A frank open letter from an emergency room doctor on #COVID-19 – The “surge” is coming

This letter from our local hospital ER doc has been circulating on social media in my town. It is applicable for anyone, anywhere, to read and heed. Note “the surge” section – Anthony


Dear Butte County and all the folks who may under the care of Enloe Medical Center,

I am one of your local Emergency Medicine docs at Enloe Medical Center. So I’d like to take a moment to explain Covid-19 and how and why it is impacting our community.

Specifically, I’d like to go through the basics of the illness and (as a consequence) what Enloe Hospital is doing to meet the coming crisis.The first thing I will mention is that the Covid-19 disaster is an extremely dynamic and changing situation.

Every day at the hospital we are meeting constantly and changing policies–directions from world, federal, and state programs change multiple times per day. This is an unheard of pace of change.Here are the basics about the Covid-19 illness. The virus is highly contagious. It is predicted that eventually, nearly everyone will be exposed and been infected.

A very few very lucky people may not develop any symptoms at all. The vast majority of people will get a mild syndrome of variable symptoms including “flu”–fevers, achy-ness, upper respiratory congestion (ie nose and throat symptoms). Then they will get over it. And probably wonder what the big fuss about it was. Younger children may have an even milder syndrome.

However, during the typical 7 days of mild disease and then another 7 days later, all infected patients will be spreading this virus. If you turn up to the Emergency Department with mild illness, you will be screened (important factors such as vital signs and your oxygen saturation percentage), and likely sent home with 2 important instructions: signs of worsening illness, and strict self-quarantining precautions.

However, if you are unlucky, after the initial mild syndrome, instead of getting better, you may get worse. You may develop worse “flu” symptoms and then pneumonia–filling of the lungs with infected fluid.

These are the patients that will be admitted to the hospital for general care and observation. Once again, the majority of these moderately ill patients will get better.

However, if you are very unlucky, over the next day or two, instead of getting better, some patients will turn for the worse and will develop a form of ARDS (Acute Respiratory Distress Syndrome) whereby the lungs will become completely saturated with fluid and will need to be placed on “life-support”, that is a mechanical ventilator. They will be transferred to the ICU (Intensive Care Unit) until their lungs can recover.

A large proportion of these patients will eventually recover, but some will not.There are some clear risk factors for ending up in the ICU. Older age and baseline medical illness (diabetes, chronic heart disease, chronic lung disease) make it much more likely to go on to ICU-requiring Covid-19 illness. However, even perfectly healthy adults can develop serious illness. Fortunately, younger children are almost entirely spared.The overall picture of this sort of illness is NOT new to the medical community. Most of what I have described above (mild/moderate/ICU levels of illness) can be applied to the Influenza virus, which we have been dealing with for years.

The concerning difference is the infectivity of the Covid-19 virus, and mathematics.Using some basic simplified statistics will yield math that is causing everyone in the hospital to enact drastic measures.

Enloe Medical Center covers roughly 300,000 people in Butte and surrounding counties. As I mentioned everyone will get Covid-19. If only 0.5% of patients who get Covid end up in the ICU, that will be 1,500 patients requiring an ICU. Prior to our Covid planning, Enloe had only 20 ICU beds. 1,500 patients will not safely squeeze into 20 beds. This, my friends, is the SURGE. This was what overwhelmed the hospital systems in China and Italy.

Make no mistake the surge is coming.

So pretty much everything we are doing- all this “social distancing”- is to even out this massive surge of patients and spread them out over time, as opposed to having all of them show up at our hospital at once.And the analysis of China and Italy has produced a clear message. The most effective strategy to mitigate the surge is strict quarantining. Not disease testing. Not experimental medications or specific treatments. Quarantining, social distancing, whatever it takes to slow (not stop, not cure) the spread of disease.

So take quarantining and social distancing seriously, because it will save lives.

And it may be hard to take seriously, because as I mentioned the vast majority of people will only get mild illness. And then they may ask themselves, why did I go through so much trouble, not being able to go to my favorite bar.

Even more seriously, the economy is heading downhill and many people are not getting paychecks. For a mild “flu”. Again, the answer is that all of the sacrifices are NOT for the mildly ill, but for the unlucky ICU bound. And that may be you or your loved one. Picture this:

Scenario One–your loved one is developing ICU level pneumonia. The team of doctors, nurses, and care-givers identify this, treat your loved one and move her to the ICU.

Scenario Two–your loved one is developing ICU level pneumonia. But there is no room in the ICU and she is put on a jury-rigged breathing contraption for life support in the hallway outside of the Emergency Department. Next to 60 other patients in the same situation.

And the message from China and Italy and other countries has been specific–the most effective strategy to avoid Scenario 2 is aggressive quarantining of the mildly ill and EVEN asymptomatic.Employing strong individual efforts to prevent contracting Covid-19 will slow the progression and buy time to smooth the ICU surge– and it may also buy time for doctors and scientists to develop and test treatments and vaccinations.Some common questions that I have been asked–Why can’t I be tested for Covid?

Every day, the hospital is attempting to obtain methods for rapid testing of Covid, but as you might imagine the supply of testing materials is a lot more rare and much more expensive than toilet paper.Another common question is: Does it seem that the hospital is over-reacting? The answer is “We hope so!”

And–don’t forget that hospital workers are at highest risk for exposure and spreading the illness. Which is why we are trying to be so meticulous about infection prevention–don’t be surprised if you end up in the Emergency Department, respiratory issues or other standard ER problems, staff are wearing gowns, masks, and greeting you from a distance. If a hospital worker starts to show symptoms of infection, this will remove him or her from a very limited working pool for a long period of time. And we need every hospital worker we have.

Another comment I would like to make: If you have an elderly family member or loved one with advanced illness, please take the time to appreciate them. And then discuss the possibility that they might develop severe Covid-19 illness. No decision at this time has to be final, but it is better to understand where everyone stands prior to the storm hitting.

Here is another question: When? This is a tricky one, because we do not locally have quick testing for Covid-19. The current wait time to get a test result back is over 1 week. Our first official Covid positive test in Butte County was on Saturday March 21. As of today (Mar 25) there are at least 4 documented positive cases in Butte County, though likely there are many more people who are infected but have not been tested, due to the shortage of testing kits and assays. So people in our community are right now progressing through the contagious but mild symptom stages. We anticipate pneumonia and ICU patients declaring themselves within the next few weeks.

Thank you for reading, and thank you for keeping Chico safer,

Ivan Liang

Ivan Liang,
MD FACEP FACMT

https://www.enloe.org/find-a-doctor/find-a-doctor?id=232

315 thoughts on “A frank open letter from an emergency room doctor on #COVID-19 – The “surge” is coming

  1. New reported cases and deaths fell yesterday in the US. Most of the improvement in new deaths came in NY (down to 82 from 277 the day before). About a quarter of NY’s deaths came in nursing homes.

    Day to day data for the US:

    March 28: 19,452 new cases; 525 new deaths;
    March 29: 18,469 new cases; 264 new deaths.

    https://www.worldometers.info/coronavirus/country/us/

    Drop in new cases despite increased testing.

    Rates of increase are also falling in the UK.

    Could be a one-time wonder blip. We’ll see.

      • He forgot scenario 3
        Scenario Three – Your loved one is developing ICU level pneumonia. The team of doctors, nurses, and care-givers identify this, treat your loved one and move her to a non ICU – quarantined hospital room with a ventilator and ICU level monitoring because stacking contagious patients in the hall outside Emergency is the surest way to infect the entire hospital

        • scenario 4…

          They start passing out the two malaria drugs like after dinner mints…

          ….FDA just approved them and so did France

          • After this is ended, let’s hope they will have learnt something about the need for real, rapid response to real threats. People did it in WWII and we can still do it today when not shackled by bureaucracy. especially with a bit of relatively cheap foresight. No need to reverse the industrial revolution.

            Hopefully, sea level rising at 1 to 3 mm per year really will be put in its proper perspective after this.

          • I would also question his statement about “unproven remedies”. 78/80 in the French study got better quickly with hydroxychloroquine and Azithromycin. That’s 97.5% folks.

            As to the statement that testing doesn’t work South Korea would beg to differ.

            Maybe he wasn’t aware of these things. I’m sure he is busy.

          • Been feeding the family tonic water for 10 days in hopes it helps knock the worst edges off it if we get it as we isolate as best possible

          • Hopefully, sea level rising at 1 to 3 mm per year really will be put in its proper perspective after this.

            I doubt it. The “rising sea” scare-moniker is like a drug — they can’t give it up, no matter how ridiculous. Same w/the the sea-ice crap & polar bears.

        • We in the medical field call it “nosocomial” infection, infections caused by or inside hospitals. We also talk about “iatrogenic” infection, these caused by actions of doctors.

          Winter is the coronavirus season. CVs are the second most usual causal agent of what we call the “common cold”. The most usual cause of common colds are rhinoviruses. There are dozens of each of these two types. This is why we can’t have vaccines for the “common cold”.

          COVID-19 is a common cold virus. Very contagious, as are most of these (common cold viruses), but very mild compared with influenza viruses, in general. You can tell because these coronas spare children and infants (Thankfully!) who are in danger from flu, because flu gives very high fevers which babies cannot thermoregulate, and these may perish in the early going.

          Why the panic, if what I say is true? Because, this is the first time in history that we can 1) identify COVID-19 AND 2) Test for it, AND 3) track it globally. We were able to do these things a little bit beginning with SARS in 2002, then MERS in 2012, but we did not have full global participation then, nor the high capacity for testing.

          Note that there are about 9-10 years between corona outbreaks, possibly because of some residual immunity among the subtypes in successive generations. Children below 10, therefore, get it, have normal colds from it, then become effective carriers to the elderly.

          In coming years, we will have developed quite a lucrative industry in virology. I predict the next “killer” will be a rhinovirus (head cold). It will have a name.

          All viruses are killers in managed health care facilities where elderly are warehoused.

      • The figures are live as reported, on weekends you need to take care they don’t reconcile them until Monday. I noticed it having watched the data for 3 weeks now

        The numbers ended up
        March 29: 19913 new cases and 363 new deaths
        March 30: 20353 new cases and 573 new deaths

        • Those numbers are meaningless absent the important “total persons tested” metric. 20,000 “new cases”. If you have tested 25,000 people, it’s a catastrophe; if you’ve tested 250,000 people, it’s a concern; if you’ve tested 2.5 million people, it’s less than 1%.

          • COVID-19 is the name of the disease, not the virus.

            The CDC recognizes seven species of human coronavirus, counting Wuhan as separate from the SARS virion:

            https://www.cdc.gov/coronavirus/types.html

            Human Coronavirus Types

            Coronaviruses are named for the crown-like spikes on their surface. There are four main sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta.

            Human coronaviruses were first identified in the mid-1960s. The seven coronaviruses that can infect people are:

            Common human coronaviruses

            229E (alpha coronavirus)
            NL63 (alpha coronavirus)
            OC43 (beta coronavirus)
            HKU1 (beta coronavirus)

            Other human coronaviruses

            MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
            SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS)
            SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or COVID-19)

            People around the world commonly get infected with human coronaviruses 229E, NL63, OC43, and HKU1.

            Sometimes coronaviruses that infect animals can evolve and make people sick and become a new human coronavirus. Three recent examples of this are 2019-nCoV, SARS-CoV, and MERS-CoV.

        • “Coronavirus” is a family of viruses, of which the virus responsible for COVID19 is only one.

        • We don’t know how many. I believe CDC has 7 genotyped so far. Very common type of virus (see my other post). Should be hundreds in history, since viruses are known to easily recombined with other RNA to produce a new coating of protein. They don’t “mutate” or “evolve” per se, rather they recombine with pieces of other RNA.

          • Virus most certainly do mutate and evolve. Many rapidly. Thank God, the WuFlu virus mutates more slowly than most RNA viruses.

            But in Iceland alone, 44 mutations have already been detected.

            Viruses do indeed combine with others in horizontal transfer of genetic material, ie nucleic acid sequences, but they also mutate and evolve with reckless abandon.

            Fundamentalism and creationism k!ll.

      • I cannot agree that the article is “hysterical nonsense. A lot is made of statistics for “ordinary” flu, but WuFlu has to spread through the population before it can become an “ordinary” flu. Until that has happened, its infection profile is very different to “ordinary” flu. The efforts being made to slow its spread are aimed squarely at preventing it from swamping the hospital system: “all this “social distancing”- is to even out this massive surge of patients and spread them out over time, as opposed to having all of them show up at our hospital at once“. Once that has been achieved, WuFlu can join the family of “ordinary” flus, with a more regular annual incidence modified by a partially successful vaccine. Until that has been achieved, “social distancing” makes a lot of sense.

        I do think that the US approach to WuFlu is better than a total shutdown, because it is aimed at having the virus spread at a rate that the hospital system can cope with, rather than trying to prevent its spread altogether. Countries that do the latter risk having the virus re-emerge in an unexposed population and hence putting everyone through the whole thing all over again.

        • Without a proper antibody test for WuFlu it is impossible to tell where the virus has been. As it is apparently quite infectious, it would move through the population quite quickly. But, we did not really start testing for it until sometime in late February.

          In the Wheeling, WV area, many of us are convinced that this virus moved through here in late January, early February, which is when some of us were very ill with all of the listed symptoms. This last month hardly anyone has fallen ill. We have been there and done that.

          Only an antibody test will allow us to properly apply epidemiological methods.

          So, far we have very radical and over-hyped predictions of deaths from WuFlu, while the actual numbers do not make sense. Why would whole parts of the country seem to not be getting this virus thus far when it is so infectious? Perhaps because it has already passed through earlier in the year. Instead, we have wanton predictions that these areas are going to be ravaged. It makes no sense considering how fast the virus moved around the world and the many people moving between states constantly. Again, the numbers do not add up.

        • I think the article is wrong. Many victims need air and ventilation to get them through. Number of days on ventilation for many is 10 days or more. This means entire hospitals are being clogged up with patients filling wards, corridors. The amount of resources needed to look after this many patients is a logistical nightmare. Add the strain on doctors, nurses and support staff. All doing this within an highly infectious environment. It is closing down the health care system.

          On a positive, US deaths have remains stable. Self distancing and isolation kicking in, US doctors are using different techniques and treatments or a mixture of both.

        • I’m no expert nor very knowledgeable on these fields -perhaps that let’s me see Reality in a different and perhaps less biased way?
          If what you assert here were the case, the data from an actually closed case, the Diamond Princess cruise, would show much worse numbers. However, zero point five percent fatality ratio, and that being a population prominently of elderly people (stranded and abandoned and being the first live guinea pig of this virus-phobia event watched by the world, but from a distance -with the ensuing trauma, which kills as a virus or perhaps more). That alone tells me a way different story, and also tells me (again, no ‘expert’) that this is no’ new virus’ at all.
          What am I missing?

          Also, the cases of:
          -Taiwan (next to China, great mingling of people for long time until they closed borders, going on since, allegedly, October? November? when the proverbial patient zero should have been already roaming lose)
          -Liechtenstein (no “social distancing” orwellian nonsense; no lockdown; no deaths)
          -Sweden (no “social distancing” orwellian nonsense; no lockdown; almost no deaths)

          Do you know what they all have in common? they all do NOT implement WHO’s totalitarian policies so far. Isn’t it quite the politicized virus? I have a different view on the body-mind-environment though, and I work with it; it’s not just theoretical. And it too comes from Science (see Polyvagal Theory, Stephen Porges).

          Furthermore, Gibraltar, with a grand total of ZERO deaths, IS LITERALLY IN SPAIN, which reports up to 10000 deaths and keeps ramping up mass-panic daily for three weeks now, opening the news reports with the fucking number as if that was all there is to it. In here, mainstream media lies and pushes fake-news every single day, it’s crazy. What about this in your country btw? Anyway, high ‘co-mingling’ between Gibraltar and Spain too; so, what is that about?

          Ths virus does behave as a highly politicized one to be honest.

          Do you see anything wrong here btw? or it’s just me?:
          https://health.hawaii.gov/vitalrecords/guidance-for-certifying-covid-19-deaths/
          I’m asking honestly.

      • Wally

        Well, you live up to your name OK.

        This has nothing to do with numbers reaching pandemic proportions, it’s about stopping it doing so.

        It’s the speed at which it propagates, and the ease with which it does so. It may not even be as deadly as flu, but it makes up for that by ruthlessly killing people who show the least weakness.

        And whilst the west has sophisticated technology, we have neither prevention nor cure. And our fatal weakness is not even that, it’s the facilities and personnel available to care for the sick. We simply don’t have the beds, nor the ventilators to deal with the number of sick demanding Intensive treatment.

        And as the numbers of cases rise, the number of medical staff falls as they succumb to the virus.

        I suspect the real threat of this virus is not it’s ability to kill people, but the speed at which it seeks out potential victims. Ripping through our youth virtually undetected, who carry it to adults, undetected.

        • Maybe we should call it the Xi Flu instead of WuFlu, if it specifically attacks those that show any weakness.
          Seems more apt, he goes for the jugular without fail

      • Six species of coronavirus are known to infect humans, some of which have more than one strain. The number afflicting other mammals and birds is untold.

        • COVID-19 actually is the name of the disease, not the virus which causes it. The virus which causes the disease is labelled SARS-CoV2, which for short, I call Wuhan virus.

          If each bird and mammal species suffers from as many coronaviruses as humans, then there are on the order of 100,000 of them.

      • Anyone who thinks this “is hysterical nonsense” go down thread and read:

        Rud Istvan March 30, 2020 at 12:18 pm

        • We have doomsday prep group like Mosher on one side, and it isn’t happening and why I am in locked group on other side … there is no perspective it’s just fun to watch.

    • Probably best to wait before considering any of those as a trend, especially given Italy’s experience.

      • At about 20 mins he talks about Italy; basically the perfect storm. Also the 40 doctors who died
        appear top be taken from an obit page of a medical magazine; includes 90 year olds; not those in hospitals.

        Perspectives on the Pandemic: Dealing with Coronavirus, a fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data. Dr John P.A. Ioannidis is a professor of medicine and professor of epidemiology and population health, as well as professor by courtesy of biomedical data science at Stanford University School of Medicine, professor by courtesy of statistics at Stanford University School of Humanities and Sciences, and co-director of the Meta-Research Innovation Center at Stanford (METRICS) at Stanford University. See his thoughts in writing here: https://www.statnews.com/2020/03/17/a

        https://www.youtube.com/watch?v=d6MZy-2fcBw

        Prof. Dr. med. Sucharit Bhakdi, Facharzt für Mikrobiologie und Infektionsepidemiolgie, leitete 22 Jahre das Institut für Medizinische Mikrobiologie und Hygiene der Universität Mainz. Er hat einen offenen Brief an die Bundeskanzlerin geschrieben mit 5 Fragen, die nach sofortigen Antworten verlangen, um festzustellen, wie begründet die derzeitigen massiven Einschränkungen unserer Grundrechte sind. Das Video erläutert die Fragen und deren Hintergrund. Der ganze Brief im Wortlaut mit den Fragen, Hintergründen und Referenzen kann hier eingesehen werden: https://docdro.id/23IE5dj

      • Italy, for whatever reason, is believed by the NIH to have over reported virus caused death by a factor of about 8x.

      • Italy has:
        a poor healthcare system, 7 ICU beds per 100,000,
        the 2nd oldest population in the world,
        many smokers,
        highly social people,
        and 300,000 Chinese moved to the Milan area from the Wuhan area in the last decade and who commute regularly from Wuhan (I think 3 flights a day).

        So, do I wonder why they got hit fast by the virus? Also, the woke Milan politicians, when the virus scare began, tried to smooth over people avoiding Chinese by starting a “Hug-a-Chinese” campaign. How stupid can you get?

        • The area afflicted in Italy the worse has some of the highest air pollution in the world, the same was true for China.

        • The Lombardy region also has the worst air pollution in Europe. The other hotspots, Wuhan, China and Qom, Iran do, have bad air pollution too.

        • Lesson one to learn from this. When a flu kicks of in another country, stop all flights from that country.

      • New cases have fallen for three days and deaths for one. With under six hours to go today in the UK, cases are up slightly but deaths down again. We’ll see how the day ends.

        • that is because in the UK the whole country is locked at home, in the US your first amendment and your stupid adherence to its importance will mean many many deaths, I cannot believe that sane intelligent people are trying to second guess facts, just because it goes against what they believe is an inalienable right, people here are showing that they are just as bad as climate alarmists, they ignore the facts because the facts don’t agree with their beliefs. I also note that more people are going to be more sceptical of models from now on. which is a good thing for the climate argument in the future…if there is one.

    • The drop in covid cases is due to stopping the spreading of the virus by isolation.

      The covid cases will, if we keep isolating, drop to some low number.

      How low that number is, will depend on, how effective and long we can keep isolated.

      A vaccine I heard was a year away.

      I do not believe China has zero internally generated cases.

      Anyway, what appears to be good news about covid.

      This is more on the anti-malaria medicine hydroxychloroquine which we discussed at here, and Roy Spencer found other evidence, that supports the assertion that it is effective against flu like illness.

      A doctor from New York, Dr. Zelenko, appears to have somehow found a breakthrough treatment for Covid-19.

      He said he has had (600 patients)

      “…100 percent success using a cocktail of drugs: hydroxychloroquine, in combination with azithromycin (Z-Pak), an antibiotic to treat secondary infections, and zinc sulfate. Dr. Zelenko said he saw the symptom of shortness of breath resolved within four to six hours after treatment.”

      This is his interview/discussion with Rudy Giuliani.

      Apparently, Rudy talked to Trump…

      … and now there is a pharmaceutical company that has donated 30 million doses of hydroxychloroquine to the US for emergency distribution.

      https://www.youtube.com/watch?v=1TJdjhd_XG8

      https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/

        • Been there, done that. 4-6 months for initial viable antibodies is SOP. But then they have to be Humanized (remove murine bits of the ‘Y’ and add human bits so the immune system doesn’t attack them. Then you have to spool them up in a cho cell bioreactor making the ‘monoclonal antibodies’, and then do clinical testing. Developing a biologic drug is a long haul and very expensive proposition. Lets hope the simple generic drug combo works.

        • Might not be the best way to go.

          Quicker, if possible, to inactive Wuhan’s RNA, then blow the envelope and spikes into people’s noses, so that our immune systems can make antibodies against a harmless virion.

          The hard part is figuring out how to render the RNA impotent while leaving enough of the shell to generate antibodies. Could happen sooner rather than later. Or, lamentably, later.

      • Here’s the link to John Hopkins world map of covid-109. Click on countries randomly to see their confirmed versus deaths versus recovered. Recovered usually under 1% and sometimes 0.

        Now click Bahrain. 499 confirmed, 272 recovered? WTF!

        They’ve been prescribing chloroquine and hydroxylchloroquine routinely since end of February. according to a few articles I came across. (sorry, I was surfing on another computer, links not handy).

        How much more evidence do we need? Normal double blind tests take months to roll out . We don’t have months. For every patient that recovers quickly , there’s one less ventilator required . There’s more than one way to flatten the curve…

        • The John Hopkins Virus Map is very misleading as it does not give any current data, more or less all accumulated data. And, then, of course, the incoming data is bad. How does California have 6300 cases (which means test positives and not illnesses, or does it, we don’t know), 233, deaths, and 6 recoveries? That makes no sense.

          Why do they never mention how many people proved negative? These people might already be immune from exposure earlier in the year.

          • ALL the compiled information has the same problem. There are no standards for reporting, there are no standards for testing, no one publishes their methodologies with enough detail that a statistician could figure out how to normalize it. Heck, how do you even compare countries when they didn’t even start getting infected at the same time, and they took completely different steps around social distancing and quarantine and border closings… there is no way to get accurate numbers. Worse than climate data by far.

            But I still find it interesting that Bahrain has such a high recovery rate, unlike any of their immediate neighbours whom one would think would be similar.

          • davidmhoffer
            + lots and lots.
            Thanks indeed!
            But –
            “Worse than climate data by far.” – now, that is going the extra mile.

            As bad as climate ‘data’?
            Well, we’ve seen some – ahem – seriously shoddy, unscientific numbers [not ‘data’], never mind the job-preserving interpretations, so – maybe.

            Auto

    • John Tillman

      To say “Rates of increase are also falling in the UK.” is misleading. There are encouraging signs, but there is a lull between people initially contracting the virus, and the establishment of social distancing measures & self isolation, where it’s incubating in many people as we speak.

      There will be a surge, that’s why Nightingale units are being established across the country by military personnel.

      M*A*S*H is alive and well.

      • Being prepared is good, better late than never.

        However rate on increase in cases and deaths is slowing:

        So far today in UK:

        Cases 22,141 New +2,619 Deaths 1,408 New +180

        Yesterday:

        Cases 19,522 New +2,433 Deaths 1,228 New +209

        Case increases at least partly due to more testing.

        Too soon to call a trend, of course, and we’ll see where today ends up in three and a half hours.

        • Numbers far too noisy to look at rate of change of rate of change on a daily basis.

          You need to do a log plot and fit a linear to log over at least 7 days. log(2)/slope give the doubling time.

          https://climategrog.files.wordpress.com/2020/03/2019-ncov-log-growth-fr.png

          There was a change in slope in France but it occurred about 2 or 3 days BEFORE movement restrictions, not five days later as one would expect after median incubation period. Any change after 5d is slightly increasing. Not much indication of the shut down showing any detectable change in the stats.

          Maybe Sweden has got the right idea.

          • Too few data to do a meaningful statistical analysis. Thus, day to day “data” are essentially as meaningful as weekly figures.

          • So in your version of statistics 2 data points are as good a 8. Where can I learn more about fascinating new field of study? It sounds really powerful.

        • You and everyone else in the thread need a class in statistics.

          Absent “total number tested”, “new cases” means nothing. If you tested 100,000 people day 1, and 110,000 people day 2, then the infection rate actually fell. Why is this fundamental point so difficult for so many to grasp?

          Another basic statistical assumption is *the sample is random*. Here, in Ontario anyway, it most definitely is NOT. Only people who manifest some of the symptoms get tested, which means the sample is *skewed towards containing already infected people*. So simply counting “new cases” is bound to overstate the case.

          Even with both of those provisos, I’ve run the numbers in Ontario, and from Mar 22-29, the ratio of infected:negative tests has hovered around 4.0%. The total cumulative has been slowly rising to 3.3% If the virus were *increasing*, we’d expect to see that ratio rise rapidly. However, as the number of tests perform each day has risen, we’ve seen the sample ratio converge to the cumulative ratio, and on the last day, when 10,000 of the 50,000 tests were reported, the sample ratio was 3.4%, compared to the overall 3.3%.

          Unfortunately, Ontario changed its reporting method on the 30th of March, so it will be a week before I can trend the new format. But if I had to bet, I’d say between 2.5-3.0% of the total population is infected, and if we believe that 80% of those experience no to mild symptoms, we down to .24% of the population who will get some degree of severe sickness, and even then – currently with no proven treatment – 80% recover without going on a respirator. So, now we’re down to .048%, which 1/10th the doctor’s .5%, who end up on an ventilator. That’s 120 cases, spread over some time, vs the 1200 he expects. Again, if I had to bet, I bet that fewer than 200 cases in this county require ventilators when this is all over. We’ll see in a few months.

    • Testing for Covid-19 is meaningless as the test has never been verified to actually identify this particular virus. The CDC released the test without checking it first. None of the other cobbled up tests have been verified either.

      Also, as the flu season is a salad of “flu” viruses (flu and coronaviruses), a person very likely might have more than one or several viruses at a time. The only thing the test indicates is that Covid-19 is present, but it does NOT finger the virus as what is making the patient ill. For all intents and purposes, Covid-19 might be an innocent bystander while another virus does the dirty work.

      Covid-19 is indeed very infectious but that does not indicate its virulence. There seems to be an inverse relationship between infectious and virulence. This would explain why we see so many positive tests from asymptomatic people. At the very worst, Covid-19 is 1/10th to 1/100th the virulence of the flu.

    • It was updated overnight. They are now reporting 19,913 for the 29th. Still, over the last week the rate of increase has been going down. Nationally the doubling time of the disease has increased from about 1.7 days, to almost 4 days. An increase in this measure is good, because it means the rate of acceleration is slowing. We ain’t out of the woods yet, but this is the first clear sign that things are just beginning to slow down. (Nothing is for sure of course, something could happen to make the rate of spread start increasing again, but this is still a good sign)

    • The daily death rate in the U.K. seems to have reached a plateau (I say seems to because it is only 4 days of plateau and this isn’t long enough to draw any definite conclusions). If we have seen death rates reach their maximum this would mean the U.K. is fairly typical of Europe, while Italy and Spain are outliers. The average daily death rate in the U.K. is roughly 200, and our population is pretty much 20% that of the U.S. so you could expect the death rate to peak at aprox. 1,000 people a day. If the peak lasts for 2-3 weeks then the death toll would be aprox. 25,000 plus maybe as many again dying before or after the peak so I make a very rough estimate of 50,000 deaths for the U.S. Donald Trump said today that 200,000 deaths would be a positive outcome, for once I think that even he is being pessimistic.

    • Yep we mounted a coup, trapped you all inside and took over the country and now you can’t even organize mass protest 🙂

    • I was shocked by the statement “If you turn up to the Emergency Department with mild illness, you will be screened (important factors such as vital signs and your oxygen saturation percentage), and likely sent home with 2 important instructions: signs of worsening illness, and strict self-quarantining precautions.”

      Not even a mention of Aspirin, Vitamin C, or hydroxychloroquine.

      • re: “Not even a mention of Aspirin, Vitamin C, or hydroxychloroquine.”

        Did you perhaps mis-understand? They are (probably) looking for Covid-19 positive patients only (and they do test). IOW do not show up to ER with only stomach ache or the sniffles. I do not recall w/o reviewing that long document where that statement is made …

        • They may be “looking for Covid-19 positive patients”. Medicine should not be about looking, it should be about treatment. This letter mentions only one treatment, a ventilator.

      • re: “Might be worth considering this as a second opinion…”

        Did you do you homework to see that that looks to be the earlier study (day late – dollar short)? Are you aware this is a dynamic situation with clinical (treatment) work ongoing even now?

        The new study is 80 individuals? Are you aware also this is not an individual effort by Raoult? Have you looked at the list of co-authors and their affiliations? No?

        Summary: You are behind the curve … recommend “get up to speed.”

        • Jim, the point is that the study would have shown that something very different had not six patients in the treated group been removed from the study because they died, or were transferred to ICU or stopped treatment because they could not tolerate the drug. This may just be the way the French do science today, but it is possible this drug did more harm than good.
          Hydroxychloroquine for COVID-19: What’s the Evidence?
          F. Perry Wilson, MD, MSCE
          https://www.medscape.com/viewarticle/927342

          • Exactly. Poorly done study (nasal swabs have been shown to give false negative results >60% of the time) on only a few pts.

            Along the lines of the classic–“In the experiment, 3 dogs got better…The 4th dog ran away.”

            Plaquenil has been around a long time. It affects Plasmodium metabolism in a way unrelated to it’s anti-inflammatory effect in humans. It is not innocuous, having fairly high rates of serious retinal, cardiac & neurological side effects….It may or may not actually be efficacious, but is dangerous enough to deserve more serious study before it’s shot-gunned out on a desperate public.

            The “study” alluded to in “Forbetterscience” involves a very unscientific “cocktail.” It reminds me of Moe calling for more Annakannapannistan to be poured into the rubber boot. I’m just surprised he didn’t add Echinacea dust also.

    • _Jim

      You unfortunately do not know very much about what you are presenting here.

      No valuable study of Raoult’s trial (hydroxychloroquine + azithromycin) has ever been presented. No double-blind tests.

      Nonetheless, the French government decided to allow tests in a wider range. This can turn into a big problem for the politicians having taken the decision.

      What, do you think, will Raoult tell you if his ‘cure’ gets off control?

      He will tell you: ‘I never told that it would be free of danger’.

      And that is the major problem, especially in the US where whole lawyer regiments wait for such an opportunity.

      It is not enough to drive an 80-person test when introducing such an unknown medical combination for a huge amount of patients.

      You need much more security.

      This is exactly the reason why you yourself might one day be hiring a law firm if the medication is causing you chaos instead of healing.

      J.-P. Dehottay

      • re: “You unfortunately do not know very much about what you are presenting here.

        No valuable study of Raoult’s trial (hydroxychloroquine + azithromycin) has ever been presented. No double-blind tests.

        Idiot. People’s LIVES are at stake here – this isn’t some ABSTRACT statistical exercise done for your intellectual benefit!!! This isn’t an improved acne skin cream being tested for efficacy!! MAYBE you would like to perform Tuskegee Experiment again and _not_ treat those afflicted JUST to satisfy your cold, morbid ‘sciency’ appetite for ‘data’?

        Must you be FORCE FED this info, and background surrounding these events, apparently yes, because you cannot figure them out yourself! HERE IS a Twitter dispatch from Dr. Raoult a couple days ago in reference to this study (he desires to show compassion for those suffering Covid-19 that might possibly die w/o treatment):

        March 28 Update: In a Twitter post day, Prof. Raoult said: “Our study concerns 80 patients, without a control group because we offer our protocol to all patients with no contraindication. This is what the Hippocratic Oath that we have taken dictates to us.

        Side question: If you present symptoms, will you volunteer for ‘control’ group OR do you want to be treated? HAVE you ever had pneumonia before? Would you like to die that way?

        • “Idiot.”

          Thank you very much for your insult.

          And it is typical for people like you to feel the need for teaching others.

          You did not understand even a bit of what I tried to explain…

          J.-P. D.

        • Let me answer for him. I am a retired doctor. I have experienced acute asthma, acute laryngospasm and whooping cough.If admitted to hospital with difficulty in breathing secondary to COVID 19 pneumonia, I would request admission to a double blind controlled clinical trial of active drug versus placebo, because this is the only way we will find the answer when dealing with a disease with a spontaneous recovery rate somewhere between 0.5% and 10%. I hope that’s clear enough for you.

          • re: “If admitted to hospital with difficulty in breathing secondary to COVID 19 pneumonia, I would request admission to a double blind controlled clinical trial of active drug versus placebo, because this is the only way …”

            No, I don’t believe you. You say this now, without the element of ‘passion’ (emotions) being involved in the picture for decision-making. No one wants to die, or face death.

            Not for your wife or mother either, IF a treatment is KNOWN by you to be available, because we ARE at that stage. To admit otherwise is, stupidity. Yes, on your part. Well, either stupidity, or you are NOT as well informed on this as you THINK you are. GO READ the continuing work in this area. To do otherwise, is, stupid, or resource challenged (IOW, you do not know where to ‘look’, yes, ‘physician’. Logic and common sense would not seem to be your strong suit.)

            https://www.sciencedirect.com/journal/international-journal-of-antimicrobial-agents/special-issue/10V3JMBH9GZ

            Notice the results here, ‘physician’, for daily hydroxychloroquine and azithromycine results in France:

            https://www.mediterranee-infection.com/covid-19/

          • re: “If admitted to hospital with … I would request admission to a double blind controlled clinical trial of active drug versus placebo …”

            John Cherry, let me say this to you: Your words sound as hollow as is your head (on this) WHEN we have on-the-ground experience as the following from such as Dr. William Grace, at Lenox Hill Hospital in New York City:

            “Everybody’s using it [chloroquine] now off-label. We have a surge of coronavirus-19 patients throughout the metropolitan area of New York. And the problem is these patients are coming in quite sick. And when they get to a very difficult respiratory status, doctors are using hydroxychloroquine [an “analog” of chloroquine] with or without a drug called Zithromax or azithromycin. And that’s showing tremendous activity, and we have not had a death in our hospital.

            We have probably close to 100 patients and not had any deaths. But I’ve talked to my colleagues at other hospitals in New York, and they are using hydroxychloroquine although the supplies are running down. So any kind of supplements to those supplies would be much appreciated…. In the trenches, we’re all using it especially for desperately ill people…. We’re not using it on everybody, but we’re using it on those people who show major respiratory compromise…

            We think it works in two ways. As you know, the death rate goes up as the age goes up. And what I think is that the more mature your immune response, the more likely you are to have what we call a cytokine storm, which means that people with viral pneumonia die because their lungs fill up with fluids largely from an immune response. And this drug works not only inhibiting virus replication but also inhibits the immune response.”

            Video of interview: https://youtu.be/sPRuCqINYh0
            .

      • You think a combination of a weak antibiotic and a cure for malaria will hurt people?

        How? It’s like saying mixing Advil and Tylenol will give you cirrhosis.

        • Both drugs prolong the Q-T interval on the ECG. This risks the development of a potentially lethal tachyarrhythmia, a form of ventricular tachycardia called torsade de pointes. This then leads to death in ventricular fibrillation. Do try to ascertain facts before making foolish remarks. John Cherry, M.B., B.S., F.R.C.S.

      • FWIW, everyone in the chain, from manufacturer to doctor, is immune from liability concerning chloroquine treatments.

      • Quite right JP, it’s all well and good that it works in practice, but does it work in theory? That’s the vital question, isn’t it?

        We need those old people to just die because the therapy hasn’t been proven yet in a double-blind study. It would be a tragedy if we let people survive prematurely, wouldn’t it?

        Why do I have the nagging feeling that some are hoping that HCQ doesn’t work, for fear that the Beast (Trump) might get some credit for a positive action?

      • This is not Thalamide. It has been used for decades to first treat malaria and now Rheumatoid Arthritis and Lupus. The side effects are all well known. All a properly run double blind will tell you is if some of the claimed successes would have occurred without the drug. In the mean time if it can help people as it appears to do us.

    • Please, everyone should read this paper by Dr. Gautret.
      Yes, _Jim, Dr Liang has NOT read the paper. Left a message with his emergency dept. operator for him to please read the paper.
      Just so that everyone knows that hydrochloroquine nor chloroquine nor azithromycin are anti-viral. The hydrochloroquine acts as an ionophone allowing zinc to enter the INFECTED human cell membrane. Zn+2 then blocks the replicase RdRP, which stops the production of viral RNA and thus viral particles.
      MedCram episode 32 on youtube is a great refresher in viral replication.
      Thanks to everyone here.

  2. I was very happy that one of the CV sites I follow showed the daily deaths dropping for 3/29.

    However, they have a note at the bottom today that reporting from NY state was incomplete on 3/29. There has been an update, but the data for NY may still be incomplete.

    • That would account for the discrepancy. But even if the figure cited in the news story link be correct, that’s a decline for deaths in NY. As you note, however, that number too might still be incomplete.

      • Good point about Sundays.

        Still, glimmers of hope for flattening curve sooner rather than later.

      • However, even if reported new deaths are up again today, the rate of increase is dropping, after a big jump last week.

      • Yep you have noticed it, I have been watching the counts for about 3 weeks happens every Sunday. They seem to reconcile the numbers on Monday morning.

  3. So how about WUWT keep track of his surge ? Update in , say every three days ? Looking for 1200 people in three weeks. Our local hospital is also looking for surge in three weeks. (VA). The hospital ship, Comfort . Last used as transportation to ….. GITMO ??? BARS on windows?

  4. Here at WUWT, we know all about the wisdom of “experts”.

    The ER doctor is talking about epidemiology. That is about as far away as you can get from his actual expertise and still be discussing medicine.

    I have no idea if he is right, but on the other hand, he is projecting doom – and he has no idea if he is right.

    As of right now, most of the rural counties that are being hit hard have an epicenter of rich, international travelers, such as ski resorts.

    • I had to laugh at the Rhode Island cops trying to stop New York license plates folks from entering Rhode Island without a quarantine order being given them. The rich just flew in on their private jets to Martha’s Vineyard. The cops are only stopping the Deplorables, you and me. The Rich elitists have their jets and private homes to bypass and fly high above all that nonsense, powered of course with fossil fuels. Just like the climate scam wants to impose.

      • Martha’s Vineyard is not in Rhode Island.

        At a Rhode Island airport, pilot who flew in from NY was told they were not allowed to leave the airport grounds.

    • Epidemiology is my field. I made my living doing it until I retired. I assure you he’s right. There are two caveats. 1) Social distancing my be working. 2) There is a new emerging treatment namely hydroxychloroquine + zithromax + zinc sulphate being in New York with what appeasements to be very great success. If those two things work his assessment and predictions will be wrong.

  5. If you have an hour, this is a Doc who does CV triage at Weill Cornell in NYC. He has seen a majority of the CV patients coming through their door, which means he has probably some of the most experience with it certainly in the US.

    Very common sense and answers some good questions. Puts you at ease. Basically almost all transmission is your hand to your face. Stop touching your face and your chances go waaay down. Casual contact is not an issue (unless they sneeze or cough on you).

    • re: “Very common sense and answers some good questions. Puts you at ease. Basically almost all transmission is your hand to your face.”

      Maybe time to shave the mustache off completely … first time in – multiple decades.

      • You can trim it and then apply vaseline to make it seal with the mask.
        Works on trimmed beards as well.

    • It seems to me that a box of disposable gloves outside the door of any retail store or restaurant would take care of 90% of the transmission danger.

      • The problem Pat is “fomites.”

        A fomite (or fomes) is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host.

        your cell phone is a fomite. your wallet/purse and credit card is a fomite. Hard currency Money is a fomite. Your car key is a fomite. Handle those with contaminated, gloved hands, take the gloves off, then handle them again without thoroughly cleaning them…useless gloves. Wash your hands, frequently, clean your smart phone with sanitizer too.

      • If you are wearing gloves and touch something contaminated, and then touch your face, you will still transmit the virus to yourself.

        • Yes, gloves are relevant for a till girl handling money all day.

          If they provide them at the entrance , they are all contaminated before you get them.

          Best thing is to wash you hands as soon as you get home and leave that box of fomites you just purchased in the garage for a couple of days.

      • I see disposable gloves littering the ground outside of my local grocery store. When the rubber meets the road (no pun intended), no one cares about environmental causes.

      • Nevertheless, Joel, one puts gloves on going in, and takes them off and throws them away going out. Much of the transmission opportunity is mitigated.

        I agree cash money is a problem. Credit cards generally not, given chip readers.

    • That’s the one. He’s the second doctor to recommend these rational and reasonable steps to limit infection, respond to disease, and mitigate collateral damage (e.g. economic, food distribution).

    • Are there any CONFIRMED cases of getting Covid from a surface? If so, how many? If not several, why are we so paranoid? I have searched and the only way this seems to be passed is person to person. Yet, we disinfect boxes from Amazon, etc. It’s a free-for-all panic session, as far as I can see.

      Not touching your face and washing your hands are prudent in any flu or other outbreak. You’d think people would do this as a matter of course, not just in a pandemic. Of course, restrooms in stores have to tell employees to wash hands before returning to work and how to do so. How helpless we have become.

      • Exactly. The viruses and other pathogens are out there, they never leave us, we should always take rational and practical, prudent and bold, steps, to limit infection, disease progression, spreading social contagion, and mitigate collateral damage.

      • baggage handlers in SA 6 confirmed and the other staff to be tested planes diverted and cancellled this arvo in Aus. prior baggage handlers il in usa too
        our media says all flights in prior to wipe luggage down
        bit(LOT) late
        and the diagnosed 18 usa tourists infected the barossa area and to be quarantined? 2 did a runner back home, so the transport to airport the plane n staff n handlers etc plus all your people on ground wherever the ran to..are at risk.
        where the hell our so called state of the art screening passports bio id etc went to ?
        nobody pulled em up at any stage as they bolted

    • This article would seem to dispute both you and the doctor. The facts presented are the clearest evidence I have seen to date about how contagious this virus is., and how it is transmitted.

      Everyone who went to the practice was aware of COVID19, good hygiene was promoted, no handshakes or hugs. Yet the vast majority of those who attended got COVID 19. Airborne transmission is much easier than most realize.

      https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak

  6. Empowering and protecting your family during the COVID19 pandemic
    – Dr. David Price, Weill Cornell Medical Center

    * social distancing (3 ft)
    * hand to face hygiene
    * coexisting with people (especially in close proximity) who are infected, who have the disease
    * when to visit the hospital (e.g. resource management), and triage (e.g. telemedical services)

    Bottom-line: We don’t have to shut down the country. We should avoid spreading a social contagion. There are rational and reasonable steps to take in order to mitigate infection, respond to disease, to manage resources, and to mitigate collateral damage.

    • “* social distancing (3 ft)”

      Clearly, 97% of Medical Scientists don’t agree about this, or the UK requirement wouldn’t be 2 metres (6′ 6″)…

  7. “A very few very lucky people may not develop any symptoms at all.”

    There was an article on the Diamond Princess stats published here the other day; 80% of passengers didn’t even test positive for the virus and, of those that did, 50% were asymptomatic. It may be that the lock down on the Diamond Princess was very, very effective, but the suggestion from its experience is that the “very few very lucky people” may be better phrased as “very few very unlucky people will develop symptoms, and even fewer may die”.

    In the UK, as of today (from the UK government website) “As of 9am on 30 March 2020, a total of 134,946 people have been tested, of which 112,805 were confirmed negative and 22,141 were confirmed positive.” Now, given that there is, as far as I’m aware no random testing going on, the suggestion is that the 135k people who’ve been tested have more than likely been exposed to the virus somehow to the extent it was felt necessary to test them, yet 83% of those were negative.

    It’s all very, very interesting.

    • as far as I’m aware no random testing going on, the suggestion is that the 135k people who’ve been tested have more than likely been exposed to the virus somehow to the extent it was felt necessary to test them,

      Or they were exhibiting symptoms that turned out to not be Wuhan virus related (IE they had the flu or other common cold instead).

    • Yes John I agree. We are unaware of the outcome for the 112,805 confirmed negative. How many had symptoms? How many subsequently died? It is only with these data that we can make a comparative assessment of the additional danger associated with being tested positive.

    • John, you say ” It may be that the lock down on the Diamond Princess was very, very effective”. You may be right except the lockdown did not happen for at least 10 days. The ship left port on Jan 20 with the virus on board. The first case to test positive was on Feb 1. Locking down started after that date and I suspect not completely and immediately. .5% of 300,000 county residents may not be a bad number though. Worldometer shows 10 deaths and 15 serious cases from the 3700 Diamond. I don’t now if deaths and serious numbers are separate or should be totaled. It also shows first case as of Feb 4 which conflicts with other reports. Lots of sloppy info out there.

    • The country that is performing the most random tests in the world is Iceland. Take a look at their updated data at https://www.covid.is/data. Most other countries are only testing people who are showing very likely cases so we have little idea the effects of COVID-19 on the general population. According to Icelandic data – 1086 people have the virus, 30 people are hospitalized, 10 in the ICU and 2 have died. This shows less than 3% of the population have a severe case and COVID-19 is lethal in less than 1%. If these are the true statistics of the virus in the general population then most governments are overestimating the impact from the virus. Icelandic projections do not anticipate anyone under 55 will end up in the ICU https://covid.hi.is/english/. Perhaps Icelanders are on average healthier than the general population, however this is perhaps the best data to work from that is available.

    • Diamond Princess was full of relatively healthy older people, and the “lockdown” didn’t happen anywhere near as soon as it should have. Even so, only 20% of the occupants were infected? And only 50% of those were symptomatic? 10% of the occupants were symptomatic?

      Everytime I see statistics for Corona, it becomes more obvious that this is nothing than a typical flu.

      • Average Flu mortality rate 0.1%, Princess Diamond mortality rate 1.3% with Quarantine.
        When was the last time you were quarantined for flu?

  8. Much of the data is unreliable.

    Using figures for ‘new cases’ is pointless because of the large variablity in testing levels both inter and intra nationally which provides them. Even then they are only the tip of an iceberg of unknown volume.

    Daily deaths are probably more meaningfully although whether patients died of, or with, the virus muddies the water even here. Willis’s daily chart relating deaths per population from Worldometer and time since first case, is probably the most meaningful guide to progress that one can get.

    Much of the other data on Worldometer has to be suspect. For example it has been showing recovered cases in the UK as only 135 and serious/critical as 163, or thereabouts, for days. Clearly rubbish.

  9. Excellent article.

    I would debate 2 points, however. Will almost “everyone” be exposed? Maybe not. And over how long a period will it take for this exposure? Certainly, if 300,000 people were exposed simultaneously, you would see a mass run on ICU treatment. One hopes it is spread out over an extended period, giving time for beds to clear as new cases come in. It would be interesting to hear how long a bed is occupied during a patient’s ICU period.

    Hopefully the “bow-wave” will not be as dire as predicted, but certainly must be taken into consideration for any preparations that can be made for an “educated” estimate of demand and resource preparation. It would be nice if we could be resourced for the very worst, but that is not always possible.

    Time will tell.

    • Why don’t you look at the data yourself, some of the Princess Diamond patients are still in ICU over a month later.

  10. You, me, everyone,… we’re all going to get SAR-CoV-2 infection… if you haven’t already (and recovered). Period.
    This virus is widespread and circulating right now everywhere except maybe the most isolated villages or closed communities.

    Any tested/safe/ effective/approved vaccine will arrive too late with the 100’s of millions of doses needed to stop this now through our communities. It won’t be available for at least 16-18 months, and then it will be a relatively moot point. It’ll be moot issue because it will be too late to be of any use today or through the next-Fall-Winter cold and flu season.
    All we are doing now is flattening the time-response demand curve for ICUs and ventilators.

    The problem we are faced with, as both individuals and as a society, is … Choice.

    I’ll let the Architect explain the in his eloquence.

  11. “Even more seriously, the economy is heading downhill and many people are not getting paychecks.”

    At least he acknowledges the economy.

    Still, he doesn’t do anything beyond acknowledging it. Yeah, the absolute worst-case-if-we-do-nothing-not-even-wash-our-hands predictions show some hospitals might get surges. But shutting down the global economy indefinitely has repercussions, too, which are a lot more severe than “people not getting paychecks”.

    This is the whole problem with minimaxing things like this. You get near 0 deaths from the coronavirus in exchange for death and destruction and tyranny worldwide indefinitely. But hey! The coronavirus didn’t kill those people or ruin their lives! Declare victory, I guess.

    • Just go hang out at Walmart and push random shopping carts around without any gloves, surgical mask, and touch your face, wipe your nose. Then isolate for 2 weeks. If you didn’t have the corona virus already and protective immunity, you will after that in 2 weeks. Just have enough stuff to stay isolated for 14 days.

      • I have already been to Whole Foods, Target, and Walmart multiple times since this whole thing started.

        Because the only truth the doctor stated was:

        “The virus is highly contagious. It is predicted that eventually, nearly everyone will be exposed and been infected. ”

        Gloves and mask in the general public are at best false security, like Linus and his blanket from the Peanuts comics.

        If you are not matching the mask to the size of the particle you trying to exclude you are not doing thing but going through the motions. If you touch your glove on something not sterile even if you have sterilized, sanitized, disinfected the glove then it immediately becomes contaminated. The outside world is not free of viruses or bacteria, it is on every square mm inside and outside of a human being. I have even heard that the seed of nearly every single snowflake that falls from the sky is some form a bacteria.

        The human body is a learning a machine in multiple ways all concurrently. Herd immunity will be way faster then any vaccine we will develop.

        • Are you sure you did not read that on a Trivial Persuits card ?

          I would have thought that aircraft exhaust is a significant source of condensation nuclei to judge by contrial formation and persistence under suitable conditions.

          BTW, bacteria is the plural: a bacterium.

    • Even better, Abbott Labs has an approved molecular tester which does it in 5 – 13 minutes.

      Abbott has received emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA) for the fastest available molecular point-of-care test for the detection of novel coronavirus (COVID-19), delivering positive results in as little as five minutes and negative results in 13 minutes.

      What makes this test so different is where it can be used: outside the four walls of a traditional hospital such as in the physicians’ office or urgent care clinics.

      The new Abbott ID NOW COVID-19 test runs on Abbott’s ID NOWTM platform—a lightweight box (6.6 pounds and the size of a small toaster) that can sit in a variety of locations.

      Because of its small size, it can be used in more non-traditional places where people can have their results in a matter of minutes, bringing an alternate testing technology to combat the novel coronavirus.

      We’re ramping up production to deliver 50,000 ID NOW COVID-19 tests per day, beginning next week, to the U.S. healthcare system.

      https://www.abbott.com/corpnewsroom/product-and-innovation/detect-covid-19-in-as-little-as-5-minutes.html.html

  12. Joe Diffie Releases Statement
    NASHVILLE, Tenn. – GRAMMY®-winning country music legend Joe Diffie has tested positive for coronavirus (COVID-19) and has released the following statement:

    “I am under the care of medical professionals and currently receiving treatment. My family and I are asking for privacy at this time. We want to remind the public and all my fans to be vigilant, cautious and careful during this pandemic.”
    –Joe Diffie
    https://edition.cnn.com/2020/03/29/us/joe-diffie-coronavirus-death-trnd/index.html

  13. “U.S. deaths from the coronavirus doubled over the weekend…” USA Today, 3/30/20
    No, they didn’t you lying weasels!!!
    Per the attached graphic based on UCDC data cases and deaths just stepped off a cliff!

    I expected by now to see satellite images of Chinese CoVid apocalypse bodies stacked by the tens of thousands in city squares, bulldozers pushing them into mass graves then covered with lime.
    According to ECDC and WHO the CoVid death toll for China is about 3,300. A mortality rate once in double digits has fallen to 4.0%.
    The US at 2,500 will surpass that shortly.
    Where is the footage of CoVid apocalypse zombies staggering across hospital parking lots, storming ERs and hallways?
    Not there – so far. Mostly just isolated anecdotal tear jerkers.

    This lying, fact free, fake news MSM’s fake pandemic is as fake as fake dying polar bears, fake rising sea levels, fake melting ice caps, fake man caused climate change.
    President Trump should bring the full weight of the Federal Government to bear, sue the fake news MSM for crying “Wolf,” for yelling “Fire!” in our crowded theater, make them pick up that 2.2 trillion dollar tab.

    Rights have responsibilities. Yeah, weird notion.
    Trump should burn the fake news media to the ground and when/if it rises from the ashes maybe it will understand what honest, balanced, objective, responsible journalism means.
    BTW looks like US cases and deaths just fell over a cliff. An uptick this large makes headline news. We’ll see if it stays that way.

    • Nick Schroeder

      Your aggressive comment shows how good ignorance and arrogance can fit together in one crank brain.

      The day isn’t at end yet, and we have over 800 deaths in Italy, over 500 in Spain, over 400 in France. Every day, the ration ‘death toll per cases’ increases.

      And you stay behind your notebook and cowardly write “fake pandemic”…

      You should be sent by law right tomorrow in the morning to one of these hospitals in Italy, Spain, France, where permanently stressed and totally tired staff tries – at their own risk – to keep patients alive.

      In Italy, over 50 of them died until now: because they could not obtain masks let alone protection clothes!

      My personal meaning: people like you are simply disgusting.

      J.-P. Dehottay

      • re: “Your aggressive comment shows how good ignorance and arrogance can fit together in one crank brain.

        The day isn’t at end yet, and we have over 800 deaths in Italy, over 500 in Spain, over 400 in France. Every day, the ration ‘death toll per cases’ increases.

        This is the same poster who decries the methods and means of Dr. Raoult (AND do not forget his team and associates in the medical and research fields!) who is working towards an effective treatment? How can one man’s brain entertain such divergence of thought w/o locking up with veritable cognitive dissonance? One is driven to as the question: Whose side are you on – the virus or humanity?

        • See my reply to your insulting comment, and… start thinking instead of writing unnecessary, aggressive stuff.

          J.-P. D.

      • “Your aggressive comment shows how good ignorance and arrogance can fit together in one crank brain.”

        Pot. Kettle. Black.

      • Every day, the ration ‘death toll per cases’ increases.

        That is what you will get if you are silly enough to compare today’s fatalities to today’s cases. There is a lag between diagnosis and death.

        French data shows a lag of 13d in stats with a scaling factor of 50%.

        https://climategrog.files.wordpress.com/2020/03/2019-ncov-log-growth-france.png

        The exponential of fatalities is dropping marginally quicker than new cases and this could become quite significant in 14 days time. ie we are probably not on course to see half the current daily case load die in 13 days.

        New cases is probably heavily dependent on availability of test kits and administration policy at any point in time. Extreme caution is required before drawing any conclusions from such poorly sample and poorly documented data.

        BTW Italy , Spain and Germany new daily cases all seem to have peaked now.

        • Greg

          ” That is what you will get if you are silly enough to compare today’s fatalities to today’s cases. There is a lag between diagnosis and death. ”

          Merci beaucoup, Monsieur l’instituteur!

          As you should have imagined, I’m not at all interested in the comparison as such, but only in how it develops over time. The lag then is of no interest, because it is an invariant.

          ” BTW Italy , Spain and Germany new daily cases all seem to have peaked now. ”

          Yes. ‘seem’ indeed is the right word, especially for… Spain:
          6368, 6922, 7457, 8271, 7933, 7516, 6875, 7846

          I think I’ll wait for a couple of days before speaking of ‘peaked now’.

          J.-P. D.

          • “The lag then is of no interest, because it is an invariant.”

            The lag is invariant but you are looking at exponential growth in both cases and deaths where rate of change is also exponential . If you had two linear relationships you could argue that the instantaneous ratio was valid estimation of the death toll.

            Both cases and fatalities are growing roughly exponentially , say exp(c*t) and exp(f*t). The ratio F/C is exp((f-c)*t) , also an exponential !

            Shock horror: it is currently “developing over time” because it is exponential. Later it will fall, quite dramatically. That is why you cannot calculate the death toll until you are nearing the end of the epidemic.

            Not only are you too ignorant of the maths to see what you are doing is meaningless , you are too pigheaded to realise it when it is explained to you.

            Despite apparently posting from Germany, you are obviously French not German. Germans tend to very sure of their opinions too but usually because they know what they are talking about , or else they have the sense to shut up.

            Eh ben, dis donc.

            I’m glad you agree that “seem” is the right word. That is why I used it.

      • Je suis absolutment d’accord, mon brave. Continuez, je vous en prie, avec vos observations rationnelles. Ce sont beaucoup rare ici. Apologies for not knowing how to put in a circumflex accent or a cedilla on this keyboard.

    • The coronavirus deaths just in the Wuhan area are estimated at 35,000-60,000 simply based on what is known about Wuhan crematorium and their delivery of urns. That number is > 10x what the official Communist Chinese press is reporting.

    • Nick Schroeder
      “President Trump should bring the full weight of the Federal Government to bear, sue the fake news MSM for crying “Wolf,” for yelling “Fire”
      Except Trump is the one yelling fire the loudest now. He was talking about the “potential” for 2.2 million deaths in the US at yesterdays briefing.

      • Simon I can see that you and Trump are on the same page.
        You want the borders closed and Boom he closed them.
        You wanted flights from China stopped and Boom he stopped them.
        You wanted Social Distancing and Boom he asked for social distancing
        You wanted more testing and Boom he orders more testing.
        You wanted to shut down most of the economy and Boom he shut most of it down
        You wanted monetary relief for those impacted by the shut down and Boom your relief is on its way.
        You wanted more deaths predicted and Boom he predicts more death.

        Birds of a feather flock together.

        • Derg
          I know you think you are psychic, but….
          You want the borders closed and Boom he closed them. Yep
          You wanted flights from China stopped and Boom he stopped them. Yep and other places.
          You wanted Social Distancing and Boom he asked for social distancing Yep
          You wanted more testing and Boom he orders more testing. Yep
          You wanted to shut down most of the economy and Boom he shut most of it down. Nope. I’d rather we didn’t shut any of it down.
          You wanted monetary relief for those impacted by the shut down and Boom your relief is on its way. I don’t want any money but I get that those at risk do.
          You wanted more deaths predicted and Boom he predicts more death. I want honesty and to listen to the experts.

          • We are pretty close in agreement. It’s a funny thing about listening to experts, at one time experts thought giving antacids to people with ulcers. Settled science is what they would have said back in the day.

            Experts indeed.

          • You wanted more deaths predicted and Boom he predicts more death. I want honesty and to listen to the experts.

            Eh? You are complaining about Trump talking about “potential” for 2.2 million deaths in the US . Trump got that number *FROM* listening to the experts. Admit it, no matter what Trump does, you’ll find fault even when he does the very things you claim to want.

          • It’s a funny thing about listening to experts,…

            Indeed. and who are the experts that decide which experts are the experts worth listening to and which are the ones not worth listening to? The fact is you can find experts with impeccable credentials that completely disagree with other experts with equally impeccable credentials.

    • This fake report is totally bogus scare-mongering false news.

      Total US cases:

      Thursday: 68,211
      Friday: 104,126; +35,915
      Saturday: 123,578; +19,452
      Sunday: 143,491; +19,913

      The only way that they could claim doubling was by adding up new cases Sat and Sun and comparing with new cases on Friday!

      Proper reporting would have been to say that the daily increase was almost cut in half, despite more testing.

  14. Please leave the statistics alone. Only the time will come. If you want to keep your family healthy, ask your doctor what is the situation in your area. Ask how many doctors are in quarantine. This doctor will tell you the truth about this disease.

    • Ren, I appreciate your comments. One of my physicians recently cancelled a long-standing appointment (not for anything critical) to take a two-week vacation or break. His office remains open, though with precautions in place. I can only speculate that he may have been exposed.

  15. The only two statistics that matter to me are (1) excess deaths over other causes and (2) excess ICU cases. The number of infected and projections based on that are just lying with statistics at this point. The death numbers are even tainted by the fact that most had other conditions and might have died from regular flu just as easily. Same for ICU numbers – regular flu and other underlying conditions would have put people in ICU as well. The important statistics are excess related to COVID-19 only, which are hard to even measure let alone report our by scientifically illiterate press.

    The sooner we get to a blood test to find those post-infected and immune for this season the better. Then we get quit the draconian quarantining of everyone and concentrate on those most at risk.

      • I work as an infectious disease doctor here in Calgary. You have accurately described the low impact at present. All the panic is around the expected future surge. I go to work presently and have a much smaller roster of patients to care for than usual. What will the surge look like? No one knows. Modelling can make almost any prediction one can imagine especially when the models never undergo validation.

  16. “A very few very lucky“

    How do they know unless we can test people that have had COVID and did not show symptoms or showed symptoms and never bothered to see a Dr?

  17. This site has daily interactive projections for all US states:
    https://covid19.healthdata.org/projections

    The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington.

    It looks like “The Surge” will occur at different times and levels for many states.
    The projections include ICU beds needed as well as ventilators and deaths per day.
    The US total deaths by Aug 4 is 82,141. Most places will level off by the beginning of June.
    Here in Vermont they expect that to occur in the beginning of May.
    We shall see.

  18. Whatever. In Lexington, KY where I practice virtually all healthcare workers are losing hours. I’ve had to change jobs to keep from being called off. Any ‘surge’ will be handled easily just as we handle influenza every year.

    I refuse to change my daily habits any more than I am forced to because of a manufactured panic. When Covid numbers start to resemble those of influenza then I’ll consider taking real notice.

  19. I am in contact with a computer savvy friend who sent me these 2 links in answer to my question, ‘who is reporting all the figures to the John Hopkins University dashboard?’

    *********
    John Hopkins answer your questions here:

    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

    see bottom centre, and then this link

    https://systems.jhu.edu/research/public-health/ncov/

    **********

    From my reading of the JHU figures I still dont have an answer. They are reported almost in real time so JHU must be obtaining information from someone. Who is it? The WHO or each countries’ health agencies? How was the system set up and how did they know to report to the JHU database?

    The UK government appears to be basing its public order restrictions on the JHU figures. Are they accurate enough for the resulting disruption to have been implemented? Can the reported figures be confirmed? Does Covid-19 appear on the death certificates of those who have died from it?

    There appears to be a link between John Hopkins University and Event 201, held in Oct 2019, where many imminent scientists from numerous world renowned organisations assembled to discuss the implications for a world wide virus pandemic. Excellent timing, so what was proposed?

    • The UK government will almost certainly have it’s own figures … ask someone in UK.

      John Hopkins University had the database setup to run simulations for the event you describe. Individuals possibly those who attended and knew it existed have joined with it to collate the data. That is why not every country has individual links, many are just black entries from official country figures. In almost all cases the number reported is just as reported by the government and they seem to audit the data back to official government figures.

      So you have it backwards countries are feeding data to John Hopkins University not the other way around.

      • Thanks for your observations about the UK govt’s reporting. I have asked, no-one knows where the UK figures come from. So my original question remains unanswered. Who reports the UK figures to the JHU dashboard? How are they collated? Does Covid-19 appear on any death certificates being included as being deaths caused by this virus?

        I have assumed that all countries do their own reporting to the JHU database. So who exactly does the reporting? Are they accurate enough for the political descisions being made at such huge cost to us all?

        The testing regime introduced by the UK govt has signally failed; they have not got the kits with which to carry out reliable tests. The NHS workers who are a priority are still waitng to be told where to go to be tested.

        It is a complete shambles, but fortunately us Brits are so used to that we just get on with life and ignore the noise. When this virus is all that is being reported on every TV channel I do wonder what else is happening we are not being told about. Anyone?

  20. Perhaps my interpretation is incorrect but looking at Willis’ excellent set of virus graphs by country I do not see a gigantic surge coming in the next two weeks. Using Italy’s data as a reference in the past five days their number of deaths has less than doubled. From 6820 to 10023. The number of daily deaths are fairly stable around 900 a day.

    Italy is a week ahead of us from their inception so if the US death rate trend is similar to Italy’s we should expect to see at most a doubling of deaths this week to around 5,000 but nowhere near the 100,000 the experts are forecasting.

    • Many with hypertension are on ACE inhibitors or ARB medication which messes with the ACE2 receptor where the virus attacks.

      Obese people probably have high serum glucose. Glucose competes with vitamin C ( dehydro ascorbic acid ) absorption and interferes with immune response.

      Expect to see some Darwinian selection.

  21. One of the difficulties in trying to get an accurate picture is that different countries have very different reporting standards. In the UK and in Germany, for example, almost no-one is in “recovered” status. And the German stats have varied wildly. Changes in reporting procedures, perhaps?

    If we look at the South Korean experience, from the day the virus becomes a significant problem to the “worst” day in terms of daily cases seems to be pretty much 3 weeks. About 8 days beyond that, the total of “active cases” starts to go down. Of course, few countries are taking the follow-every-case measures the Koreans have. Are there other, better strategies? No-one knows.

    From a UK perspective, a repeat of the Korean experience would put the “worst” around April 2, and the El Alamein moment about April 10. There’s still a lot of mopping-up to do after that, of course.

  22. I have spent the last few days gathering data from sources like WorldoMeter, Statista, Covid Tracking Project (US), and numerically reported news from places like NYC and NOLA.

    Best place to start analysis is South Korea. Now over 370k tests, over 9600 positives, over 5200 recovered, 158 deaths, new cases down to about 100/day thanks to very aggressive contact tracing, testing, and quarantine. Viral Attack rate with social distancing, widespread testing after contact tracing, and strict positive 14 day quarantine is 2.6%. 20% of positive asymptomatic cases remain asymptomatic after 14 day quarantine; bad news in general, Implies a higher attack rate elsewhere. CFR yesterday ( we know numerator and denominator) was 3.0%—was 3.4% 3/17. It will drop further when you look at yesterday’s active and reported serious/critical (s/c) cases. Will end somewhere around 2%. In Korea up to mid last week, s/c was running a steady 11% of positives.

    To understand US or UK potential, some higher end attack rate assumption is more likely, but in what follows I key off SK’s optimistic 2.6%. US population about 327.2 million* 0.026 attack rate* ~2% CFR is ~170 thousand fatalities. Lower than High end of Dr.Fauci’s Saturday range.

    There is a second way to back into deaths without knowing CFR, using US data from NYC and NOLA from late last week. First is to know % serious/critical: for NYC 12%, for NOLA 12.6%, both a bit higher than SK. I use 12%. Then you need to know the % that progress to critical (ventilator) because that is where deaths occur. Averaging a Wuhan doctors estimate of 26%, NYC last Thursday 29%, NOLA last Friday 35% gives 30%, 0.3 multiplier. The lead NOLA critical care pulmonologist says about 50% on ventilator under his care are dying. It was 80% in Wuhan. Fatalities multiplier 0.5.

    Out of sample multiplier test—as of 3/30, California reported 1034 hospitalizations (s/c) and 138 deaths. 1034*0.3*0.5=155. That is a good enough result because deaths relate to past hospitalizations, which are growing.

    Full ‘model’ validation. US presently has 155969 cases and 2854 deaths. 155969*0.12*0.3*0.5=2807 predicted deaths. 98.4% model to actual is good enough for government work.

    Future ‘model’ estimate. US has 327.2 million citizens (about, dunno illegals). At SK’s attack rate, future Wuhan virus deaths will be 327200 thousand (k) *0.026*0.12*0.3*0.5= 153k. The middle of what Dr.Fauci estimated on Saturday. If US attack rate is just 25% higher than SK at 0.0325, then expected deaths are about 200k—exactly Dr. Birx most recent Sunday ‘if everything goes nearly perfect’ estimate.

    Bad news, and mathematically showing why ‘bending the curve’ to avoid the NYC surge as this physician pleads for is essential.
    The president made the right call yesterday, as economically painful as it is.

    • “Bad news, and mathematically showing why ‘bending the curve’ to avoid the NYC surge as this physician pleads for is essential.
      The president made the right call yesterday, as economically painful as it is.”

      So, it looks like Dr. Fauci’s numbers are in the ball part, which ought to be an answer for people who seem to think the economic pause was not necessary. Dr. Fauci’s number of 2,200,000 deaths from Wuhan virus if no action was taken to mitigate is probably accurate. So the choice is do what we are doing and hold the number of deaths down to 100.000, or do nothing, let the economy roll, and suffer 2,200,000 deaths.

      It looks like a no-brainer to me. I think the economic pause is worth saving 2,100,000 American lives.

        • I don’t know what happened, Simon. I refreshed the article you would have put those links in and there was no post from you regarding that. I have no idea why it didn’t show up, if you say you posted it.

          So, post it here, and I’ll look it over. But, I should modify my request: I don’t want a link to the New York Times or the Washington Post because all I will get from that is a biased opinion of what Trump said by a leftwing reporter.

          The links I want are Trump’s actual words. A transcript or a video. That’s the only time Trump’s words are not distorted, when you hear them from his own lips, and nowhere else.

          Trump isn’t perfect, but he’s not nearly as bad as leftwing reporters and you make him out to be.

          Transcirpts and videos, please.

          • Tom
            I am not sure why you can’t go back to the original thread which is here:
            https://wattsupwiththat.com/2020/03/29/fight-the-virus-not-carbon/#comment-2950575

            I don’t really want to duplicate everything and clog this thread, but if you want a clue that all is not well for Mr Trump at this time read this article from National Review (which I am sure you will agree is right wing).
            https://www.nationalreview.com/2020/03/president-trump-needs-to-step-up-on-the-coronavirus/

          • I did go back, Simon, and there was your post!

            Well, I see you have provided “quotes” from various news organizations, which, no dobt, have been twisted, or taken out of context. I don’t have time to research every quote and debunk it.

            As for your National Review article, here’s the money quote:

            “The failures of leadership at the top, however, show no sign of being corrected. In a serious public-health crisis, the public has the right to expect the government’s chief executive to lead in a number of crucial ways: by prioritizing the problem properly, by deferring to subject-matter experts when appropriate while making key decisions in informed and sensible ways, by providing honest and careful information to the country, by calming fears and setting expectations, and by addressing mistakes and setbacks.

            Trump so far hasn’t passed muster on any of these metrics. He resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.”

            I completely disagree with that. You’ll notice the writer of the article didn’t point out any specific failures of the president, and as far as I’m concerned, the president has not failed in any aspect of this crisis. You may want to point out specifics, yourself. What does “properly empower his subordinates” mean in this context? I bet you can’t answer that question. This is an opinion piece by someone who obviously doesn’t understand the situation or is deliberately distorting the picture.

            As for the “Get it yourself” article in the Hill, here’s the quote:

            “Beseeched by governors to use the power of the federal government to get and deliver Coronavirus tests kits, N95 masks, protective gloves and gowns, and ventilators to their states, President Trump declared, “Try getting it yourselves. We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”

            His response — and his approach to the greatest public health crisis in American history — reveals a willful ignorance of, contempt for, and determination to hide behind “federalism,” which along with the separation of powers among the executive, legislative, and judicial branches of government, is a foundational principle of our democracy.”

            This is a complete distortion of the facts. Trump did tell the governors to try to get the medical supplies they needed themselves because Trump said it would be quicker for them to do it that way. In other words, it was beneficial to the States to do it this way. You’ll notice the article didn’t point that out, instead it tries to make it look like Trump is refusing the governors or avoiding taking action. Both of which are lies, Simon.

            Simon, you are putting too much faith in the opinions of leftwing and Trump-hating journalists.

            Btw, the Democrat meme is now that Trump didn’t take action fast enough to quell the Wuhan virus and blood is on his hands. The facts are President Trump set up the public/private network to combat this disease about two days after the first infected person was discovered in the United States around Jan 21. That was about the same time all the Democrats were complaining about Trump’s travel ban of China, which was put in place Jan 31, and Nancy Pelosi was out encouraging people to go to Chinatown and other Democrats were telling New Yorkers they had nothing to worry about from the virus.

            Trump was on top of it from the beginning and he is still on top of it. The only thing Democrats were on top of was trying to remove Trump from Office, and opposing him at every turn, during a national crisis. That shows where their priorities are. It has nothing to do with the people of this country, and everything to do with their own political power. Anyone who would vote for a radical Democrat is a fool. And just about all the Democrats are radical Democrats.

            I hope that satifies you, Simon. You know, I used to go on Usenet (alt.politics) with article after article from the leftwing news media and I would put the entire article in the post and then I would proceed to debunk every lie in the article. I did that for years because I thought the lying leftwing news media was the most dangerous organization in the nation because of all the lies they constantly tell and the distortion of reality they create, and I thought people ought to know that.

            Nothing has changed between now and then, except there are a whole lot more people who are wise to the lies of the leftwing news media now. The leftwing news media’s credibility is in the toilet, and that’s a very good thing. You should be angry at them, Simon, for misleading you.

        • Btw, I don’t know if WUWT is messing with the comment software, but I have had a couple of posts just disappear lately, and that never happened in the past.

          I saw a post this morning where a person said they had a “like” button on their screen, and another person said they had a “more” button on their screen, but I don’t see anything like that.

          Of course, I do employ script blockers, but that didn’t prevent me seeing the updated comment software that was installed in the past, so I don’t think it would stop me from seeing changes now, especially since I allow both WUWT and WP.

          Oh well, the text is the most important part and I get all that, so it’s all good.

    • Fauci’s 100 to 200 K deaths is a worst case scenario. He didn’t estimate 2.2 million. That was a UK doc, who backtracked, then backtracked on the backtrack.

      About all that can be said now is that the US might suffer more deaths, largely among the old and already sick, with WuFlu (not necessarily from it) than with the 2009 swine flu pandemic, ie 12,000. Whether the toll will be on the order of ten times that bill or not, only time will twll.

      • “Fauci’s 100 to 200 K deaths is a worst case scenario. He didn’t estimate 2.2 million. That was a UK doc, who backtracked, then backtracked on the backtrack.”

        I don’t think that is correct. I think those numbers are the ones Dr. Fauci came up with based on the data he has collected.

        Dr. Fauci stated that without mitigation the deaths were estimated to be between 1.6 million and 2.2 million, so he did estimate and publicly state 2.2 million and I doubt that he is using a study that has had doubt cast on it.

        Correct me if I’m wrong.

      • There was no backtrack. The 2.2 million was the figure estimated if NO mitigating action were taken. That is unchanged,

    • Using the Italy numbers on the US I am going for 50K deaths just based on US ventilator numbers and curve. On current projections you won’t have to make decision not to ventilate certain groups like Italy has. So I expect lower death rate than Italy. New York is supposed to peak April 8-9 so I might revise then.

      • I hope it will substantially lower with the aggressive use of Drugs.
        Unlike you theb people in the Uk are not allowed to use the drugs unless it is for a clinicla trial.
        But what is even worse there is none of those drugs available, they appear to have been sequestered by the government.
        So Malaria & Lupus sufferers are having a great deal of trouble getting it.

  23. We have watched people talk about the future with Climate Change. Now we are watching it in the medical field.

    The problem is that the future is unknowable. And the small amount of data that we can gather about the present is often compatible with a wide variety of possible futures.

    For all we know, some unknown tipping point in the climate MIGHT suddenly bring us into a ‘Day after Tomorrow’ scenario. Very unlikely, but no one could rule it out 100%. With Covid it COULD mutate into a much more damaging illness, and that’s probably more likely than the Climate disaster.

    The problem that we have is of balancing relative unknown risks. Dr Liang does not have that problem. He has one issue on his mind – he does not want to be working in an overloaded ER where he will have to decide who lives and who dies. So to him, any disruption to society is preferable to placing him in that awful position.

    The rest of us will have to make our own minds up about where the balance lies. We might note that bad flu epidemics kill people on their own, and by hospital overflow, in precisely the way that he expects Covid-19 to do. Does this mean that we should shut down our economy each heavy flu winter? Perhaps – I am sure that we could adapt our economy to handle lock-downs if we so wished. But we do not do this at the moment – we don’t even prioritise the one palliative which Dr Liang does not mention – medicines to minimise the worst symptoms without hospitalisation. Perhaps we ought to do that?

    I will be watching the mortality stats with considerable interest. It seems to me that the press are hysterical and the experts are responding to them rather than trying to produce a balance. The Imperial College projections were a major example of this. I suppose that we should hope that Dr Liang’s warning is similarly exaggerated, while preparing for it not to be.

    • There are some things in all this which are quite obvious, Re: “Bending the Curve”.
      Other than that trying to make projections based on different countries data is really not usable because THERE IS NO GLOBAL PROTOCOL FOR DATA COLLECTION AND VERIFICATION.

      You could be way out in left field and not even know it before the right handed batter sends one the opposite way.

      If there is one thing the planet can learn from this virus is how to assess the quality of reported data.
      At the moment, it is absolutely not there.

      It may be a problem which is resource constrained with fuzzy answers as the only solution, but it is worth admitting and focusing on a better way to report.

  24. In Culpeper Va. the medical center and emergency rooms are nearly empty. They’ve canceled all elective procedures and routine appointments. Small towns and outlying communities have a significant surge capacity. Governors need to use this wisely.

    • Tom Kennedy

      ” In Culpeper Va. the medical center and emergency rooms are nearly empty. ”

      What a lucky corner… Well, if you have time and money enough to do…

      What about visiting those hospitals in Italy and France which are so overloaded that the most vulnerable COVID-19 patients are brought from there to Germany by plane so that they do not have to die?

      This is not a joke, I am really serious.

      J.-P. Dehottay

      • Italian ICUs are close to max every winter. They collapsed during the 2017-2018 influenza outbreak. Sounds like they have an endemic capacity problem, but every bozo extrapolates their problems to the rest of the world.

      • the most vulnerable COVID-19 patients are brought from there to Germany by plane so that they do not have to die?

        Really ? Numbers, sources ?

        Last I heard Germany had offered to take 45 cases from Italy ( but not straight away ).

  25. Anthony Watts

    Thank you very much for publishing Ivan Liang’s impressions, experiences, thoughts and advices, even if imho few of your readers will take them serious.

    I read upthread things like

    “When Covid numbers start to resemble those of influenza then I’ll consider taking real notice.”

    and I’m simply stunned.

    Here we have for the current seasonal flu a tiny bit over 300 deaths for … far over 150,000 cases. This is 0.2 %, to be compared with our COVID-19’s death/case ratio of 0.87 for yesterday (1.74 % for the US… and 6.5 % for France).

    Hmmmh.

    Rgds
    J.-P. Dehottay in Germany

    A rich country, oh yes, in which a hospital director recently had to provide his medical staff with missing protective clothing and masks – on his own initiative !!! – because neither the federal government in Berlin nor his state government were able to do so in due time.

    • I agree. Very good letter to print. Everyone needs to read this. I have a daughter who is a doctor and she tells me the next two weeks will tell the tale. Clearly Trumps advisors have convinced him. Good on him for listening.

      • “Clearly Trumps advisors have convinced him. Good on him for listening.”

        Good on you for saying that, Simon.

    • Here we have for the current seasonal flu a tiny bit over 300 deaths

      If you are just looking for flu on the death cert. that is probably at least an order of magnitude too low. Influenza is rarely the actual cause of death, most commonly pneumonia or other complications.

      Influenza outbreaks lead to thousands of excess deaths for the year but only hundreds get directly attributed.

      You insist on dividing concurrent cases and fatalities, which is NOT the way to work out mortality. You should be a climatologist.

    • That is my quote. Why not properly cite me? We have had closer to 23,000 influenza deaths (per the CDC) than 300. Covid deaths are just about 3000 (and I don’t believe that number). We disrupt our entire culture for 3000 lives but not 23,000? Huh?

      I am an RN with 30 years experience, 12 of those in various ERs. I’ve been on the ‘front lines’ of flu epidemics and I have never seen this kind of over the top response, because it has never happened before. As you are stunned at my take on the issue I am stunned at your ignorance.

      • By ‘we’ and ‘our culture’ I mean the US. The comparison of influenza deaths between the US and Germany simply underscores the fruitlessness of comparing one nation’s statistics with another’s.

    • Sorry for all repliers, tired old nurses included.

      The yearly death toll for seasonal flu was this year until now 323 by March 29.

      The 2017/18 season was heavy, with about 21,500 deaths:
      https://www.aerzteblatt.de/nachrichten/106375/Grippewelle-war-toedlichste-in-30-Jahren

      Thus, you all see that in Germany the people establishing death certificates are not quite as dumb and ignorant as you ‘suggested’. They really CAN make the distinction. Incredible, n’est-ce pas?

      You Americans are really arrogant and think you know everything better. We will see in a few months how your comments then will look like.

      Look at Canada’s way of collecting stat for flu and pneumonia (row 6), and you will understand why I have some doubt about your claims concerning flu vs. pneumonia:

      https://www150.statcan.gc.ca/t1/tbl1/fr/tv.action?pid=1310039401

      I collect the Worldometers data every day at:
      https://www.worldometers.info/coronavirus/#countries

      Let me just tell you that on March 23, the COVID-19 death toll / case ratio for the US was 1.26 %; for yesterday March 30 it is at 1.93 %.

      Again according to Worldometers, the ratio for the seasonal flu in the US is… 0.2 %.

      Wether or not you believe in their data and numbers does not interest me at all: this blog is over and over full with comments made by people doubting about everything (their own meaning excepted, of course).

      Wait and see, guys ‘n dolls. I don’t feel the need to convince you. That is your job.

      Best regards from Germoney
      J.-P. D.

      • Thus, you all see that in Germany the people establishing death certificates are not quite as dumb and ignorant as you ‘suggested’.

        Where did it say in the article you linked that those figures came from death certs. ? That is in your head. You are not even aware that you are looking different stats. Your science and understanding does not go beyond reading headlines and “worldometers”. You then start doing your own stats with zero knowledge and think it means you can correct everyone else.

        Still waiting for you source of the claim that the sickest in Italy are being flow to Germany and the numbers involved. Last I heard it was a few dozen and “not straight away”.

  26. Compare US stats with a cluster of European countries (Italy, France, Spain, Germany, UK, Switzerland) with the same total population. Current stats 19h45 GMT:
    333 314 cases and the US 158 290 (47.5%)
    24271 deaths and the US 2930 (12%)

    • Michael in Dublin

      I’m sorry, but your comparison is a bit dangerous, as you mix countries with a low death toll per case ratio (Germany, USA) and such with a high ratio (France, Spain, Italy):

      29.03.20 | Cases | Deaths | Dths/Cs

      Germany | 62435 | 541 | 0.87
      USA | 142460 | 2484 | 1.74
      *
      France | 40174 | 2606 | 6.49
      Spain | 80110 | 6803 | 8.49
      Italy | 97689 | 10779 | 11.03

      The point more interesting imho is: why is this d/c ratio in the US twice that of Germany?
      My layman guess: the column missing (number of tests performed on ‘day – 10’) might explain a lot.

      J.-P. D.

      • It is meaningless to divide today’s cases by today’s fatalities ! That is not you work out mortality of an illness. This can only be done in retrospect when all infected patients have reached an outcome: they either made or they didn’t.

        Even more so when the number of *detected* cases is almost directly proportional to the number of people you are testing ( ie test kit availability and use policy ). UK can’t even manage to test it’s own front line staff. It’s a joke.

        • Greg

          ” It is meaningless to divide today’s cases by today’s fatalities ! ”

          Again 1: thanks for ‘teaching’. Reminds me pretty good ‘Temperatures do not add!’…

          Again 2: not the number is of interest, but how it develops over time.

          J.-P. D.

      • Bindidon

        While we should try and compare apples with apples, there are grounds for comparison. Outside of areas like NY, there are cities with very low numbers of reported cases in the USA. However, the USA with all its states is like the EU with its many countries. As the percentages of deaths varies between European countries so it varies between states.

        The fact is that 51% of coronavirus cases and over 71% of deaths are in 18 countries in Europe. The USA just has about 20.6% of cases and 8.2% of deaths. It may be useful to consider why these differences and whether these would indicate that it may not be as bad in the USA. We will know in a year or two looking back but this may help to temper rash and hasty decisions now.

  27. Hopefully, all of these scenario “projections” are not using the same computer programs that determine global warming scenarios? \sarc off

  28. Is it OK if I am skeptical of this “letter”? It is supposedly written by someone with a Russian first name and Chinese last name living and working in a state known to be inhabited and run by INSANE Leftists bent on supporting ANTI-social behavior and oppressing anyone expressing rational thought.

    • Most Chinese-Americans have given names from Indo-European or Semitic languages.

      Presidential candidate Andrew Yang’s first name is the English version of a Greek original. Former WA governor Gary Locke’s last name is even anglicized.

      • I was just trying to be a bit humourous. I’m amazed at how many “Hispanic” names there are in South Carolina. Until you do a bit of research and find that the Spanish had settlements along the coast and one of the first … (can’t recall offhand but don’t have time to look it up) was Spanish. Fought in the Revolutionary War I believe.

  29. For those commentators who are all the time looking at one or two numbers, and say

    “Oooh! Less people died yesterday than the day before. All is well, the decline started.”

    Here is a little stat, showing for five countries, starting with March 23 and ending with March 29:
    – cases
    -deaths
    – deaths per cases ratio ( in %)

    If you think that the number for France, Spain and Italy are exaggerated or faked: simply look away.

    23.03.20

    Germany | 29056 | 123 | 0.42
    USA | 43734 | 553 | 1.26
    France | 19856 | 860 | 4.33
    Spain | 35136 | 2311 | 6.58
    Italy | 63927 | 6077 | 9.51

    24.03.20

    Germany | 32991 | 159 | 0.48
    USA | 54881 | 780 | 1.42
    France | 22304 | 1100 | 4.93
    Spain | 42058 | 2991 | 7.11
    Italy | 69176 | 6820 | 9.86

    25.03.20

    Germany | 37323 | 206 | 0.55
    USA | 68211 | 1027 | 1.51
    France | 25233 | 1331 | 5.27
    Spain | 49515 | 3647 | 7.37
    Italy | 74386 | 7503 | 10.09

    26.03.20

    Germany | 43938 | 267 | 0.61
    USA | 85435 | 1295 | 1.52
    France | 29155 | 1696 | 5.82
    Spain | 57786 | 4365 | 7.55
    Italy | 80589 | 8215 | 10.19

    27.03.20

    Germany | 50871 | 351 | 0.69
    USA | 104126 | 1696 | 1.63
    France | 32964 | 1995 | 6.05
    Spain | 65719 | 5138 | 7.82
    Italy | 86498 | 9134 | 10.56

    28.03.20

    Germany | 57695 | 433 | 0.75
    USA | 123578 | 2221 | 1.80
    France | 37575 | 2314 | 6.16
    Spain | 73235 | 5982 | 8.17
    Italy | 92472 | 10023 | 10.84

    29.03.20

    Germany | 62435 | 541 | 0.87
    USA | 142460 | 2484 | 1.74
    France | 40174 | 2606 | 6.49
    Spain | 80110 | 6803 | 8.49
    Italy | 97689 | 10779 | 11.03

    As you can see, the major number – deaths/cases ratio – is nowhere decreasing, excepted for the US from March 28 to March 29.

    So let us all keep patient, and wait for better numbers. They will come, even if certainly not… tomorrow.
    *
    Btw: the current deaths/cases ratio for the 2019/20 edition of the seasonal flu in Germany is… 0.02 %.

    Rgds
    J.-P. Dehottay

    • Germany doesn’t test the dead, so its figures aren’t comparable to those of nations which do.

      In Italy, whether you die from or just with Wuhan virus, you’re counted, as Willis has pointed out.

      • What do you mean with

        “Germany doesn’t test the dead…” ??

        Some explanation for this brilliant claim? I’m interested.
        J.-P. D.

        • Some countries test those who have died – without a previous coronavirus test – to see if they were infected. I believe Italy ascribes death to the virus even if there is no causal link and they died of another existing medical condition. This, besides the fact we have no idea of the number who have contracted the virus with no or very mild symptoms, complicates comparing numbers. Perhaps only when we have a reliable test of whether someone has been infected and a cross section of the population is randomly tested we will get a much better idea

    • J.P., I have read elsewhere that when the pandemic broke out Germany had something like 3 or 4 times more ICU beds available in their hospitals than did the UK (as a comparison).

      Is this the reason Germany has managed to keep their death rate so low?

    • That is going to cause a problem for some on here .. we probably need to sort out if we attribute deaths due to the drug to Covid19 or not.

  30. As of yesterday, there are approx. 4000 cases in Italy described as ‘serious or critical’ (source: https://www.worldometers.info/coronavirus/country/italy/) this is at the peak, which has continued at this level for about a week. The population of Italy is about 50 million, which means about 1 in 12,500 are serious or critical, in the country which is right now the hardest hit anywhere. By extrapolation, you will need, at peak, 24 ventilators for a population of 300,000. (This assumes all cases that are ‘serious or critical’ need a ventilator.) Telling the people in your community and those across the country that they need 60 times more ventilators than they actually do is simply causing unwarranted panic. I’m sure you mean well, but please do a bit of research before painting unrealistic apocalyptic pictures.

    • Italy’s population is 60.5 million, with an unknown number of illegal immigrants as well.

      While March 27 was the high death day so far, as Italy reports mortality, the trend since March 20 has been essentially sideways. The disease is concentrated in the north, and has predominantly killed the old and already sick.

      Lombardy, like New York, has hundreds of thousands of recent Chinese immigrants, with direct flights to and from Wuhan.

  31. There is some useful information in this story but some fundamental mistakes. The main one is a claim that 100% or nearly 100% will get the virus during this outbreak. That essentially never happens during outbreaks of new diseases. It really isn’t feasible. CoVID does appear to be highly infectious and the perception of large numbers of people potentially spreading it with little or no symptoms is gaining traction. Regardless, there are many factors that limit spread of such a virus to a much smaller segment of the population. These may include inmate immunity by way of genetics, acquired immunity (which might include the role of exposure to other related viruses), and a lot relating to behaviours and environmental factors dictating exposure. We won’t know real numbers till after the fact when we have serologic testing.

    • “inmate immunity by way of genetics”
      Does that assume that criminality is a genetic trail or that we lock people up based on genetic traits such are race? Oops.

    • In the essentially free-range 2009 swine flu pandemic, US infections were estimated at under 60 million, ie fewer than one in five Americans.

      • With 12,000 people dying with the flu, not necessarily from it. As with WuFlu, mainly the old and already sick.

  32. From the article: “Even more seriously, the economy is heading downhill and many people are not getting paychecks.”

    I don’t think it should be put that way. The economy is in a pause. It is not heading any direction right now.

    If the economy gets moving soon enough, within the time that out-of-work people are still collecting payments from unemployment or from their employers, then there will be very little harm to the American economy.

    Consider that 75 percent of US GDP is generated internally with Americans doing business with other Americans. The other 25 percent of GDP is made up of foreign trade, half of which is between the US and Canada and Mexico. So about 90 percent of the US GDP is generated “locally”.

    A couple of months ago everyone had money in their pockets and the economy was booming as a result, and then the Wuhan virus reared its ugly head and the US economy was put on pause. And it’s not really on pause, either, there are a lot of people doing work right this minute.

    So, assume a positive scenario, and we find that some of the treatments for Wuhan virus are effective enough to allow the American population to go back to work.

    So what has changed between the time the economy went on pause and the time it starts back up? I would submit that not much has changed as far as the American consumer is concerned.

    If the U.S. government manages to keep everyone financially viable until the economy opens back up, then American consumers will still have the same amount of money they had to spend when the economy was going good, and they will spend that money and the economy will respond.

    No doubt the economic pause has caused numerous disruptions but so far, it hasn’t taken the spending money out of the American consumer’s pocket, and that’s what counts most.

    Of course, this will not work for a long period of time. The U.S. government can’t afford to keep everyone whole for too long a period because there won’t be enough money to pass around. The government has put enough money into the system to sustain us for a couple of months, but beyond that, then we are talking about serious damage to the economy.

    Get the economy up and running by June 1, and we will be in good shape, imo. The American economy is like a coiled spring ready to be sprung.

    • I don’t think it should be put that way. The economy is in a pause. It is not heading any direction right now.

      There is no such thing as “being on pause”. It costs trillions to run a country, that bit is never “on pause”. If you revenue stream is “on pause” you’re screwed.

      Neither is just like putting video on pause while you go grab a beer. Infrastructure collapses rapidly, when you release the “pause” button a lot businesses simply won’t be there to magically switch back on again.

      Once you go into repo on your home, no one is going “pause” for you. The blood suckers at the bank will want their pound of flesh.

      • Perhaps not on pause but there is no underlying structural weakness to the US economy at the moment. While the lost GDP can’t be made up I believe we will recover very quickly.

        • US is running deficits your projected Fiscal Year 2021 U.S. budget deficit was to be $1.1 trillion. I haven’t seen the number since the stimulus anyone know it?

          You can make back the GDP but there is an underlying issue the US like most other countries is hooked on importing junk from China just because it’s cheap.

          • We have been running deficits forever. While I agree with your point our addiction to deficit spending does not mean that the underlying economy isn’t sound.

          • “You can make back the GDP but there is an underlying issue the US like most other countries is hooked on importing junk from China just because it’s cheap.”

            I think if Trump gets elected in November, and gets a majority in both the House and the Senate, they I would bet money that Trump will address the budget deficits and the national debt. He has talked about the “Penny Plan” or something like that on more than one occasion, so he is thinking about it. The Penny Plan would cut one penny out of every dollar for every government agency. This would exclude the military and probably some other programs, but even so, following a Penny Plan would eliminate the debt in a reasonable amount of time.

            If the Democrats hold any political power such as holding on to the House, then you can forget abut reducing budgets. That is not in their DNA.

            I think the importing of junk from China is going to change drastically. I heard Nigel Farange say last night that when he goes to buy something in the future, he is going to look to see if it is made in China, and if it is, he is not going to buy it. I think a whole lot of people are going to have that attitude.

            I also think the U.S. and probably a number of other nations are going to be moving their supply chains out of China in the future.

            China’s leadership screwed things up royally. There will be consequences for them, perhaps even domestically. Some Chinese are so fed up with their leadership that they are calling them liars in public. The head of Wuhan’s hospital said recently the Chinese leadership had misled the world about the Wuhan virus, and now she has disappeared. The Chinese leadership has a lot to answer for, to a lot of people.

      • If Americans have the same amount of money in their pockets after the pandemic as before, and they will with the stimulus package just passed by Congress, then they are going to resume spending that money and the economy will take off, and all those deficits will be fixed eventually.

        The American economy is strong. We can’t find enough workers to fill all the jobs available. Energy prices are very low, and regulations have been cut and that’s why the economy was booming in the first place, and nothing has changed along those lines other than oil is even cheaper now than it was then.

        Let Americans out of their houses soon and this economy will resume right where it left off.

  33. I am one of your local Emergency Medicine docs at Enloe Medical Center.

    First off, I want to thank Dr. Liang (and others like him) for the difficult work he does. I doubt I would last even 5 minutes in that job.

    But (and you knew there would be a but) I wonder if people in that type of job always see the worst possible outcomes. Like the reformed alcoholic who foresees disaster when friends are enjoying a few beers at a local tavern. I’m not saying that’s the case here, I’m just wondering…

    • “I doubt I would last even 5 minutes in that job.”

      Ditto and even being a GP you’d have to ask yourself why is everybody I meet crook or falling to bits?

      OTOH I can be out driving somewhere and spot a building and remember building that one. The missus being a retired JP teacher has them calling out to her with prams, toddlers and adolescents in tow nowadays. So each to their own and the docs have to concentrate on the ones that go home fixed I guess. Haven’t had any buildings fall down on me and the missus doesn’t get to meet any of her charges in prison or worse unlike the docs I suppose.

      Funny what you fall into or keep climbing out of as I’ve had a few changes of direction and some might say ADHD. Some like the roller coaster and some prefer the quieter merry-go-round for a bit of philosophy.

  34. The 100% infection prediction is absurd. It would be the first disease in recorded human history to do that. The 1918-1920 Spanish flu infected only around 27% of the world population, in much worse hygienic conditions and far less medical support than we have now. During the Black Death in the Middle Ages, it’s unclear what percentage were infected, but certainly not everyone.

  35. Thank you for the information. Really the first time I’ve read someone lay out an infection scenario. Being a student of history, I’ve read about the horrific Spanish Flu pandemic and black plague. Isolation and containment appears to be critical in halting massive infections. Patience is needed in enduring this outbreak. As for lethality and spread, I’ll leave others to comment.

  36. Early detection and treatment with malaria drugs, doctors that are familiar with their use, are having good results.

    • What alerted the Chinese to using malaria drugs against the Wuhan virus was when they saw that lupus and arthritis patients who were being treated with the malaria drug, hydroxychloroquine, were not getting infected with the virus.

      It looks like this drug does have the ability to keep one from getting infected. There is a clinical trial for using this drug as a preventative going on right now.

  37. A 101 year old Italian woman reportedly was released from a hospital in Italy 2 days ago after having the Wuhan virus. And a 102 year old Italian male likewise reportedly recovered from the Wuhan virus & went home yesterday.

    Maybe these 2 cases are actually the same person being confused by news service press releases. I have no knowledge about the veracity of either case.

    If any case is true then I think the factor is immunological genetics. The salient feature in the genome of the extremely old is supposedly related to immunity.

  38. When you have Covid-19 symptoms do not stop taking the medication you are taking. Consult your doctor immediately by phone.

  39. In the United States, the disease was first observed in Haskell County, Kansas, in January 1918, prompting local doctor Loring Miner to warn the US Public Health Service’s academic journal. On 4 March 1918, company cook Albert Gitchell, from Haskell County, reported sick at Fort Riley, a US military facility that at the time was training American troops during World War I, making him the first recorded victim of the flu.[38][39][40] Within days, 522 men at the camp had reported sick.[41] By 11 March 1918, the virus had reached Queens, New York. Failure to take preventive measures in March/April was later criticised.[42]

    In August 1918, a more virulent strain appeared simultaneously in Brest, France; in Freetown, Sierra Leone; and in the U.S. in Boston, Massachusetts. The Spanish flu also spread through Ireland, carried there by returning Irish soldiers.[citation needed] The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.
    https://en.wikipedia.org/wiki/Spanish_flu

  40. Rapid tests for the detection of antibodies should be developed to detect people who have immunity. These people can help a lot in the long run.

    • Yes, we definitely need an antibody test. Then we can get a much better picture of where we stand. As infectious as this Wuhan virus is, there may be a lot of people who have already caught the virus and gotten over it and are immune, and they certainly can be used to get the economies going quicker.

      Plus, if you take the test and find you are immune then you can relax a little bit.

      All the things we are doing now will serve us well in the future when another one of these viruses comes along. the next one could be a really deadly one, but we will definitely be better prepared.

  41. I’m sorry, but this is how nature works, and man has no influence on it. One outbreak of the virus will be extinguished, and new mutations will appear in other areas of the world.

  42. Source: Pulse of Medicine
    https://pulsmedycyny.pl/koronawirus-sars-cov-2-uszkadza-serce-986835?fbclid=IwAR22YMB6BEN5FGa-cRyCLfhHyIwr0Wqhf5ArNL8sDMPSgIip8F5NM7UFZRY

    SARS-CoV-2 coronavirus not only affects the respiratory system. “People who have cardiovascular disease such as hypertension, myocardial infarction or diabetes are more likely to die from coronavirus infection than those who are not burdened with these diseases. Observations also indicate that the virus can irreversibly damage the heart in previously healthy people “- says prof. dr. n. med. Adam Witkowski, head of the Cardiology and Intervention Angiology Clinic of the National Institute of Cardiology in Warsaw, president of the Polish Society of Cardiology.

  43. I think that all efforts these days are simply aimed at avoiding overload on hospitals. This is also what nearly most European countries do. If you listen carefully to most virologists and epidomologist this is exactly what they say. They don’t say “we need to stop the virus” or “we need to win the war”, that is politician talk. They carefully say words that come down to flattening the curve. They say that the virus will likely be around till there is a vaccine.

    Most of the population understand it wrong, one shouldn’t be that much afraid of being contaminated for his/her own health, a majority of us will get it anyway. But we need to protect from it spreading to fast, or to much to the elder population

    One should not have the illusion of being able to manage hospital capacity very accurately, this is not like tuning the radio.

    Even with the (partial) lockdowns in place there is already impact on the health system. In many countries in Europe nearly all hospitals have postponed all non essential surgery. There is a lot of fear in hospitals that people needing care do not dare to come to hospitals, there is for instance an unexplainable decrease in number of hospitalizations for heart problems (beyond what one can expect because of lockdown effects)

    In Italy already 63 doctors died, not a regular flu in any case. It will only become a regular flue once all those that are genetically disadvantaged have died…

    • Eddie

      ” I think that all efforts these days are simply aimed at avoiding overload on hospitals. ”

      ” They carefully say words that come down to flattening the curve. ”

      Exactly. I have read reports from Italian and French medical staffs who all were horrified to lack personnel and material to such an extent that they really had to decide who would be helped to survive and who wouldn’t.

      Who wants to have to make such decisions?

      J.-P. D.

  44. “Make no mistake the surge is coming”

    Make no mistake, if you are wrong and have destroyed the lives of millions, you should STFU and learn to code.
    The medical system currently kills about 120/day on any normal day in the US.

    If you wish to survive this, do anything you can to avoid a hospital.
    -They give anti-virals with many serious side effects along with antibiotics. Never tested together. God forbid they give you Chloroquine which has serious listed interactions with antibiotics.
    -They starve you
    -They isolate you from family
    -They put you on a mechanical ventilator which has a very well correlated relationship with mortality. Check it some time.

    [Borderline paranoia? Publish or not? Mod]

  45. New York had exactly half of all 558 US deaths yesterday. Of total deaths, NY has reported “only” 39%, because of Washington’s early lead. But yesterday, WA had only ten new deaths, vs. 279 in NY.

    Total deaths by state and nation, as of March 30 (rounded to nearest whole number):

    NY 69
    LA 39 (Mardi Gras hangover)
    WA 28
    NJ 22
    MI 18

    US 10

    CA 4
    FL 3
    TX 1

  46. Anthony, thanks for posting this letter. I have sent it on. It helps to remind everyone that this virus is not the flu, it is new, and has extreme infectivity – and that is the issue. Health care must be supplied and expanded for the extra load or no one will have available health care. We also have to care for health-care workers.

    I am looking forward to the cures (e.g., the triad of hydroxycholorquine, zinc sulfate, azirothomyicin) working on a large scale, quick tests for the virus readily available, and antibody tests such that we can identify those with (new) immunity.

    I think we are going to come through this stronger and better prepared than ever before. Certainly we will be more knowledgeable about those who are trying to help and those who are trying evade, lie, or destroy.

    • When Mainland China enjoys the blessings of liberty and good government like Taiwan, future potential pandemics originating there can be nipped in the bud.

  47. Just a word of thanks to _Jim for kindly calling me an empty-headed liar. I am reminded of a question asked by Rex Stout’s Nero Wolfe in the debut novel: If a man makes a dummy, dresses it to resemble you and strikes it on the face, does your nose bleed?

    Thanks also for the link to a series of papers, none of which gives outcomes for treatment with hydroxychloroquine and two of which refer to other drugs (remdesivir and teicoplanin.). Perhaps it is inevitable that those who are desperately grasping at treatments for a frightening condition will react with childish anger to anyone who points out the need for well controlled studies, and _Jim has my sympathy. He could try psychotherapy or anger management. I stand by my comments.

    Let me add this. I am not going to follow any of these threads any longer, as too many armchair physicians are writing too much nonsense about a genuinely difficult pandemic. There have been several honourable exceptions, and my compliments to Bindidon, Andy Patullo, Nicholas McGinley and others.

  48. Ridiculous. Every medical professional I know has been programmed with this narrative.

    Lifeboat ethics: I’m guessing we see a death count in the USA closer to 50k. Should we sacrifice the lives of 327 million for the few who are vulnerable? Hell no. Totally absurd. But yet our governors are in a race to the bottom to show who cares more.

    This will be remembered as the time when humans lost their minds to social diseases of political correctness, irrational fear, and socialism.

  49. My biggest concern is the availability and use of the Hydroxychloroquine treatments. Ivan describes the point where patients are being admitted to the hospital:

    “…if you are unlucky, after the initial mild syndrome, instead of getting better, you may get worse. You may develop worse “flu” symptoms and then pneumonia–filling of the lungs with infected fluid. These are the patients that will be admitted to the hospital for general care and observation. ”

    These are the patients that Dr. Zelenko has been starting on Chloroquine treatments in his NY outpatient clinics. He says he would like to start patients earlier, especially if they fall into a vulnerable group, but the supply is too limited at present.

    Just giving it to the people who are entering pneumonia/distress has kept all but 4 of his 700 patients from needing hospital care. Zero intubations. Zero deaths.

    So it looks like treatments could well keep hospitals from being overwhelmed, even if infections proceed at high surge rate.

    Thus I question Ivan’s view that the only thing that matters for preventing facilities from being overwhelmed is slowing down the contagion. It looks like treatment could do a large part of the work.

    But for that to happen outpatient facilities (at hospitals, doctors’ offices and clinics) have to be stocked with the treatments and have to be prescribing them.

    One of the most alarming things that has been happening is it looks like a lot of doctors/facilities will not prescribe the treatments unless they have a positive Corona test in hand, and as Ivan notes, those are still taking an alarmingly long time.

    Zelenko isn’t waiting. If he can diagnose Corona by symptoms he will start treatment but there was the insane story out of MI the other day where a young man was dying waiting for his corona test to come in. It came in just in time to save his life and he came out publicly afterwards and said “this is insane.” There was a similar story from WA, and a Dr. who was fired for criticizing his hospital for taking 10 days to return corona test results.

    The combination of slow testing and conditioning treatment on testing is a killer. This should be sent out as an alert across the country: don’t do this!

    Drs using it are saying it is crucial to start before lung damage. Results are better earlier and even if late treatment saves the person’s life, they still have lung damage.

    All of these problems would be greatly reduced if there was a big push to use the treatments in outpatient fashion to prevent hospitalization but I’m worried we are not there yet, with all the resistance that states and the FDA have thrown up, hating on a CURE because they associate it with Trump or something. Sheesh.

    Hydroxychloroquine is going to the thing that saves lives and allows us to keep our hospitals from being overwhelmed, not social distancing. Of course that helps to, but it also has a gargantuan price. We right now have higher unemployment rate than at the bottom of the Great Depression, and I believe it is unnecessary.

    For now, to get our systems of treatment up and stocked and ready, fine. Then we must let the treatments carry their major part of the load.

  50. Why would an emergency department doctor have special insights into the epidemiology of the virus. If he was talking about first response and triage and emergency life support, then yes he would be worth listening to.

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