Guest Post by Willis Eschenbach [Note updates at the end]
Since the earliest days of the current pandemic, Italy has been the scary member of the family that you absolutely don’t want to emulate, the one cousin that gets into really bad trouble. The Italians have the highest rate of deaths from the COVID-19 coronavirus, and their numbers continue to climb. Here’s the situation today.
Figure 1. Deaths from the COVID-19 coronavirus expressed as deaths per ten million of the country population. Percentages of the total population are shown at the right in blue. All countries are aligned at the date of their first reported death. Most recent daily chart and charts of previous days are available by going here and scrolling down.
Italy, with over six thousand dead, is up well into the blue range. This is the range of annual deaths from the flu in the US. If the US coronavirus patients were dying at the same rate as in Italy, we’d have 38,000 coronavirus deaths by now in addition to the same number of flu deaths …
As a result, there has been much debate about why the Italian death rate is so high. People have suggested that it’s because they have one of the older populations in Europe. Others have noted that they often live in extended families. Some say it’s high numbers of smokers and polluted air. And some have pointed to their social habits that involve touching, kissing cheeks, personal contact during church rituals, and the like.
But we haven’t had good data to take a hard look at the question, or at least I hadn’t seen any.
In the comments to my post entitled END THE AMERICAN LOCKDOWN, wherein I passionately advocate just exactly that, I was given a link by a web friend, Mary Ballon, hat tip to her. It’s a report by a Swiss medical doctor about the COVID-19 deaths in Italy, well worth reading.
And in that document, there’s a further link to an Italian Government report. It’s in Italian of course, I have it on good authority that’s what they actually speak over there, who knew? They reported on the statistics of a large sample of the Italian deaths (355 out of 2003 total deaths at the time of the report). I got it, and the numbers are very revealing.
Let me start with the age distribution of the 2,003 Italians who had died at the time of the report. Figure 2 shows that it’s almost entirely old people.
Figure 2. Age of 2,003 Italians who had COVID-19 at the time of death.
Out of the 2,003 deaths, seventeen were people under fifty, and only 5 people under thirty died, while almost two hundred deaths were of people over 90. I’d read that the people dying in Italy were old, but I didn’t realize quite how old they actually are …
One thing I learned on this voyage was that the Italians distinguished between dying FROM the virus on the one hand, and dying WITH the virus on the other. Once I looked at the state of health of the Italian victims, however, I could see why they had to do that. Figure 3 shows the generous apportionment of serious diseases and conditions among the unfortunates.
Figure 3. Numbers of diseases in the sample of 355 Italians who had COVID-19 at the time of their death.
WOW! Yeah, they all had COVID-19. But three-quarters of them also had hypertension, a third had diabetes, a third had ischemic heart disease, a quarter of them had atrial fibrillation tossing clots into the bloodstream, and so on down the list.
As you can see from Figure 3, some people must have had more than one other disease besides COVID-19. Figure 4 shows the breakdown of the number of other diseases per patient.
Figure 4. Other diseases (comorbidities) of a sample of 355 of the 2,003 Italians who had COVID-19 at the time of their death.
For me, this was the most surprising finding of the entire study. Of all 355 people who died, only three did not have any of the diseases listed above. Three!
Looking at all of this as a whole picture, I had a curious thought about who they were representing. I thought … consider the characteristics of the people who died:
- More of the patients were over 90 than were under 60.
- The average age was 79 years.
- All but three of them had at least one other disease, so basically all of them were already sick.
- Three-quarters of them had two other diseases, and half of them had three or more other diseases. Half!
My thought was … that’s not a sample of the people in the street. That’s not a sample of an Italian family.
That’s a sample of a totally different population.
I was forced to a curious conclusion, both discouraging and encouraging. It is that most of these diseases were probably not community-acquired. Instead, I would hazard a guess that most of them go by the curious name of “nosocomial” infections, viz:
nos·o·co·mi·al
/ˌnōzōˈkōmēəl/
adjective MEDICINE
(of a disease) originating in a hospital.
Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.
And in some fashion, it got into the medical system. Doesn’t matter how. But once there, it was spread invisibly to other patients, in particular the oldest and weakest of the patients. It went from patient to patient, from patient to visitor and back again, and it was also spread by everyone in the hospital from administrators to doctors and nurses to janitors. In many, perhaps most cases, they didn’t even know they were sick, but they were indeed infectious.
And that’s why the pattern of the Italian deaths is so curious, and their number is so much larger than the rest of the world. It’s not a cross-section of the general population. It’s a cross-section of people who were already quite sick, sick enough that they were already visiting doctors and having procedures or being bedridden in hospitals. It was 85-year-olds with three diseases.
And it’s also why the death rate in Italy is so high—these people were already very ill. I can see why the Italians are distinguishing between dying FROM the virus and dying WITH the virus.
DISCUSSION AND CONCLUSIONS
As I said, this is both discouraging and encouraging. It’s discouraging because getting the virus out of a modern medical facility and a dispersed medical system isn’t easy. Italy has a big job ahead. And it’s discouraging because it means that the medical personnel who are so needed for the fight are getting the disease as well. Very likely they won’t die from it, but they will be hors de combat for three weeks or so. No bueno.
On the other hand, it is encouraging in a couple of aspects.
First, it lets us know what we need to do to prevent the Italian outcome. We have to, must, keep the virus out the medical system.
- We need to seriously quarantine the sufferers away from other sick people.
- We need to set up testing facilities at all medical centers and test the medical personnel daily.
- In areas with a number of COVID-19 infections, we need to set up separate field hospitals. There are a number of commercial versions of these that are expandable by adding modules, and are pathogen-tight, with airlocks at the doors, HEPA exhaust filters and negative air pressure maintained throughout. We know how to do this stuff, we’ve just got to do it.
- We need to test in-hospital patients at the time of their arrival and continue to test them at intervals during their stay.
- We’ll have to be very careful with visitors to patients in the hospitals
It’s a big job, and we absolutely have to do it.
Second, it cautions us to not claim that everyone who tests positively for COVID-19 after death actually died FROM the disease. They may very well have died WITH the disease.
Finally, the other reason it’s encouraging that Italy’s infection is likely nosocomial is that it removes Italy as the mysterious bogeyman of the COVID-19 pandemic. In addition, it points to just what we have to do.
IF (and it’s a big if) we take the proper precautions to protect our vulnerable medical system and personnel, I don’t think that the US will get as high a death rate as Italy has today.
Note that this makes me seriously question the idea of “flattening the curve” … if you let the virus into your hospitals and medical system you’re toast, no matter how flat the curve is.
So let’s end this crazy American lockdown, there’s a whole raft of work to be done shoring up our medical sector to withstand the coming wave, and it can’t be done at home with our heads in the sand, hundreds of thousands of people not working, jobs disappearing daily, and our economy in a shambles …
My very best regards to all, stay well in these parlous times,
w.
As Usual: I ask that when you comment, QUOTE THE EXACT WORDS YOU’RE DISCUSSING. Knowing who and what you’re referring to avoids endless misunderstandings and arguments.
[UPDATE]: Just after publishing this, I was reading about loss of the senses of smell and taste being symptoms of coronavirus infection. In the article, I found this:
Hopkins says an Italian doctor shared that “he and many of his colleagues had lost their sense of smell while working in northern Italy dealing with COVID-19 patients.”
… “many of his colleagues”. Kinda support my theory of nosocomial infection in Italy.
[UPDATE 2]: In the news today, the headline Coronavirus: 4,824 Italian Health Workers Are Infected … one in ten of their coronavirus cases are health workers …
[UPDATE 3]: Here’s a graph showing just how different Italy is from the other countries with numbers of cases …
PS—Let me take this opportunity to provide a wider readership to a comment that my obstropulous (yes, it’s a real word) good friend Steve Mosher posted on my blog yesterday. He’s living in Korea and has been a close observer of just how they are succeeding in controlling the virus. He spells out the level and the details of what we have to do. His comment is below, my thanks to him.The key is changing the criteria for testing. Here [in Korea] we test and track.
An employee of a call center in Seoul, was infected.
Office had 207 people.
March 8th. he tested positive.
EVERY person in that office was tested. today 152 have tested positive, they tested floors above and below his floor. Today 3 more from the 11th floor were found and 1 contact.
They are now tracing the contact, and the contact’s contacts. All will be tested. The business was in a residential building. 553 of the people in that building were tested. floors 13-18
This little beastie lives on surfaces for up to 3 days. See that elevator button? the hand rail on the stairs? the bathroom door handle? the coffee cup that pretty girl behind the counter handed you? it’s there. Now in my building we have hand sanitizer by the elevator buttons. you get in the habit of not touching public pretty quickly. Trust me I am not a germ phobe, but the changes have been simple when they are reinforced.
Let me give you a little taste of the highly detailed info we get.
Info that is shared daily in one spot, I will include some of the earlier call center case snippits
“In Daegu, every person at high-risk facilities is being tested. 87 percent completed testing and 192 (0.8 percent) out of 25,493 were confirmed positive. From Daesil Covalescent Hospital in Dalseong-gun, 54 additional cases were confirmed, which brings the current total to 64. In-patients on 6th and 7th floors are under cohort-quarantine.”
“From Guro-gu call center in Seoul, 7 additional cases (11th floor = 2; contacts = 5) were confirmed. The current total is 146 confirmed cases since 8 March. (11th floor = 89; 10th floor = 1; 9th floor = 1; contacts = 54)”
“From Bundang Jesaeng Hospital in Gyeonggi Province, 4 additional cases were confirmed. The current total of 35 confirmed cases since 5 March (20 staff, 5 patients in inpatient care, 2 discharged patients, 4 guardians of patients, 4 contacts outside the hospital). The 144 staff members who were found to have visited the hospital’s Wing no. 81 (where many confirmed cases emerged) were tested, 3 of whom tested positive.”
“Five additional confirmed cases have been reported from the call center located in Guro-gu, Seoul, amounting to a current total of 129 confirmed cases from the call center since 8 March. As of now, 14 confirmed cases in Gyeonggi Province has been traced to have come in contact with a confirmed patient who is a worker at the 11th floor call center at a religious gathering. Further investigation and tracing are underway.”
Test, Trace, Test more.
A random test in Iceland found 1% infected. 50% asymptomatic.
If the US persists in only testing the symptomatic you won’t squash this bug.
Our cases are going up in Seoul. So we will have 15 days of voluntary social distancing.
go to work
stay away from crowds
wash your hands
wear a mask
don’t touch your face
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Another factor is that Italy has the lowest vaccine rate of Europe. It’d be interesting to know whether Italian elderly receive annual flu shots or have the pneumonia vaccine. Meanwhile, US media should encourage adults to get a flu shot, and wash their hands.
Ultimately, the US financial ramifications will create more despair and will cause a higher mortality rate then the COVID-19 virus. Meanwhile, 2 billion are infected with the flu which causes 300-500k global deaths every year…
Willis is only 2 years older than I am.
I just checked out Willis’ curriculum vitae here:
https://www.dropbox.com/s/uqnhc0aw562k79j/Willis_Eschenbach_CV.doc?dl=0
I AM IN AWE!
“Family Is Italy’s Great Strength. Coronavirus Made It Deadly.: In a country where multiple generations live close together, a difficult separation is underway to protect parents and grandparents.” By Margherita Stancati on March 24, 2020
https://www.wsj.com/articles/family-is-italys-great-strength-coronavirus-made-it-deadly-11585058566
The Italy pattern isn’t dramatically different from the other epidemiological breakdowns. China didn’t have as many really old people, but still lots of old people.
However, I still note that a 0.2% to 3% mortality rate among 30-59 is still pretty damn serious. There are probably 70m to 100M Americans in those age groups; 140K to 3M is still a serious trauma to US society.
The medical impact is also likely to be high – I’m not seeing any indication that the ~20% serious respiratory problem rate is signicifantly lower for 25-59 vs. 60+.
The mortality rate is among those with the disease, not the general population. In no country does even 1% of the population have the disease.
Taking the midrange population of 85 million in the groups you discuss, if 1% has the virus and the mortality rate is say 0.8%, that’s 6,800 people …
w.
“In no country does even 1% of the population have the disease.”
Yes indeed, nowhere close to 1%! Even the outlier, San Marino (a small country landlocked within Italy) has by far the highest at 619 cases per million, which comes out to 0.06%. Italy’s % of population infected has been counted as 1/6 of that. Spain is an order magnitude less than San Marino, and it falls off sharply from there.
Of course, we could try to extrapolate the number infected per population. But I ain’t going there 🙂
We are not in an equilibrium situation.
A few months ago, the sum total of the living creatures on the planet with this virus may have been exactly one pangolin in a cage in food market in a city half a world away from most of us, in a city most of us never heard of.
But now, this virus may be one of the most numerous life forms on the planet, and my guess is the biomass of it is still increasing rapidly.
It is the trend…not the number.
I agree Nicholas, and in the vein, I wrote in…
“…Of course, we could try to extrapolate the number infected per population. But I ain’t going there “🙂
I do understand that there will be many more counted, and that the numbers will rise…
“The mortality rate is among those with the disease, not the general population. In no country does even 1% of the population have the disease.”
and given R0, no country will ever have 1%, ……. for more than a day or so.
daily compounding interest is a wonderful thing.
crazy thing about exponential growth.
wasn’t long about folks here pointing at 68 cases and saying Mosher you are nuts
Funny thing about discussing exponentials. One day you are right , and the next day
BAM.
Here’ hoping your hospital doesn’t exceed the tipping point
I’m not sure they are listening, Steve. Perhaps try again in a week or two. Thanks for posting the videos by the way. There are some good S-I-R tutorials knocking about on Youtube.
They cannot hear. Its a threat to their identity.
I know it changed my life overnight as I commute from China to Korea monthly.
Folks will find multiple ways of denying/questioning/ data
Until it hits their life
I haven’t tried to run the numbers on the Oxford University model, but if their estimate/conjecture that 50% of the UK has already had the disease is correct it would imply a higher rate of peak infections.
The young can have illnesses that have the same symptoms as CV and are just as deadly, but are hard to diagnose:
* Vaping illness (EVALI) that appeared just a few months before CV; most doctors have no experience with this disease.
* Tuberculosis among immigrants who brought latent TB with them from their home countries that have endemic TB
So if a youngster shows up at a hospital with either of these, and tests positive for CV, what do you think the diagnosis will be?
0.2% to 3% of the deaths, not of the whole population.
“…Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease…”
Have to use the disclaimer that this disease crosses nationalities, races, genders, ages, etc.
But Italy has over 320,000 Chinese citizens. And this does not include Chinese people who gained Italian citizenship or were born to such parents. I’ve heard this is the largest in Europe. It is easy to see why it may have gotten established there from travelers.
Pardon my ignorance, but what exactly does testing accomplish?
If a person tests negative, does that mean they won’t get sick tomorrow? Can they go to work and mingle?
If a person tests positive, do we quarantine them? Where? With all the other positives or alone? For how long? Does a + get to leave quarantine in 2 weeks?
People who get the virus and survive are then immune. They can’t get it again and can’t pass it along. Do the Immunes have be locked down with everybody else? Wouldn’t it be better to have the Immunes get back to work? A herd of Immunes would be beneficial in many ways, including disrupting transmission.
But you can’t tell who is immune unless you test for antibodies, which is not happening. The Immunes are hidden. The herd is invisible. What good is that?
If you are real sick and choking, go to a hospital. If you have a minor cough, or no symptoms at all, what do you do? What good is a test, unless it’s an antibody test and you can get stamped Immune?
Does social distancing really work? Does it have an endpoint, a date certain exit strategy? Must we all be locked down forever? Who is going to feed the chickens?
I think the testing concerns are really just one or both of the following: (i) a real interest in understanding the spread of the disease–in which case universal testing would be required, and (ii) a chance to spread the faux news of a supposed failure of the Trump administration.
For practical testing to be in any way helpful in the short term (and I’m not sure it would), we would have to do infection-tracing in the way South Korea is doing it. However, the people screaming that we in the USA have been having a failure in testing are of the same ilk who said we should not be doing infection-tracing during the HIV/AIDS outbreak in the early 1980s.
re: “Pardon my ignorance, but what exactly does testing accomplish? ”
If symptoms appear, it gives adequate time to “treat”* (be treated) using one of several different regimens (including Hydroxychloroquine) found to offer “good odds” for a recovery …
.
.
* I’m assuming.
All good points.
Testing negative for the virus only means you do not have any on the lining of your nose.
You may have got and cleared it, you may not have got it, or you may have just been exposed and not have any viral replication yet, or you might be exposed and become contagious ten minutes later on your way to the front door of the place you got tested in.
A negative test would have to be repeated like, daily or so, to be sure no one contagious was walking around and only having these tests to determine that.
You bring up a *very* good point that I have yet to see mentioned on this thread.
So S Korea tested *everyone*? So what? Like you point out, those that didn’t show corona virus infection could show it tomorrow! So what good did the widespread testing actually accomplish? It gives you ONE SINGLE DATAPOINT concerning infection rate. You can’t trend from one data point! That one datapoint doesn’t tell you anything about the future.
And the data that S Korea is getting now is the same type of data the US is generating – infections vs deaths based on an ad hoc testing regime. At least I have not read anywhere that S Korea is continually testing the entire population over and over again.
I suspect that SK is has probably instituted the same protocols the US has such as social distancing, isolation, etc. They just started sooner than we did.
About the only type of testing I can imagine being really helpful in navigating something like this with anything like aplomb, would be for everyone to have a little watch on that continuously monitors the blood and tests it in real time.
By the way I just thought of that and I got dibs on the patent.
Even without symptomes you can infect others, as they told us here in GER today.
That is not a news item. That is normal during the incubation period. COVID-19 has a relatively long incubation period for a flu virus ( 2-12 days, median 5d ) . Part of the reason it spreads so quickly.
“Pardon my ignorance, but what exactly does testing accomplish?
1. identifies the positives, asymptomatic and symptomatic. Gets them out of circulation
and into hospitals
If a person tests negative, does that mean they won’t get sick tomorrow? Can they go to work and mingle?
2. They might get sick tomorrow.
3. In Korea, yes you can go to work.
4. MINGLE? No one should mingle.
If a person tests positive, do we quarantine them? Where? With all the other positives or alone? For how long? Does a + get to leave quarantine in 2 weeks?”
1. Yes they are isolated.
2. Where? In china they set up gyms and large facilities with hundreds of beds for less serious
cases. In Korea the government took possession of 7000 offices and converted them
to life care centers. Most cases are not serious, they go to life care centers
3. With other positives
4. Until they need the hospital or test negative several times.
5. You leave when you are well and test negative
Here are two medical, paradigm changing breakthroughs, that might end the Corvid-19 problem/crisis.
https://www.distributedbio.com/covid19
First) Corvid-19 Antibody
A US company, ‘Distributed Bio’ have developed a technique that produces Corvid-19 anti-bodies that they believe will kill the virus in the body and provide the body with 8 weeks protection against Corvid-19.
This is different than a vaccine.
A vaccine is given to healthy people so they can give their body the capacity to produce antibodies.
This new technology (other companies are working on the same new technique) directly produces the antibody.
The antibody can then be given to sick people by injection and within 20 minutes the injected antibodies will start to kill the virus in the body of the infected.
The antibody can also be given to health people (target group, health care works) and if it works it will provide them with 8 weeks of protection against the virus.
The first tests of the new antibody, to test for virus killing effectiveness, will be July of this year in the US.
If all goes well, mass production of the antibodies and use in humans could start in September, 2020, this year.
Second) Universal Vaccine
The second is the development of the so-called universal vaccine.
The Universal Vaccines concept is to develop a vaccine that attacks the portion of a virus that does and cannot change.
A universal vaccine if it worked is a game changer, as it eliminates the need to vaccinate every year and makes the vaccine much more effect every year.
This is a link to a Distributed Bio’s discussion of their universal vaccine CENTIVAX which they say also would be effective to stop Corvid-19.
https://www.distributedbio.com/centivax
CENTIVAX
https://www.distributedbio.com/covid19
Word of mouth info from a cousin who’s uncle died from Spanish Flu at age 28, in NZ:
The outbreak in NZ lasted from October to February (our summer). I will research it
Willis,
Your comment makes even more sense for the situation here in Spain with a culture and a population structure similar to that of Italy. Infected people under 60 outnumber those above 60, and are (roughly) evenly distributed by sex, yet the dead are overwhelmingly males over 60-70. In support of nocosomial factors, almost 13% of all recorded cases are people related to the health system. Add poor testing and equipment, and we are first in the race.
As to the effect of gatherings, one can see in the link below that, unlike older groups, women 25 to 60 outnumber men. I wonder if that has to do with the goverment-supported feminist rallyes of March-8. In fact, several participant female ministers (and the primer minister’s wife) got sick.
https://www.libertaddigital.com/ciencia-tecnologia/salud/2020-03-24/los-graficos-que-explican-la-incidencia-del-coronavirus-por-sexo-y-edad-1276654585/
Willis,
I don’t know if you’re aware that by Median age Italy has the 6th oldest population in the world. I think Greece is 5th, Germany 4th, Japan 2nd and Monaco 1st. Monaco is a bit of an odd one, but the other nations venerate their old and grandparents.
From the head post:
w.
And to fortify Willis’ consciousness of age and it’s relation to this post:
“Let me start with the age distribution of the 2,003 Italians who had died at the time of the report. Figure 2 shows that it’s almost entirely old people.”
Willis,
One question I have: is it possible that the results for this preliminary study could be skewed because the really sick people die faster?
nCOV/COVID-19 doesn’t seem to be like SARS-1, which was killing younger people via cytokine storms.
Rather, it seems like nCOV goes from virusemia, to viral and bacterial pneumonia, to non-cardiopathic edema, to sepsis. Given this progression, it doesn’t seem unlikely that someone already sick would die pretty quickly, but that someone otherwise healthy would either recover or take a lot longer to expire.
I have just visited another excellent website, The Cosmic Tusk. Here you will find several very important posts from Dr. Chandra Wickramasinghe, an expert on viruses. The Dr. has theorized over the past many years, about viruses as originating from space. Specifically, the viruses are seen as entering the EARTH’S atmosphere and then taking in certain regions and then spreading elsewhere, and often becoming a widespread disease such as the current Coronavirus. I think the Dr.’s ideas deserve serious consideration, as he explains the origin of the Corona virus as beginning in China, from a fireball that struck China not that far from the city of Wuhan, where this virus got its start.
re: “The Dr. has theorized over the past many years, about viruses as originating from space.”
Hmmmm … from where in “outer space” does the good doctor theorize these originate? This also presumes ‘life’ is out there, yet, we found (at least) no sign of it on the moon (in the samples brought back I’m presuming.)
Hi Jim: I will just add, that conditions within comets is much different than our believed to be on our sterile moon. There are very complex molecules within comets that are capable of supporting viruses. This of course also implies that the virus can withstand extremely hot conditions. And this of course, the good doctor has taken into consideration
The existence of organic chemicals does not mean, or even imply that comets are capable of generating viruses.
He has taken this into consideration? How? It is well known that heat kills viruses.
Virus aren’t supported simply by complex molecules. They can’t reproduce without cellular machinery. They don’t have metabolism, so can’t make use of organic chemistry less complicated than biochemistry.
The constiuent building blocks of life do exist in space, but as yet no evidence supports actual cellular life. It’s not outside the realm of possibility, but there is zero, zilch, nada evidence in support of viruses from space as yet. It’s pure, idle conjecture and, as noted, highly improbable.
Just like the Cosmic Tusk’s evidence-free Younger Dryas impact speculation, easily shown false.
Highly unlikely, to say the least.
The genome of the virus from space just happens to be highly similar to those of a local bat genus?
And the 2015 and 2019 fireballs were far from Wuhan, both in NE China.
It is well known that UV light can kill most viruses.
Space in the region of earth is loaded with UV light, and there are no shadows to hide in.
If these viruses were coming from space then they would have been killed millions, if not billions of years ago.
Beyond that, how do they get through entry into the atmosphere without burning up. Yes, they don’t have much mass so they would slow down quickly. However, they don’t have much mass which means it doesn’t take much energy to heat them up.
Most viruses on/in comets would be safe from UV. Say your comet is something like a mile across (seems to be the right order of magnitude for the comets we have studied). The UV hits the surface of the comet. But there’s a lot of comet that isn’t surface.
Nor is Dr. Wickramasinghe an expert on viruses. He’s a mathematician and astronomer.
Agreed, John Tillman, but Dr. Wickramasinghe has been working in the field of astrobiology for decades and he along with the now deceased Dr. Fred Hoyle, another renowned expert on astrobiology, I believe must also be well acquainted with the nature of viruses. Within comets as Ellen points out, there are places in a comet that are not heated as much by their travels, even as they enter the Earth’s atmosphere. I am not totally convinced of the Hoyle/ Wickramasinghe theory, either, but I think it does warrant some further scrutiny.
In other news New Orleans is reporting rats are coming out on to the streets due to restaurants shutting down. The rats are hungry and looking for food. This is no joke, google it for articles.
That would be great fun to sit up on a balcony with a pellet gun.
Willis, great read, as always. Just thought I’d share that I have a family member who has worked in a hospital for nearly 20 years now that services about 60,000 people in a rural area in the US. That hospital has already implemented extreme preventative measures. And they haven’t even had a COVID-19 case in the area. (And hopefully they won’t at all.) Among many of the practices they’ve implemented, they’ve closed all entrances except for the emergency entrance, where potential COVID-19 patients must enter. Foot traffic in the emergency entrance is guided to specific places that are isolated from the rest of the hospital. If you walk in with a fever, you are immediately escorted to an isolated area. Even vehicle traffic is clamped down, with checkpoints, and entire sections of the parking lot closed off to keep the number of human beings in the hospital as low as possible.
Assuming all hospitals around the US are doing this, I think were prepared for it. Not saying it’s the end-all-be-all solution, but as you pointed out, containment is hard when spreading outside the hospital, and much harder when it spreads within the walls of the hospital.
Thoughts and prayers for our Italian friends out there.
This is a link to a CNBC video that interviews the CEO of the company that have used new technique to virus.
See my above comment for details of the new medical science. As noted in my link and this interview, human tests are scheduled to start in July of this year and if the test works, mass production and use in humans could start in September of this year.
https://www.cnbc.com/video/2020/03/23/distributed-bio-ceo-on-developing-therapeutic-antibody-treatment-against-coronavirus.html
The FDA might have something to say about that.
Certainly nothing like that timeline has ever happened in the US for a new drug application.
There are a lot of ifs going on here.
This stuff has not been given to a single human being.
There are a lot of people who have lost a lot of money listening to drug company hotshots with glowing tales of their life saving new med that is just a formality to get through testing.
Someone feel free to give me my prognosis.
I have Hypertension, Diabetes, MGUS. Chance of survival ? 2% ?
you will 100% live and be fine Stephen….a Dr in NY was just on the news….said he has given Hydroxychloroquine to every patient that has come in….they have all recovered
Willis, your nosocomial theory seems to find at least anecdotal support from reports of multiple deaths of Italian medical personnel in recent days.
Snape on March 24, 2020 at 2:49 pm
Starting March 9, I’ve noted the dates when a doubling of total fatalities from COVID-19 occurred (global).
3/09/20: 4,000
3/17/20: 8,000
3/23/20: 16,000
https://www.worldometers.info/coronavirus/
Whoops, I didn’t mean to include the top line.
Everyone with high blood pressure is not exactly on their death bed.
Just saying.
Same with diabetes.
Many people live long and otherwise perfectly healthy lives with these conditions well controlled the whole time.
Over 100 million Americans have hypertension.
That sounds like most people over some middle age.
Another thing that ought to be mentioned is that a lot of people that are not very old and getting very sick and living.
In Italy they have had to decide who they will give a ventilator and a bed too.
Anyone with viral pneumonia and lack of proper care is gonna die.
The young people who live through viral pneumonia will not be back in the pink in a week or two…many of them will never be the same.
Most people who are youngish and get decent care can live through just about anything, but it aint no picnic, and it does not mean they are not severely damaged.
I lived through a car accident in 1982 that just about killed me, but I was very stubborn, the the surgeon who just happened to be at the Lake Hospital clinic in Yellowstone Park that morning was very very good.
But I was definitely never the same.
The binary case, lived/died…rarely tells the story where such matters are concerned.
Just sayin’.
I am not saying it is wrong to put lipstick on a pig…just that this is lipstick on a pig.
This disease is not a bunch of people who were waiting to die, finally kicking the bucket.
Thanks Willis. ICYMI, the Italian report is now available in English:
https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf
Commentators have mentioned ACE inhibitor drugs in relation to proclivity for Wuhan virus fatality. I’d like to contextualize a few details, with the caveat I am not in a position to confirm these drugs are actually a co-factor in the disease outcome.
ACE inhibitors are commonly prescribed for hypertension. While diabetics get it for it’s antioxidant properties (drug limits precursor reactive carbonyl & also stymies oxidative sequels required to form advanced glycation end products. COPD lung patients on oxygen get it because reduces the drug reduces fatal outcome rate.
The medical test for the ratio of albumin to creatine is used to determine if a patient has albuminuria. So called micro-albuminuria (excess albumin) conditions are a diagnostic indicator often used for diabetics being prescribed an ACE inhibitor.
Excess albumin is clinically often associated with some degree of tissue damage in both the kidneys and the lungs; and ACE inhibitors are a drug for limiting lung damage. In cases of chronic micro-albuminuria there is an increased risk in lung patients with COPD of experiencing low oxygen content in the blood. Furthermore, smokers also have excessive albumin & chronic smokers have a propensity to kidney glomerulus damage (sclerosis).
What needs to be understood is that drug regimens that worked for patients from their 40s to (say) 70s are not necessarily appropriate for geriatric years. And also sodium restricted diets are another common age appropriate consideration.
Let me try to connect things in light of how excessive albumin relates to kidney glomeruli damage causing reduced filtration rate. ACE inhibitors reduce renal pressure & thus filtration in kidney glomeruli; while restricted salt plus ACE inhibitors reduces glomerular filtration even more. NSAID drugs (ex: ibuprofen) are anti-inflammatory drugs deemed COX inhibitors & this class of drugs significantly reduces sodium levels – to the potential extent of causing renal vaso-constriction.
Which brings me to the conundrum of why male mortality rate (in Italy at least) is higher than for women. The diagnostic level of albumin where micro-albuminaria kicks in is 20mg albumin/g. for adult males & it has to rise to 30mg albumin/g. for adult females.
In the geriatric cohort they can get low sodium despite regular sodium intake with food when take a diuretic. And a drug combination of ACE inhibitor plus diuretic is prescribed for congestive heart failure.
edit: should read “…renal vaso-constriction…” in last words of last sentence ending 3rd paragraph from bottom
Fixes, I hate typos, although I did enjoy “renal caso-construction”.
w.
The first alarm was about SARS. At the time, pundits predicted that SARS would become a pandemic and that more than 100 million people would die. Wrong. SARS died out because it was not really very infectious outside of hospitals.
http://www.thestar.com/comment/article/669727
Schabas: Get a grip – SARS is nasty but it’s not the next plague
The SARS outbreak in Toronto was a hospital-based problem. The vast majority of SARS victims have acquired their infection either directly in a hospital or by infected hospital staff, patients or visitors who infect other members of their household. This hospital-based problem has been brought under control.
snip
There have been very few cases of community-acquired SARS, and there is no evidence of a sustained community spread in Canada.
SARS transmission is by respiratory droplets; it is not airborne-spread. This means that, in practical terms, it requires prolonged close contact with a SARS patient to become infected.
The disease has been effectively controlled in Toronto since stringent respiratory precautions were introduced in hospitals over the latter half of March. The success of these precautions is the great story of the Toronto experience and our lesson to the world.
https://www.theglobeandmail.com/news/national/schabas-get-a-grip—sars-is-nasty-but-its-not-the-next-plague/article1159807/
Did they do an Autopsy? Seems strange that only 1% had no other disease. By that I mean that it is entirely, stylistically, probable that close to 1% actually had some other disease and it was not diagnosed and thus not in the health record. Seems to me that more than 1% of the population is walking around, functioning normally with one of the diseases that would aggravate the conditions when combined with COVID19.
Thanks WE, a real eye opener.
But of course the sample is not a cross section of normal healthy society. It’s a cross section of people who are now dead, so obviously not healthy. But it doesn’t prove whether or not their origins are hospital.
“This little beastie lives on surfaces for up to 3 days. ”
Reports today from the people investigating the cruise ship tell of them finding live virus in the cabins of the people who were infected, both the symptomatic and the asymptomatic ones, over 17 days later!
I am not sure what to make of this.
It turns all previous research on the subject on it’s head.
Now, the report was short on detail, and it seemed to say that what they found was viral RNA.
I am not sure if it is a fact that finding viral RNA means live virus is present, or if it is, if it is infective.
I have read a lot on this topic over the past few months, and at least one or two reports were to the effect that some human respiratory viruses can be alive on surfaces but no longer infective. Not that this makes a lot of sense…since viruses are not exactly alive on their best day. What does it mean to be alive but not able to cause an infection in a host? What other definition of alive is there for a virus?
Like a lot of things we hear these days, every scrap of info leads to more questions than answers.
Could be indoors. But direct sun does seem to destroy (or kill, if you consider virions to be alive) them fairly rapidly.
If it can survive on surfaces for that long, I expect it can survive in water supply.
I’m curious what the water treatment is on cruise ships, do they chlorinate the water between reservoir and tap? Are they wiping surfaces down with tap water?
The high rate in Wuhan specifically, in comparison to the rest of China also makes me suspect the water supplies, as if there’s something common they’re all accessing, hence the spread, and possibly why it was so deadly in Wuhan in particular in comparison to the rest of China.
Nicholas, they found RNA..not a live virus
..the report wasn’t short of detail…the media was long on hyperbole…as usual