus-fight/12079044
        https://www.msn.com/en-au/lifestyle/coronavirus/queensland-premiers-stern-warning-as-borders-close-to-non-essential-travelers/ar-BB11BWaK

        The clear intent of the 1910 Federation was to ensure exactly the opposite with free movement of goods and people while the foreign powers vested in the Federal Govt and these insular panic merchants tear it up in an instant and circle the wagons. Listen to the rhetoric. The narrative changes by the day as they parade about pretending they’re not headless chooks and trust them they’re from the Gummint and they’re here to help.

      • Michael in Dublin

        I live in Germany since over 50 years, and can tell you that your Wodarg guy is in Germany an absolutely irrelevant person.

        People of his kind find audience at best at more or less paranoid web sites like

        publikumskonferenz.de

        which outside of a few readers have no resonance.

        We in Germany are responsible people, love our basic rights but place them below those of our community when there is need to.

        We will see from here how the US manages to get out of the CoViD-19 disease.

        J.-P. Dehottay

        • While I do not share the political views of Dr Wolfgang Wodarg and probably have a different world view, this should not prevent me from seriously considering the merits of what he says in the above statement. If you are able to refute any of them with biological/medical/statistical insights then you should do so. I would, however, not be honest if I do not recognize that my enemy may be right, far more often than I am prepared to admit that I am wrong. This virus infection calls for compassion but also sober realism that when we grow old we face the certainty of death.

    • Yes countries which ignored this problem as medical to save their economics are currently most affected: Italy, Spain, Germany, US. On the other side of spectrum is China which protected lives regardless of financial loses, and their economics is already ramping up again.
      You can see what will happen when this virus is going unchecked. 9% mortality as in Italy.
      And all those countries are slowly implementing rules, while on start they claimed that problem is virtual and they will not negatively impact their economics.

      • Peter: “countries which ignored this problem ….. are currently most affected”

        WR: Correct. At a doubling rate of about twice times a week without measures the number of patients for the hospitals multiplies as follows:
        one week too late: 4 times as much
        2 weeks too late: 16 times as much
        3 weeks too late: 64 times as much
        4 weeks too late: 256 times as much
        etc.

        • Just case of US. Currently 45 thousands, with 2 days doubling that means that already now there are 2^7 x 45,000= 5.7 million walking infected people.

        • My son watched an interview of someone from Japan on CNBC yesterday – I could not find it online – who said that they treated coronavirus like a flu. Perhaps both a less alarmist attitude and good medical services has contributed to what appears much lower numbers of cases and deaths compared to what one would expect from a neighbour of China.

          • New cases in Italy appear to be peaking. The same will happen in the U.S., probably when it happens in NYC.

            The U.S. faced multiple points of Wuhan virus entry within much larger populations.

          • Nobody can now, that is true. Maybe 10 years later they will find, that eating raw fish will provide your body some essential chemicals preventing Coronavirus spread…

          • The only thing that matter are deaths and hospital visits. Numbers of infections are irrelevant.

          • “Nobody can now, that is true. Maybe 10 years later they will find, that eating raw fish will provide your body some essential chemicals preventing Coronavirus spread…”

            Or more likely they’ll find that not putting certain chemicals into the body, things like ACE2 upregulators and vaping chemicals, increases a body’s chance of mounting an essential immune response against coronavirus.

            btw Japan restricts vaping due to vaping illness (EVALI), which has identical symptoms as coronavirus. But there is no marker or test for EVALI, so if an an EVALI patient shows up and tests positive for CV, guess what they are diagnosed with.

          • Phoenix44
            March 24, 2020 at 7:29 am

            Japan. Explain Japan. Nobody can.

            Have you seen Japanese game shows? Anime?

            There IS no explaining the Japanese, bless their hearts. Not even COVID-19 can handle them.

          • Phoenix44. I got it. Difference is in wearing face masks.
            In Japan it is already part if culture. Same Taiwan, China.
            In Slovakia we started to wear face masks very early, like week after first cases.
            Now it is law to wear mask outside of home.
            Look on our graph:
            https://domov.sme.sk/c/22367242/koronavirus-sledujeme-minutu-po-minute-25-marec-2020.html
            vertical dotted line is time where strict government measures started, including face masks.
            All countries around are reluctant, or rejecting face masks. Eyewitnesses are writing, that people in Germany, Italy, Switzerland, UK are simply not wearing face masks even in shops, public transports…

      • China’s numbers can’t be trusted at all. Every number released goes through the CCP. We have no idea how many in China test positive or die from this. It is not a free country and if the chairman wants there to be no new cases then there will be no new cases. They lied for months about the disease and are still lying.

      • And all those countries are slowly implementing rules, while on start they claimed that problem is virtual and they will not negatively impact their economics.

        China is the world’s largest exporter there Petras.

        The next time you see an American (if you should ever be so blessed by the gods), then I would argue you have a moral obligation to bow your face low to the ground and kiss his feet for his willing sacrifice in attempting to keep our economy going on behalf of you and others on the world stage.

        Your “country,” Slovakia I believe, is a tiny, nothing country in terms of the big picture of the world (one might legitimately say, “useless to the workings of the world,” mightn’t one? ) has +/- 5.5M individuals in the entire land “mass.” Compare this to New York, USA, with +/- 8.6M in that one … city … alone.

        In 2018, We the humble, loving, benevolent People of the Great United States of America gave you Slovaks $50M of OUR very hard earned tax dollars. We labored for that money, not you. Our blood, sweat and aching backs went into creating that economic benefit for you. An economic benefit which works out to about $9.9M per person to benefit you in your tiny, little, insignificant country (hereafter, “TLIC”).

        Slovakia, as a member of NATO, also receives the benefit of military protection from We, the humble, loving, benevolent People of the Great United States of America. This in case someone (I don’t know why anyone would for goodness’ sake, but regardless) decides to invade your TLIC and do you harm.

        So, Peter, tsk, tsk, don’t criticize. Nay rather, bow your face low to the ground and gently, with upmost respect, kiss my feet when you see me walking on the street, lest I with that same strong American back that gave you $50M decide to suddenly and with some force snatch you up by the nape of your pencil Slovakian neck, bend you over my knee, and apply the rod of correction until your backside glows red and you repent of your impunity.

        We clear?

        (This goes for the rest of you foreign types commenting on this blog in criticism of We the humble, loving, and benevolent People of the Great United States of America as well.)

        🙂

        • If the numbers you quote are correct, your calculation is off by three orders of magnitude.
          $50M / 5.5M people =$9.09 per person, not $9.9M per person, and cost my wife and me, as US taxpayers, about 31 cents.

          • If the numbers you quote are correct, your calculation is off by three orders of magnitude.

            Thanks Bob. They are correct.

            If only I could blame it on the Gin and Tonics. But that would be a lie.

          • I have some spare checks, where I can send it?
            I think I have right to criticize, I still have my 401K and it is in my best interest to keep value of those money.
            So what I’m saying here is just unbiased opinion.

          • Oh you think you have the right to criticize because you have a 401K and it’s in your best interest to keep that money?

            Brilliant thinking, how did I miss your logic?

            🙂

          • You just made fascist fool from yourself. I see fear talking from you. You littered this great site and discussion with rubbish.

          • No you don’t Petras. You don’t “see” anything of the sort.

            But thanks for your comments. I’m not so embarrassed any longer for not paying attention to my maths. I’d much rather be a mathematical moron than a philosophical one.

    • Have they shut down surfing yet?

      The Colorado governor has shut down all ski resorts, which may be slightly justifiable.

  18. They say lots of younger people with disease taking up beds. But do they all need hospital bed ? Can’t we move the healthier ones to hotel that is makeshift hospital. Monitor their vitals and if things go south bring in portable ventilator? I would guess most do not need ventilator.

    Doctors likely afraid of liability. We need to pass special law so doctors can get creative without worrying about being sued.

    • My wife worked for the NHS for many years(UK). She worked in a unit called ‘transitional Care’ which was a sort of low level icu. They requied much less resources and were flexible when it came to moving recovering patients out of icu and relapses back in. They had the same arrangement with the general wards.

  19. I spoke to a biologist researcher about tests and he tried to explain to me – one illiterate in this field – that the testing is not nearly as simple as journalists and politicians make it out to be. I tried to find out if one can identify if a person who had a mild or asymptomatic case can be proved – months later – to have had the coronavirus. I was surprised to find that different people can produce different antibodies in response to the same virus. I read of a recent rapid test in Germany, in 20 minutes. However, the test did not pick up two thirds of people infected.
    https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/neue-corona-symptome-entdeckt-virologe-hendrik-streeck-zum-virus-16681450.html

    • Ask your own questions, find your own answers.

      Humans produce about 10 BILLION antibodies but immunology deals with a much smaller – tens – set of immunoglobulins. Immunological testing must be sensitive and specific to differentiate among the 10 BILLION.

      Fanning LJ, Connor AM, Wu GE (April 1996). “Development of the immunoglobulin repertoire”. Clinical Immunology and Immunopathology. 79 (1): 1–14. doi:10.1006/clin.1996.0044. PMID 8612345

  20. Phoenix man dies, wife in critical condition after self-medicating to treat coronavirus

    PHOENIX (3TV/CBS 5) — Banner Health officials are warning the general public after a man died and his wife was hospitalized in critical condition from self-medicating to treat coronavirus.

    According to a press release from Banner Health, the product that the couple used was chloroquine, which is a malaria medication that they recommend to not be ingested or used to treat or prevent COVID-19.

    The man and his wife, both in their 60s, became sick within 30 minutes of ingesting chloroquine phosophate, and experienced immediate effects requiring hospitalization. Chloroquine phosphate, is an additive commonly used at aquariums to clean fish tanks.

    https://www.azfamily.com/news/continuing_coverage/coronavirus_coverage/phoenix-man-dies-wife-in-critical-condition-after-self-medicating/article_fac3d7cc-6d48-11ea-9092-8b65922dc7c0.html

    • He should have not taken any drugs without a doctor. Who knows what dose he took, as well the drug that you want is hydro chloroquine.

    • It appears a journalist, Heidi Przybyla, that helped spread this story later admitted:
      The toxic ingredient they consumed was not the medication form of chloroquine, used to treat malaria in humans. Instead, it was an ingredient listed on a parasite treatment for fish.

      These old people responded irrationally and foolishly because of all the alarmism and tried self medication.

        • There was a story that over 50 people died in Iran from drinking methanol as they were told that it would cure the disease. It’s amazing how readily people will ingest something foreign without knowledge of what it might do.

  21. While reading this, my first reaction was that it didn’t sound like “non-fake news”, as the title said, but rather like a Swamp insider justifying the bureaucratic morass of the Swamp. It took to the end to find out that the author was not an objective scientist, and not even a disinterested observer. At the end, she was described as “regulatory counsel to FDA-regulated companies’. After 35 years in the Swamp slime, objectiveness may some times get diluted, even when you’re on the other side.

  22. Probably one of the worst false equivalences I can think of is to lump all people who test positive and then do not die, into one pile.
    And yet there seems to be an unspoken undercurrent of thought that the only measure of the severity of the disease is the number who die vs those who live, over the very short interval we are looking at.

    • Nicholas
      Your remark sounds a little like what Mosher has been promoting. Can you expand on what you mean?

  23. False negative tests are a real problem, but false positives can be worse.

    A test is 99% accurate (1% false negatives) and has a 5% false positive rate. Real rate of what you are testing is 3%.

    Test 1000 people. 30 have the disease. The test identifies all 30 (99% x real rate) PLUS 49 false positives (1000-30 x 5%). So 79 in all, with two thirds being false positive.

    It has been claimed the CV that has few false positives but that’s difficult to prove.

    Incidentally most doctors fail to get this right when asked to assess the chances of so nobody who tests positive for something actually having the disease. So next time a doctor gives you the results of a test, check he knows the numbers!

  24. Kudos to Dvorah Richman for providing a very clear and useful overview of the testing issue for SAR-CoV-2 and CoVID-19.

    Unlike some other countries, the United States does not have a centralized National Health Agency that is in charge of the nation’s public health — but rather a fragmented system of agencies with diverse responsibilities.

    Maybe that should change?

    • I have two friends that came down with it and are recovering, ages 69 and 71. Both in good physical shape, non-smokers, no underlying health issues I know of. They caught it on a ski trip to Vail at the beginning of March, just before all heck broke loose.

      Notes from them include “I don’t think I was ever in any danger of things getting bad, but, it was not good either”, and “symptoms were extreme fatigue, aches, and mild temp. (100.4 at the peak)”.

      Sounds like relatively good news to me. Also, having first hand knowledge is far better than the rumor and “we can all die from this” messages from the 24-hour news media.

  25. Correct me if I’m wrong, but this reads to me like a FDA/CDC press release lauding the heroism of their heroic bureaucrats. . . .

    Probably to counter those nasty articles that have come out about the FDA & CDC incompetence.

  26. Ms Richman discusses our regulatory framework as if it were inevitable. It’s not. There is/was no reason to give FDA the ability to prohibit LDT developed tests. CDC should not be determining the testing criteria. Perhaps, for the future, any company that developed tests, vaccines, or therapeutics could provide them to any U.S. hospital or physician who requests them subject only to a notation that they were “not approved by FDA.” My physician cares about my health and is likely to make the best possible decision given the information available. Certainly more so than someone behind a desk in D.C. While it sounds like a good idea that CDC should supervise a repository of emergency supplies (masks, respirators, protective equipment, etc.) they utterly failed. How about we tell the health care industry that having sufficient supplies for a pandemic will be their responsibility from now on?

  27. Yooohooo! We have serology tests for the antibodies. (I posted this yesterday in a different article)

    OK. Done. Here is the FDA list of serology tests for SARS-CoV-2.

    Jan

    The FDA has not reviewed the validation of tests offered by these developers, who will not be pursuing EUAs, and is including this list here to provide transparency regarding the notifications submitted to FDA.

    BTNX, Inc. Rapid Response™ COVID-19 IgG/IgM Test Cassette
    Coronacide™ COVID-19 IgM/IgG Rapid Test
    Diazyme Laboratories, Inc.
    Nirmidas Biotech, Inc.
    Phamatech Inc. COVID19 IgG/IgM Rapid Test
    Promedical
    SD Biosensor Standard QCOVID-19 IgM/IgG
    United Biomedical, Inc.
    Zhuhai Encode Medical Engineering Co., Ltd
    Zhuhai Livzon Diagnostics, Inc.

  28. In Brazil (you know, this country ‘led’ by a guy thinking CoViD-19 is no more than ‘a small flu’) the disease has entered Rio de Janeiro’s favelas (don’t ask me why it happens so late).

    But I suppose that this secondary information will be understood by most people as simple alarmism.

    Of course: the US will quickly and perfectly get rid of the virus!

    Best greetings from Germany
    J.-P. D.

  29. Still waiting for the explanation:
    – how WHO tests were defective, or subpar
    – why the CDC is in the business of making, well, stuff; anything (tests or other)

  30. An alternative theory, ACE Inhibitor may actually aid in protection from corona.

    Also info on a new study launched to investigate correlation of corona severity and medications.
    ————
    Dr James Freeman in Australia.

    https://www.michaelwest.com.au/why-are-so-few-children-suffering-from-the-virus/

    So here is a question. What do patients with hypertension, diabetes, cardiovascular disease, and indeed old age have in common?
    The answer is that many of them will be on either and Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) or and Angiotensin Receptor Blocker (ARB). The ACI Inhibitor class drugs end in -pril and the ARB class drugs end in -sartan so they are easy to tell apart……

    ……So here is the theory. Patients on ARBs may have a greater risk of COVID19 due to higher levels of Angiotensin II resulting in higher levels of ACE2 facilitating SARS-CoV-2 to infect cells. Conversely patients on ACE inhibitors may have some degree of protection due to the absence of Angiotensin II and the need for the body to up-regulate ACE2 production. Our bodies are lazy and tend to produce less of things we don’t need and more of things we do.

    The launch of Fixcovid19 yesterday has a very simple purpose: to gather data for analysis to see if there is any correlation between the medications people took before and during their COVID-19 illness and how severe it was. The key questions we are looking to answer with this data are: (1) Do any medications increase the risk of severe disease?; and (2) Does a medication have no impact on the risk of severe disease?”

  31. Before diving into any statistical problem you should draw a little cartoon of what do you want to know and how are you going to answer that from the data.

    I want to know the number of hospitalizations vs. time. Being admitted and put on a ventilator sounds like absolute hell to me. Overwhelming the hospitals is also the biggest fear. The death rate doesn’t answer the question, varies with treatment. The number of mild cases is not so important as the mild cases are not a reason to shut down the economy.

    Being admitted means some pretty bad symptoms. I believe that the staff would be reasonably consistent at determining a probable case of the virus. These should be pretty good numbers up to the point the hospitals are overwhelmed as in Italy.

    Too much analysis here of the numbers trying to estimate how many will die given we will not know the numbers of mild cases until this is past. By then we can just count the dead.

    A similar mistake is made by climate “scientists” busy calculating a average earth temperature. That is a nonsensical number. What we want to know is there a trend. The correct way to to that is to calculate the trend at each site and then average trends. Tony Heller is the only one to get this right.

    • Gary Palmgren

      “A similar mistake is made by climate “scientists” busy calculating a average earth temperature. That is a nonsensical number. What we want to know is there a trend. The correct way to to that is to calculate the trend at each site and then average trends.”

      This is not true when you do your job correctly, by calculating trends for the same reference period.

      When you for example average all trends calculated for all PMSL tide gauges having sufficient data for a common period (say 1993-2013), you see that the average of all trends is nearly identical to the trend of all gauge data averages.

      Averaging trends for different periods, e.g. 1807-2018, 1883-1957, 1990-2015 and the like gives only rubbish.

      J.-P. D.

  32. It is my understanding that there’s a self administered (finger pin prick for blood) test that gives results in 3 hours if the virus antibodies are present or not. This should be sent to everyone starting in high impact zones first. Those that have the antibody can’t pass the virus on and can go back to normal life and in fact maybe replace people in critical job positions that don’t have it (a stretch, but sometimes possible). With a high asymptomatic rate (50% has been found) we would be wise to start now in those heavily affected zones like New York city. I am under impression that it’s not for testing active cases so if antibodies are found the RT-PCR test would be needed.

  33. Trust them they’re from the Gummint and they’re here to help-
    https://www.msn.com/en-au/news/coronavirus/coronavirus-border-shutdown-sees-hundreds-dash-across-the-nullarbor-creating-outback-traffic-jam/ar-BB11CPDI

    “It’s over the top. Who knows who’s got it?
    “You’re going to go into lockdown. What is that going to solve?
    “The truck drivers are still going to go through. Who’s to say they don’t have it?”

    Don’t ask silly questions Lindsey but I didn’t notice the checkout chick at the supermart with rubber gloves let alone full body suit and if the bill is over $100 you can’t use tap and go with the plastic. Never mind she has to handle all the goods you just did while you enter your pin and there’s no hand sanitiser to be had anywhere along with the gloves shortage not to mention wiping your ass. Having to eat meets theoretical boofhead quarantine and hygiene construct of the mind or their infernal computer modelling or some such.

    Some workers are more equal than others while Hollywood types and ex Governors show them how they should be quarantining at home in the spa. Presumably cigars are not in short supply.

  34. For Pete’s sake people, it’s the flu. Get it, get over it and go back to living your lives. People are acting as if the flu is a death sentence when it’s no more than an inconvenience for the vast majority of us who even catch it.

    • No- it’s a coronavirus- about 2-3 times as transmissible as influenza and with somewhere between 10 and 15 times the death rate, and will probably end up infecting between 20%-60% of your population.

      There is a tsunami coming and your inefficient, most expensive, worst in the first world American Health care system is about to crumble under the load come end of April round about the time your moronic idiot in chief is thinking of ordering people back to work. Who would have thought putting a sociopathic failed real estate agent in charge of the country would be a bad idea?

      Why is it that the scientifically challenged morons on this site are so god damned stupid?

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