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
https://www.foxnews.com/media/newt-gingrich-italy-south-korea-coronavirus
Willis,
There seems to be an uptick in U.S. deaths coinciding with increased testing. Are earlier deaths presumed to be COVID-19 (or not) being re-attributed post-mortem? If so, are these deaths counted on the date of death or the date of the test results? It would change the shape of the curves.
John Bell March 24, 2020 at 11:46 am
“Why now? The Chinese have been eating bats (or however this started) for 1000 years, why did this not happen before now?”
Lancet: Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%).
My DNA has 97.5 % identity with a DNA of a mouse and 50% with the DNA of banana.
Mistakes do happen, and this is going to be a very expensive one.
There are four corona viruses that are constantly circulating amongst human beings and causing one out of three common colds.
So my guess is, it has happened many times, some do not become widespread, and of the ones that do… over time we get used to each one after a while.
Wuhan virus has a tiny genome, which evolves very rapidly. The ID with bat and pangolin coronavirus genomes is based upon sequences.
Even for us cellular organisms with much more stable DNA as the storage molecule, one needs to be careful to compare like with like. In eukaryotes, the comparison can be with the mitochondrial DNA, the whole nuclear genome or only those sequences coding for proteins, ie “genes”.
For instance, human and chimp protein coding sequences are 98.5% identical, but the “junk” sequences diverge more, as would be expected because epigenetic material includes control areas, such as for how long body hair or leg bones should grow.
Corn (maize, or in Chile choclo) and its wild Mexican ancestor teosinte are 100% identical in terms of proteins. Their startling differences are entirely because of control sequences.
Who says it hasnt happened before? we are a much better informed and aware world now so we know what goes on in other countries. Sadly we are also far more connected than ever before so spread is far more dynamic.
One factor in the coronavirus pandemic to justify a strong response, is the traumatic nature of death by coronavirus viral pneumonia. It’s a bad way to go, essentially drowning while coughing up blood from fluid filling lungs. And isolated from all family and friends.
Findings from the Wang et al study published on JAMA and based on 138 hospitalized patients show that,
despite the talk of needing more respirators, that once Covid19 goes down the path of serious complications, time is short and chances of successful treatment are not high.
https://jamanetwork.com/journals/jama/fullarticle/2761044%20
The median time observed:
from first symptom to → Dyspnea (Shortness of breath) = 5.0 days
from first symptom to → Hospital admission = 7.0 days
from first symptom to → ARDS (Acute Respiratory Distress Syndrome) = 8.0 days (when occurring)
Fear of a bad end like that is inspiring a lot of popular support for the lockdown policy.
Note also – Covid19 has a long tail.
Among those with serious illness who “recover”, many have permanent lung damage and they can remain hospitalised, even on a respirator, for weeks or even months. That’s why in China, where the spread has long been curtailed, there are still several thousand patients in intensive care. You never get that with flu. Comparisons of Covid19 with flu-colds are inaccurate and not helpful.
Evidence suggests that this is a multi-factorial illness with more than one cause. Flu for most, but more severe to deadly for various risk groups.
Hey Willis, Fearless Leader says he’s going to back off on restrictions by Easter. You are a smart guy, will he listen to you and can you please change his mind?
I read an interesting piece which compared Italian and Japanese aged health care models.
Italy relies highly on low paid migrant workers (both legal and illegal); many of whom are poorly trained, speak little Italian and come from countries with poor hygiene standards.
Thanks Willis – for a well-written dose of sanity amid the panic and hyperbole. The Italian analysis answered many questions.
My concern is the reliability of the data. China has been attacking those who have been raising concern since the beginning. From defaming Dr. Li Wenliang to shutting down people reporting on happenings in China itself while blaming the US for the origin and claiming that the epidemic had ended in China.
Italy may have overstated the number of cases and of course, with limited testing in the US, the true numbers cannot be fully known.
This leads back to the old maxim: Garbage in, garbage out.
Willis, great data charts and I like your use of starting with the day since first death.
It would appear from your charts that NY is on track to get to ‘common flu level’ in 15 days (assuming they do not bend the curve), which is half the time that it took Italy to get to that level (31 days). Several of the other states (same assumption) will get to that common flu level way before Italy.
NY has ~12% of population over age 65 with Italy at ~22% over the age of 65.
Would that counter your suspicion that Italy high death rate is primarily due to “And in some fashion, it got into the medical system.”? Or would you make that same suspicion in NY?
It seems that quarantining the country from travel to and from these hot spots in this country should be considered, similar to what Florida just implemented. Trump is looking to relax restrictions where it seems to me to be too early to make that call. Unless you are trying to solve the Social security trust fund issue.
New York state is also running a clinical trial beginning Tuesday of a treatment regimen of hydroxychloroquine and azithromycin, two drugs that doctors in Africa and elsewhere say they’ve seen anecdotal evidence it may help fight the virus. The state health department will also be running a clinical trial using the blood plasma of recovered patients to treat new infections, he said.
https://www.cnbc.com/2020/03/24/troubling-and-astronomical-coronavirus-cases-increase-urgency-for-hospital-beds-new-york-gov-cuomo-says.html
The blood plasma will definitely work.
As for that other stuff, Over a week ago we saw a directive for emergency room doctors from at least four countries in the EU list it for the treatment of choice of all but the worst off of the corona virus patient.
Over a week ago.
They apparently have plenty.
People are dying in large numbers of this in all of those countries, and I am looking for but not seeing some diminution of the numbers in those places.
If that stuff was working, why are so many still dying?
One possibility is that it is not working.
I suspect any of the things we have to use will help at best some fraction of patients.
This is what is usually found with with antiviral therapies until a lot of work has been done, typically over many years, and combinations are identified that become either gradually or sometimes and occasionally dramatically more effective.
I can recall zero instances of a new disease of such a nature being overcome with off the shelf drugs in more than a percentage of people.
Chloroquine increases the effectiveness of zinc anti-viral activity, and the antibiotic protects against additional bacterial infection. Plasma from people who have antibodies can be very effective. The virus is not transmitted through blood.
My point is that people are still dying in the places that have made hydroxychloroquine the standard of care, and in fact the number of daily deaths has increased sharply since that standard was adopted.
So if it does work, it is only working for some, and only helping somewhat.
The clinical trials testing chloroquine over the past two decades vs various viral illnesses have all failed to show any direct antiviral benefit.
Also, these are drugs taken by many millions of people over many decades, so if it is a general wide spectrum antiviral, as is implied by the assertions made for the value of these drugs, why has no one ever documented a decreased incidence of viral illness in the people who take it for malaria?
The benefit for people with lupus and RA was noted soon after usage began over 50 years ago.
I think if it cured people of viral illness, it would be impossible no one ever spotted that correlation, or noted that effect.
And now it seems very apparent that much of the hype was ginned up by a known fraudster and huckster.
We can hope for a strongly positive effect, but we should all be prepared for some disappointment once results are tabulated and analyzed.
re: ” in the places that have made hydroxychloroquine the standard of care, and in fact the number of daily deaths has increased sharply since that standard was adopted.”
Holy Toledo.
Can you substantiate any of that? Broad, sweeping statements like that require it. If you EVEN had a phone call from a physician or nurse ‘on the ground’ that would work towards same …
re: ” people are still dying in the places that have made hydroxychloroquine the standard of care ”
AND on the other hand, we have this ‘nutball’ Vladimir Zelenko who has now claimed to have cured: “699 coronavirus patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak”. Last week he had claimed 350, then later the number was 500, and now the number is 699.
Last Wednesday, we published the success story from Dr. Vladimir Zelenko, a board-certified family practioner in New York, after he successfully treated 350 coronavirus patients with 100 percent success using a cocktail of Hydroxychloroquine Sulfate, Zinc and Z-Pak. Now, Dr. Vladimir Zelenko is providing updates on the success of the treatment.
https://www.fliegerfaust.com/coronavirus-update–2645583199.html
———–
Whom to believe (accept as authoritative, presenting actual facts) – you, NM, or this other nutball VZ?
Side note: I’m just a ‘trier of fact’ passing on information at the moment.
A new report by the CDC has “The virus] was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted.”
We are quickly at the point of being unable to stop the spread. It’s time to let healthy people get infected while we isolate the vulnerable for a month or two.
Identifying a virus does not mean it is alive or contagious, me thinks.
exactly…they found RNA…not a live virus
My skeptical meter is still working. Thank you Latitude!
It’s time to let healthy people get infected while we isolate the vulnerable for a month or two.
+==≠========
Agree.
It just occurred to me to consider the fact that although over 7,000 people in Italy have now died (extrapolating slightly from the 6,820 listed in the last daily report), this report only gives data on the about 2000.
So…we know that some people die quickly from this thing, and others linger for a protracted period of time.
It stands to reason that the weakest and most frail are the ones which are expiring the most rapidly after becoming infected…so that may be what we are seeing here…the fraction of the deaths who were least able to fight for their lives.
I am also gonna remind myself and anyone else that with some 69,000+ total cases, something like 3,400 people in critical condition, and only 8,300+ recovered, it is a good bet many many more will die, and they will be the ones who were not so old, not so frail, possibly not having numerous comorbidities.
Over 5,000 new patients are being listed every day recently, and we might take this to mean that lots and lots of new cases are still newly acquired, and thus many more people will wind up in critical condition.
I really am not seeing a lot of sunny news when I drill down into the details.
Kudos to anyone who can look at the bright side, and I mean that with all sincerity.
This is really depressing to me.
A week or two ago, I was thinking that most who die from this will be people who are near or at end of life stage…but i am no longer of that mind.
The information being reported has changed from that view.
Perhaps we should revisit this post in another 2 or 3 weeks time but, at the moment, I feel a bit like the Richard Dreyfuss character in Jaws who tries to convince the Town mayor that the beaches should be closed.
While I’m sure most WUWT readers understand exponential growth there seems to be a significant number who don’t understand that is the reality of this outbreak. The number of US deaths doesn’t sound too alarming at present but there has been 5 or 6 doublings over the past 3 weeks. There is no reason why that rate should not continue. An effective level of herd immunity is a long way off. If the mitigation measures introduced don’t work the death toll could easily reach 30k by mid-April.
I’ll be more than happy to be wrong but I can see the UK heading down the same path. When China widened their lockdown on Jan 24th they had recorded just over 1000 cases.
John what if the virus hit the most vulnerable first?
If Willis is right, then doesn’t the death rate kind of run out of steam? Healthy people just recover?
It will run out of steam eventually – when a population has gained herd immunity.
It might be the old & vulnerable that are dying but it doesn’t mean it’s just the old and vulnerable who will need medical treatment. That’s the problem. Some young, fit people will need ventilators and other critical care. If the health system is overwhelmed there’s a risk they won’t get the care.
I think it is fairly well established that only a proportion of those who will ultimately die, do so quickly, and that many more die over time, as they were stronger and healthier to begin with, and thus are able to hang on for longer.
If the data indicated that anyone who lived through the first two weeks of the pneumonia stage would all recover, we would be seeing that…but it is not what we are seeing.
We are seeing people who started out strong eventually lose the ability to fight on, and many are dying after weeks in critical condition.
Those are likely not the ones who were frail to begin with.
The USA has a doubling time of 2-3 days in cases so maybe 100,000 cases by friday, still showing consistent exponential growth. Similar stats for deaths, 775 at the moment, so over a thousand in a couple of days. Another disturbing factor is that when you look at settled cases is that in the USA deaths are double recoveries. Some better news is that Italy is flattening and may have reached the inflection point.
Willis, you have a freakish talent for looking in the right place for data. I am sure the social conditions and direct flights to Wuhan are part of the story but your analysis is another big chunk of understanding Italy.
I also found your quote from your obstreperous friend valuable. Towards the end he mentions people in Seoul moving to voluntary social distancing. Could you prevail on him to provide some description, images, whatever of what that looks like on the ground. I live in Australia and I have been fortunate enough to visit Seoul and my impression is that it would take major effort to achieve distancing in Seoul equivalent to here on a normal day. I am hoping to get some calibration of how far we need to go.
I tweeted some photos and videos when I went to the market
In words:
I live by this
http://english.visitseoul.net/shopping/I%20Park%20Mall_/1703
Foot traffic is down by about 50%, people keep their distance so no crowding in the cross walks
or by the taxi stands.
https://twitter.com/stevenmosher/status/1239385987639173121
https://twitter.com/stevenmosher/status/1239385731274919936
https://twitter.com/stevenmosher/status/1239342923746955267
https://twitter.com/stevenmosher/status/1239124201618849794
#########
Unrelated, but related.
Watching how other people are following social norms and manners is very very
important in Korea. from how you speak ( formally or informally) to how
you regard other people.
The government doesn’t watch you, other people do
https://www.youtube.com/watch?v=WOs-QrGzLNw&feature=emb_logo
So, other folks will correct you if you go off track, or point out if you are behaving correctly.
watch the fans all follow the bodyguards every action
https://www.youtube.com/watch?v=mV-y8IdSKEs
Nosey as fuck,
Thanks Steve. When I posted I was looking at the thread on my (small) phone and I missed seeing that you were active on it else I would have asked you directly. Sorry about that.
No need to apologize, glad to share
Coronavirus: There is no need to shut down the economy. Quarantine the high risk group and let the low risk group keep working.
Very quickly the low risk group will become immune and the virus will die out. The high risk group can then gradually come out of quarantine.
This will minimize deaths and minimize damage to the economy.
You cannot end a pandemic locally until a large percentage of the local population has immunity. A lockdown will not work unless applied to the whole world due to reinfection from outside.
I endorse this. Let it be done!
IMO, we should be prioritizing masks for everyone in the country being supplied as rapidly as possible, in sufficient quantity so everyone can always have a fresh when when needed.
I suspect it is the only way we get this under control and still have an economy.
Who is the genius at the CDC who is telling the whole country that we should not be wearing masks because they do not help?
Th crazy thing about masks is that they dont really seem to protect the user, but others. Thats how doctors use them for operations. It is an act of solidarity to wera a mask!!
Surgeons wear masks so you cannot identify who operated on you.
Virtually no studies exist proving masks protect surgeons though they might slightly help the patients if the surgeon is ill.
Having sterile conditions in the operating theater is a very well understood and time tested best practice.
People have all sorts of things in their mouths and on their skin that do no harm, but very definitely will not be good to have inside the body or under the skin.
Masks work.
Look at the places that have got this under control.
We seem to want to ignore this single aspect of what they have done in South Korea, and in China, and now we find out, what they have done in Slovakia.
This order to not wear masks in the US, I will wager anyone interested, will turn out to be one of the worst blunders in the history of medicine, and certainly in the history of this event, once it is written.
I thought that the Masks primarily do two things:
1) They protect others from solid particles spewing from the wearers mouth
2) They may protect the wearer’s nose and mouth from having particles of someone else’s sneeze.
Is it practical for everyone to wear a mask every day in public?
Yes it is. It is only little inconvenience. See our new government picture: 🙂
https://domov.sme.sk/g/154838/podpis-koalicnej-zmluvy-a-vymenovanie-vlady?gref=strm_art-22364645&photo=p6189061#
In Slovakia masks were ordered in shops, public transport and gatherings 2 weeks ago. Now they are ordered outside without exception.
Our first patient was 6th March, we had substantial inflow of positive people from Italy and Austria.
After 18 days, we are at 216 positive, mostly returnees from abroad and contact with them. Today we had 12 new cases.
See our graph:
https://domov.sme.sk/c/22367242/koronavirus-sledujeme-minutu-po-minute-25-marec-2020.html
Our country has 5.5 million people, comparable with New York. In New York first case was detected around week later than in Slovakia.
Now see what is situation in New York:
https://nymag.com/intelligencer/2020/03/new-york-coronavirus-cases-updates.html
Excellent.
In the end, I am confident we will find that masks are very important in slowing the spread and protecting people.
It is not a magic shield or silver bullet.
It is one more tool in the kit, one more layer of protection.
It stops the vast majority of what is in one’s mouth from spewing into the air, and from what is in the air to being inhaled into the nose and mouth.
Masks are for the sources, not for the “receiver”
Of course I know that masks are mainly for the protection of other people.
But not completely.
After all, doctors do not wear them in the operating theater to keep from getting something a patient may have.
But besides for that, and assuming it is true that they provide zero protection for the wearer…this is why everyone has to wear one.
No one knows who carrying and shedding the virus.
In fact no one can know, except in the case of someone who has already cleared the virus and is now immune.
But no one even knows for sure at this point if someone who has recovered from feeling sick is indeed no longer shedding virus.
The point is, as long as the virus is in circulation and there are people who have still not been exposed, everyone must assume that any given person MAY have the virus and be shedding it.
Therefore, unless we are all going to stay inside until all the virus is gone from every person, we will have to take steps to keep anyone infected from shedding the virus, the the MAXIMUM DEGREE POSSIBLE.
The logic is inescapable. No one can know if they are a carrier, and no one can be sure someone else they come in contact with is not a carrier.
So the only way we can get on with have a civilization is to stop being afraid to go outside, and to do that we have to stop being concerned that every single person we encounter MAY be spewing virions by the billions per breathe.
And even if the masks are not perfect, it is just like the fact that hand washing is not perfect: We not not have to avoid every single virion. One virus particle is not sufficient to infect anyone. Neither is a hundred, or a thousand.
A typical infective dose for a typical virus is in the hundreds of thousands to tens of millions, over a short interval of time, and whatever the average number is, it is far higher for some people and much lower for others.
This is why everyone does not get every illness going around, even if you are in a house with someone with a virus, and they are for sure spewing virions by the trillions per day. We have layers of defenses inside our body, inside our tissues, and inside our cells, to anything and everything, even if brand new bugs for which we have no memory cells or antibodies whatsoever.
And every layer we add to our bodies defenses, like masks, glasses, hand washing, keeping our distance, not touching body fluids of other people, or getting right into other people’s faces, frequent bathing and washing of clothing, etc…increases the odds that if we do get some virus in our body, it will be less than the amount required for the virus to overcome our defense layers and become established within our cells as a systemic infection.
Masks is a no brainer.
Anyone who cannot understand that, just baffles me what they are thinking.
As for them not protecting the wearer, to revisit that…if we rinse our skin and face with something like povidone iodine, which has proven hours long residual action, and we impregnate the mask with something similar or even a layer of fabric soaked in iodine and then dried, we can very likely create a virus proof barrier that is quite effective.
And quite effective is gonna be good enough to keep us from having a great depression scale disaster on our hands.
Thank you Willis for being the Gallileo who questions what all the others say.
The number that we ar normal people can use to guide us concerning risk is not the number of deaths pr positive test. We don’t know the percentage tested, we don’t know how reliable the tests are, and we don’t know how many have had Covid 19 and are immune.
But luckily, like you indicate with your graphs, we can know risk of death by nationality. China is a bit over 2 pr million. Right now, Italy has 6820 deaths in 60 million, 113 pr million.
Annual flu deaths in Italy are around 340 pr million. It the numbers doble for Covid 19, we will still be way below normal flu deaths. And most of the people dying from Covid 19 would be the ones most likely to die from the flu, so if we hadn’t started testing for Corona, we might not have noticed anything at all, especially in China, but even in Italy.
A lot of people die every day from all causes, 1700 pr day in Italy, so many die with Corona, not from Corona. Maybe all the Corona deaths would have died anyway. We really don’t know.
We could know, though. Antibody testing (now available as fingerpick) of 100 random persons would establish the percent who have or have had Corona. 100 normal swab tests of the same group could establish current virus in the system. Maybe authorities are afraid of doing this. It could make them look really stupid if we see that over half of the population has antibodies, and possibly show that it has been around much longer than we think.
The major disease groups in the study would almost all be using ACE inhibitors and could be dying because of that. It is estimated that up to 700 000 patients in the US die every year because of medical errors or side effects of medication, so that wouldn’t be the fist time doctors do more harm than good.
Anyway, the big doctor organisations sign up for Catastrophic Climate Change, so they may not be the ones to trust blindly when it comes to numbers or reasoning ability. And now the cardiac organisations say patients should not change their ACE medication…
“And most of the people dying from Covid 19 would be the ones most likely to die from the flu, so if we hadn’t started testing for Corona, we might not have noticed anything at all, especially in China, but even in Italy.
A lot of people die every day from all causes, 1700 pr day in Italy, so many die with Corona, not from Corona. Maybe all the Corona deaths would have died anyway. We really don’t know.”
And this jackass crap is why we are in the predicament we are in, and will not soon be out of it.
Nils, you must be in the Twilight Zone or some alternate reality if you seriously think if we had not tested anyone we would never have noticed this pandemic was sweeping the world.
As if ignoring it and going on with business as usual would not have meant that what we are seeing now would be many times worse.
You need to keep up with current events if you think only people who would have died anyone are being killed and getting viral pneumonia.
That is nothing like even close to true.
The stats on the first few thousands deaths in Italy are more like if 50,000 people had their heads held under water for five minutes, and someone looked at the ones who were drowned after two minutes and concluded having your head under water was only dangerous for people who are old and sick.
Typo:
“…would have died anyway…”
Hi Willis,
I dont know if somebody have made an analysis on the cost of COVID-19? I have read in one country the stock market valuation have fallen by almost US$150 billion for 2000 reported cases and some 120 deaths. This cost excludes other cost to the whole economy. If this is true, the cost just on the stock market valuation is $75 million per case and over a billion per death. Again just like in climate change debate, the politicians could always claim that the number of cases could have gone to 100 million (far exceeding this country population) so the cost to the economy by taking draconian action is just $1500 per case and the death could have exceeded 10 million or something like 15,000 per death. Hopoefuly, the COVID is not a dry run to throw away $100 trillion to save 10 billion human lives who are at the tipping point of extinction because of climate change.
“The flu kills about 36,000 people a year in the United States, according to the CDC”
P.S. I do not believe the numbers coming out of China. Not the economic numbers, the prison death numbers, the “detained” numbers, nor the COVID-19 numbers.
Either they already had some kind of herd immunity, or those numbers are just flat out wrong.
Looking at death rate is obviously important, but it is not the only metric – and possibly not even the most important metric when deciding policy on things like the lock-down.
If 15% of cases need intensive care and ventilators to survive, hospitals will become over-run and people will die in corridors and waiting rooms. That is what is happening in Lombardy today.
Therefore the plan is to minimise the number of cases, to protect our health facilities.
I don’t understand why this Anosmia (loss of sense of taste or smell) thing is not being picked up on a lot more. Even if it could be due to something else, so can the other 2 main symptoms. If this is a symptom shown by many of those not showing any other symptoms then isn’t that incredibly important and urgent to be screaming from the roof tops since several days ago and may be very significant in helping us significantly reduce infection rates? It was in several UK newspapers several days ago, but no changes to the advice of symptoms to look for to self isolate, from governments, not even hardly any comment or discussion on it that I can find. Even if it turns out to be irrelevant, until we know that for sure isn’t it a case we would have little to lose adding it to the list of symptoms now and potentially a huge amount to gain?
I don’t understand when they say it is a new symptom; does that mean people didn’t have it before or is it a case we just didn’t pick up on it until now and if we asked all those from the early days of this virus that didn’t show symptoms but tested positive many would say “now you come to mention it, yes”? How soon does it appear? I got the impression, but could be wrong that it appears about the time you could start to be infectious, unlike the other symptoms, hence incredibly important and we shouldn’t delay waiting for peer reviewed papers?
Beat up.
True anosmia is extremely rare and is not a common symptom. In corona virus.
Some loss of smell is to be expected in a small number of respiratory infections if the developer sinusitis.
The story is a total beat up.
If you do develop anosmia it is a sign that you might be developing Alzheimer’s.
Be a shame to recover from the virus and find the true (still very,extremely rare) cause.
My case was very unique. Only lungs, very little sinus and no throat. Lung phlegm was not a lot, but tremendous gurgling in lungs… Never had I started a lung virus, without first having throat and sinus pain. So, fever with aches, lungs and little phlegm compared to flu or common colds.
5 days of this with extreme nutritional support, D3, Zn, quercetin, C, 3x/day and veggy and fuit juice powders and lots of water taken in small qty throughout awake time. Would not have been able to survive without rescue inhaler, albuterol.
I have posted this for others because I think that is what got me through it at 55 yrs of age with a history of lung and sinus issues. I believe there is lots of confirmation that these things work for immune response nad virus weakening support.
I take all of these supplements in moderate doses every day, so I was pre loaded.
NO! That is what you may read in newspaper but it is NOT what is actually reported medically.
The Alzheimer test is for the capability to IDENTIFY smells. That does not mean you have lost your sense of smell, it means you have NOT lost you sense of smell but lost your memory of what that smell is associated with ! ie it is a memory test.
Since the association is quite subtle, this is often a more demanding test than asking if you can remember what day to the week it is.
The problem is sorting out cause from effect with messy, often inappropriate data.
The post on South Korea shows a typical pandemic survey protocol- basically tracing the path to infection and the spread from an infection. You can’t reliably break a chain of infection if you don’t know how the chain is tangled and interlocked.
Good analysis Willis.
You might want to reflect that right across Northern Europe, including Italy, there are no excess deaths, indeed they are lower this year than the average.
https://www.euromomo.eu/slices/map_2017_2020.html
https://www.euromomo.eu/outputs/zscore_country65.html?fbclid=IwAR0j5zB5rWYoxEnEyM4V3FOHSXgUgohHIOm5mmRuP9A7maGvj9p1u-lJAjw
Not all these coronavirus deaths are real excess deaths a proportion would have died anyway as they are old and/or have significant health issues.
Germany is comparatively low for a number of reasons, one of which they are not checking for the virus postmortem and deaths are getting recorded for the underlying health issues. Italy, Spain etc are checking all deaths postmortem and if the virus is present that is going down as the cause.
The measures these European countries have taken has reduced the transmission of all other respiratory diseases as well, protecting the old and vulnerable.
Take the UK.
Here is the Government site which records statistics around deaths each week in the UK.
https://www.ons.gov.uk/peoplepopulat…nglandandwales
It compares that weeks deaths with the average over the last five years for that week. Of course you would imagine that this year, with the population growing over those five years and with it ageing slightly, that we would be getting a few more deaths than the past average. However, up to the 19th of March the UK has had, cumulatively over 4500 LESS deaths than the average.
Deaths due to respiratory causes have dropped sharply since the third week in January, when the UK started getting serious with hand washing and separation etc more than a third lower than 10/01 for instance. The individual protective measures, such as the washing of hands and social distancing will be impacting on the other respiratory illnesses people catch.
Deaths continue to occur by and large in the elderly and with very few under 45.
Also of course, you have to figure that the UK population increased about 3.4% over those five years and continued to age slightly. I would have thought we should be seeing an EXTRA 3-400 deaths a week compared to this average if we were standing still so to speak.
If you look at the 11 weeks of winter prior to the start of the fall off in deaths in late January, we did indeed see an extra 4000 deaths in that period compared to the 5 year average for those 11 weeks.
It’s now after midnight GMT. I don’t know if this site has made its last update or not, but at present, the US had fewer new cases yesterday (still today in the US) than the day before, 9876 vs. 10,168. For new deaths attributed to the Wuhan virus, it’s 145 vs. 140, so slight increase. But WA State had no new cases or deaths, vs. 930 and seven.
Of the 9867 new cases and 145 new deaths, 5621 and 70 were in New York and New Jersey.
Final was 11,074 new cases, so an increase, but up less than 10%. New deaths 225, up from 140.
https://www.worldometers.info/coronavirus/country/us/
In final tally, WA had 248 new cases, vs. 225 the day before.
Might be flattening out.
NY Metro Area still the epicenter.
Exactly, STOP public transport.