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    Fear, Loathing, and Pandemics

    An epidemic turns out to be a rotten time to have a germophobe President. Trump's more obvious pathologies -- ignorance, narcissism, magical thinking, pathological lying -- have gotten the obvious attention, because those are all real dangers to public safety. But Trump's germophobia makes him fundamentally unsuited to a public health crisis. His focus on making sure that he, personally, does not get ill, is just the mindset that increases the number of people who will. Selfishness helps an epidemic thrive. The outbreak can only be defeated by cooperation. It attacks the whole society, and the society needs to fight back together.

    How do I not get it? is the wrong question to ask in plague time, although of course everyone would like not to get it. How do I not spread it? is the more important question.

    If your goal is to be one of the lucky ones, to be spared while others fall ill, that will be counterproductive, because other people getting it raises your risk. The fewer people get it, the less likely you are to be one of them. (This logic can be particularly difficult for elites or the super-rich to grasp, since they're used to being spared from widespread problems.) If your whole strategy is just to protect yourself, that will likely fail. Viruses gonna virus. If your strategy is to help your whole community control it, your individual odds will probably go up.

    I've found myself, for the last week or two, treating myself as presumptively infected. There's no sign I have covid-19 or anything like it, but I live with someone I don't want to get sick. So I'm acting as if I have something and trying not to expose my wife to any germs I might have. Likewise, I'm trying not to do anything in the classroom that might expose my students. I wash my hands a lot these days.

    I'm middle aged, but not elderly, and there are no known covid-19 cases in my area yet. My odds if I come down with covid-19 aren't as good as they would be if  were 10 years younger, but they're not bad. Should I come down with a case, I will probably ride it out fine. But I don't want to spread the damn thing.

    Pretty soon, this very infectious little bug is going to get close to Trump. I don't expect him to respond well.



    Trump attended CPAC. A CPAC attendee tested positive for the virus. Anyone working at the WH who went on the trip to CPAC with Trump and starts coughing is in trouble.


    Yes, that is definitely one scenario. As is the possibility of a covid-19 cluster being traced back to a political rally, whether Trump's or one of the Democrats'.

    And there is a non-zero, maybe even a non-trivial chance, that Trump bugs out at some point out of his own fear of infection. If POTUS cancels all public appearances in the middle of an epidemic because he's put himself in protective seculsion ... 

    Here we go:

    A growing sense of concern and uncertainty about the reach of the novel coronavirus has begun to take hold in the White House, after an attendee at a recent political conference where President Trump spoke tested positive for covid-19, the disease caused by the virus.

    Trump was photographed shaking hands with Matt Schlapp, the chairman of the American Conservative Union who confirmed that he had been in direct contact with the infected man during the Conservative Political Action Conference last month.

    The handshake at CPAC put Trump just two degrees of separation away from the virus that he has sought to minimize as it has rocked financial markets and tested his leadership skills. While the White House has maintained that Trump was never in direct contact with the infected person and is not suffering from any symptoms, the potential close call at a political event underscores how the outbreak threatens to upend the president’s routine as he campaigns for reelection.

    Edit to add:

    Senator Ted Cruz is self-quarantining after shaking hands with COVID-19 positive individual at CPAC.


    2nd Edit to add:

    Ditto Rep. Paul Gosar




    Lancet, March 9, 2020

    Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

    From the paper:

    ...we  included 191 inpatients in   the   final   analysis.  54  patients  died  during  hospitalization  and  137 were discharged. The median age of the 191 patients was  56·0  years,  ranging  from  18  years  to  87  years.

     The shortest observed duration of viral shedding among survivors was 8 days.... whereas the longest  was  37  days.  

    The median time from illness onset (ie, before admission) to  discharge  was  22·0  days,  whereas  the  median  time  to  death  was  18·5  days  

    Median age all 56 years

    Median Age 54 non-survivors - 69·0

    Median Age 137 survivors - 52·0

    total in study - 72% cases male, 38% female

    deaths - 70% male, 30% female

    28% death rate for those hospitalized with coronavirus in this study. For 2020 flu, 8200 deaths with 140,000 hospitalizations, or 6% death rate those hospitalized for flu.


    Lancet study, earliest age coronavirus case hospitalized, 18, oldest 87. Note viral "shedding" was detected up to 37 days after illness onset. (why the current procedure of a 14 day quarantine? A educated guess it seems, this virus is previously unknown as to its behavior)



    Check out the research on China response that PP posted on the other thread, very interesting. (I *love *the 4-to-an-elevator thing especially, in NYC if they did that it would take us all day to visit someone in a midtown office....)

    Drumpf is supposed to appear at a press conference his very self, any minute now, they're waiting on him on CNN as I write. Reporters did not expect him, they thought it was going to be Pence, but then they put the presidential seal on the podium.

    Lancet's editor extremely unhappy with Downing Street "leadership":

    And I note our Anthony Fauci has been out on the cable news TV networks specifically advocating social distancing and especially for those most at risk. I saw that several times yesterday...

    I think Sarah Kliff is the best reporter in the country on our health care system and health care policy. If she recommends something, I read it. Here it is a tale of chaos, showing that how a bunch of state and city Democratic bureaucrats with their spin on how they have everything under control and pictures of big meetings and plans, all of that, means nothing when you already have a health care system that is at a breaking point before a pandemic arrives. Because: we are not a totalitarian country! And further, our health system is not under direct control of the government. What the bureaucrats say they are doing isn't necessarily what is going to happen. Is what it is, all you got is knowledge is power:

    It took one New Yorker a full week and three separate E.R. visits to get a Coronavirus test.

    — Sarah Kliff (@sarahkliff) March 10, 2020

    here's just another example of chaos from a large bureaucracy during something like a pandemic when the bureaucracy does not have totalitarian control. I am not saying that more totalitarian control can't make mistakes, it most definitely can-was just thinking of the example of FDR with war powers sending Japanese Americans to internment camps. Just is what it is.

    An introvert willing to admit looking forward to this whole social distancing thing wink

    Went to a Networking talk tonight - half carried out by video. A bit like Big Brother (except Sister) on the screen. As someone noted on Twitter, "now we'll find out for real if my presence was really needed at all those meetings". Other ways to socialize?

    Kos,  Mark Sumner:

    "Here’s your sobering thought for today. As of 3 PM ET, U.S. cases for the day were three times those of China and South Korea, combined. And the day’s not over......


    ....In fact, the first time I ran through this post, the top number was 870 cases. But before I could finish, that number was at 950. It seems likely to be at over 1,000 by the end of the day. That growth rate is even more disturbing when you check back just over a week and see that the numbers in the United States are going up faster than the growth rate Italy followed in the last week of February.

    Also, despite claims over the past two days that the United States has shipped 1 million COVID-19 test kits to health departments across the nation, the actual number of people tested by the end of Monday was … 4,800. Considering that 1,800 had been tested by last Wednesday, the rate of testing to this point remains inexcusably low. This isn’t a containment strategy. This isn’t a mitigation strategy. This isn’t even a strategy."

    US cases rising exponentially:

    Before coronavirus appeared, we still didn't even have enough providers to take care of the added patient load from the introduction of Obamacare. (I.E., primary care docs have thousands of patients, suicide is growing among M.D.'s, serious R.N. shortage even before that, less and less care of any kind in rural areas, etc.). If the social distancing thing doesn't work out well to "flatten the curve" so the system can manage, this will not only kill people, it could truly crash our health care system so many more die of many other things for a long time. That they all need the best in protective gear stat is a given, but even with that, our current system cannot handle a mass of patients at the same time. Irony: could be begging for immigrant doctors and nurses, begging.

    Politico reporter got the CDC Director to admit to something:  Exclusive: U.S. coronavirus testing threatened by shortage of critical lab materials 

    ...that he is not confident that U.S. labs have an adequate stock of the supplies used to extract genetic material from any virus in a patient’s sample — a critical step in coronavirus testing.

    “The availability of those reagents is obviously being looked at,” he said, referring to the chemicals used for preparing samples. “I’m confident of the actual test that we have, but as people begin to operationalize the test, they realize there’s other things they need to do the test.” 

    The coronavirus task force convened by the White House is also aware of the shortages, and one official said members are working on it.

    The growing scarcity of these “RNA extraction” kits is the latest trouble for U.S. labs....

    ... Equally in character was Trump's preference for the vast, sweeping edict over the detailed, calibrated policy response. What the US needs most is a serious, extensive program of testing. Currently, the US is bottom of the global league table for coronavirus testing, at a rate of just five people in every million. (South Korea is testing 3,692 people per million.) But that kind of announcement would require too much work, not least because Trump shut down the dedicated Obama-era, White House unit that had focused on preparedness against a global pandemic. ...

    Guardian, March 12

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