Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Day 59: COVID-19 “Shelter-in-Place”
177 countries and territories currently reporting cases of COVID-19. My guess is that every national leader today of a truly democratic country is questioning the timing of their own personal rise to power. Today is a day for Churchillian resolve to take a beating but nonetheless prevail.
First, a note of caution: If you obsess over the tables on Worldometer.com (as I have a tendency to do) you will note anomalies in tabulations, for example the US total on the all countries table and the US total on the USA states table do not always correspond. That may be a database update issue. But also note the Vatican City with 1 case is also displaying 1,248 cases per million population on the table. This may be a residual from the malicious hacking the other day. All of this means that snapshots are not gospel.
As I survey the reporting and the commentary it is difficult to understand what is signal and what is noise. Momentous decisions are being made over individual lives. Mrs Rodin, her mother, and I are just fine sheltering in place. Before COVID-19 by our own predilections “social distancing” was pretty much the default except for most days eating out once a day and the various medical, nail and hair appointments. Yesterday a local eatery we frequent delivered meals to our house, the day before I did take out at another restaurant where we would normally dine. Today I will check further on the small circle of local eating that we frequent. The freezer is pretty full but our meal preparation “muscles” have gone flat from disuse over time. The biggest threat to date was the panic grocery buying occurring locally that deprived us of ready eggs, fruit and milk for a couple of days. Thankfully I had a small reserve, so it was only the lack of ability to replenish and the implied threat if this behavior continued.
People are confused. Seven counties in the Bay Area have issued shelter in place orders. My residence is closer to the seat of the next county over, the jurisdictional boundary about a mile away, than to the population centers of my county. That next county over is not sheltering in place. But it may be required to by the Governor in days to come. My sister-in law in Southern California, living in a place with similar numbers of cases to my county, has different rules as well.
As a nation we have shifted over time from a fundamental understanding of the necessity of patience in the pursuit of every day life. The great achievement of humanity was deferred gratification, that we could have more later if we used less now. It helped us build civilization, a civilization that now measures time not in minutes or even seconds, but milliseconds, refresh rates, and “on demand’ entertainment. To wait for the beneficial effects of the sacrifices we are making now for a healthier future is excruciating. To wait for the data to tell us how things are trending, to help us understand what progress is being made, exercises muscles now much in disuse. Our society has profited off of impatience. We sell consumers products that shorten the gratification cycle. Haven’t saved enough money to buy? Borrow! Want to find out what’s going on in the sporting events while watching “Love, Actually”? Press a button on your remote and see both displayed on your large TV. Can’t sit and read a book? Listen to its audio version on your phone through earphones while you do something else. Need to cash out of those home mortgages whose income stream you own? Bundle them and securitize them and sell fractional interests to institutional investors.
But COVID-19 takes its sweet time. Replicating when it finds a vulnerable host, lying in wait on surfaces until either a host is found or its RNA decays or is destroyed by disinfectant. Time matters not, happenstance determines its existence. It is a simple and unreasoning enemy. Is it fundamentally transforming us?
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
Isn’t the cases per million people an important watch? What’s going on in Switzerland??
I live in Germany and am partially involved in the local response here. The truth is that nobody has a clear answer. The most likely explanation is that Germany is testing much more comprehensively than other countries, so it is detecting many more mild cases.
Which is a good reminder for the Worldometer sports radio crowd: the top-line “total cases” statistic is very unreliable, especially when comparing between countries. This is because every country is testing a different percentage of their population, and they’re also using different protocols to decide who gets tested, which can easily skew the makeup of sick/healthy people who get the test.
At best, the total cases number is somewhat more useful for observing trends within a given country. However, even in that case, some countries may curtail testing or shift their testing priorities as the outbreak expands and the availability of tests/qualified personnel becomes strained.
The most reliable number in the table is probably deaths. Of course, deaths are also a lagging indicator in many respects, but since death is impossible to miss, is almost always reported to authorities, and most deaths are being tested for the virus, this is the best indicator of the true burden of the disease in my opinion.
Very little is known about reinfection at the moment. As is the case for many very obvious questions surrounding the virus.
One major problem is that the testing procedure, while reliable enough to make decisions about hospitalization or quarantine, is not yet reliable enough to say when a patient is truly no longer infected. As a result, some patients have been declared cured only to pop positive in a test a few days later. It’s not yet clear whether those cases represent genuine re-infection or simply a false negative on the first post-symptoms test.
However, the dengue example is luckily a very rare one among pathogens – for the vast majority of viral and bacterial infections, reinfection is either non-existant or much milder than initial infection, and in a few rare cases equally intense as the original infection. (This should not be confused with the phenomenon of re-activation of some chronic infections, such as when the chickenpox virus re-emerges later in life to cause shingles.)
The best guide in this case is probably the other, milder coronaviruses that have been widespread in the human population for years and cause common colds. While reinfection with these viruses is possible, they do not cause worse disease the second time.
Thanks for the response Mendel. Not much has been reported about what is happening in European countries other than those with dramatic statistics. Can you give some insight into life in Germany at the moment?
Different places are updating their data at different times.
This tracker has US cases at 13.6K
https://www.domo.com/coronavirus-tracking
While the JHU tracker has it at 14.2K
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
However, since it is worldwide data, I expect the sources to get out of wack for any given day. Countries are updating their info at variouse times and the refresh rates account for much of the discrepancy.
I follow both the JHU and the Domo tracker. I find the Domo tracker to be more informative.
My sister-in-law, a home healthcare nurse, is receiving hazard pay – she’s on the front lines, Panama City hospitals have armed guards and are locked down – all who go in and out screened – our county beaches closed, so are restaurants – take out only – Panama City Beaches open so those spring breakers still here – a confirmed case yesterday here, one in another county – I’ll be getting my taxes done via drop off and phone conference next month…
When these confirmed cases come in, I’d like to know the demographics.
There was that horrible story of the family that lost four people. When I first read that headline, it was something like “Mother dies with two of her children.” (Another of these children died later.)
I was like… woah. That is horrific. And new.
I thought a mother with two kids had died. Then I looked at the picture of the family.
This is not a comfort to those who knew and loved the lost–this is certainly a horrific thing to happen after a family reunion; I can hardly imagine the depths of despair there–but it’s important for the wider American community to know that the mother was of a very advanced age. The “kids” were in their sixties. The family had some weight issues, which are often tied to other co-morbidities. (Weight itself can be an underlying factor, especially if tied to heart disease, diabetes, etc.). The health histories of the deceased have not been disclosed, and the headline just seems… well. Not the whole truth?
I have great compassion for the family, but I think it’s important to understand the disease.
Am I just a monster?
@loislane, you are not a monster. There is compassion and there is policy. We have compassion for individual losses, but our policies must be informed by the ultimate health of the society. In California the entire state is under an indefinite shelter in place order. As time marches forward there will be accumulating consequences to the economy and well-being of Californians and anyone outside of California whose livelihood is reliant on economic activity in California. It is important that the right balance be achieved between public health measures to protect people and adverse consequences to those same persons from economic destruction. So understanding exactly how this disease affects our society differently from other diseases that are not generating this public health response is important.
My friend in Spain says that at 8pm every evening in Málaga everyone goes out on their balcony to applaud all the doctors and nurses working on helping stop the virus and save lives.
Remarkably calm and reasonable, especially when compared with neighboring countries or even with what I’m hearing from relatives back in the US. In fact, this may be the first time in my adult life I’m very glad to be in Germany and not the US (although who knows what tomorrow brings at this point…)
Basically, the authorities have been very emphatic about the common safety measures and have been ratcheting up the closures and curfews…but slowly and deliberately. Germans are still scarred by the human rights violations of the Nazi era and as a culture take individual freedom and autonomy almost as seriously as the US. At the same time, there’s also an understanding among the populace that avoiding the most draconian of measures means voluntarily restricting one’s own private behavior, and most (not all) have been fairly conscientious about adhering to all of the new best practices for contact and movement in public.
It also helps that Germany has a fairly strong federal system (for Europe) and a rather boring head of state. The federalism means that most of the closures and restrictions have been enacted at the local or state level, which makes them easier to tolerate and provides less opportunity for an overbearing or panicky central government to go overboard. Merkel’s cardboard-box personality is also a welcome alternative to Emmanuel Macron’s constant declarations of a state of war and accusing his own citizens of having blood on their hands because they had the audacity to go to a cafe when it was still legal.
The big question in Germany is why the case fatality rate is so much lower than neighboring countries with similar total numbers. It’s genuinely puzzling because Germany had some of the earliest outbreaks and is geographically more of a crossroads.
Nobody has a good answer, but some of it is almost certainly due to more widespread testing here than in other countries, which helps detect and record more mild cases. I’d like to say some of it is due to the great professionalism of German doctors and public health officials, but I’m biased since many are my friends and former colleagues.
Nonetheless, the experts are predicting that the tsunami is just offshore and is about to hit the continental shelf and rise up to smother the country in a wave of mortality. Apparently the underlying data shows the same kinetics as Italy, just delayed by two weeks. We shall see in the coming days.
I had that same reaction to the headline, Lois. It was a ridiculous, click”-bait” headline, which I realized after reading the article.
Death may be impossible to miss, but cause of death not so much. It seems likely that there were many in Wuhan who died out of hospital of the flu and weren’t counted.
This is not specifically clinically relevant to COVID-19.
We exist in a sea of viruses, bacteria and multicellular parasites.
We have been learning that some of the bacteria are helpful long term residents, other friendly short term tenants, others seem to be (as far as we know so far) mainly freeloaders that can turn sour on us if our health is compromised, and others are frankly pathogenic.
The same is true for viruses, though that’s even more complex: we have our viruses, and the bacteria in and around us have theirs.
This stuff can get weird. Scarlet fever? That’s from strep infections in which the strep bacteria are infected by certain viruses; said infection is necessary for the strep to produce the toxins that cause the damaging immune response. (That doesn’t mean that without that toxin the strep is benign.)
As to the parasite thing:
I once knew a man who, on being given Plaquenil for malarial prophylaxis developed wild hallucinations. His friends had to restrain him to keep him from committing suicide until he could be hospitalized. This is a known adverse effect.The antiviral, antibacterial and antiparasitic effects of chloroquine undoubtedly disrupt our microbiome in unpredictable ways. All medications are two edged swords.
I was on some sort of powerful malarial prophylaxis when my military unit was in Ghana for three weeks. I can confirm the side effects include very vivid dreams. No wild hallucinations, but dreams were quite vivid.
This guy was both highly imaginative and wrapped kind of tightly. The episode with him started with dreams and got worse, he said it was pretty hellish for a few days.
Even creepier, in my opinion, is the fact that at least 5% of our own DNA is actually of viral origin – endogenous retroviruses that are either inactivated or dormant.
Hat tip to Willis Eschenbach of WUWT for the link to this insane epidemic modeling site.
Also interesting at WUWT is this overview of the science behind the proposed treatments we’ve seen discussed here.
And the global warming grifters are now grifting with COVID-19:
Eric Worrall notes:
Worrall also notes:
Yes, but:
What’s really creepy are things like the fungus that hijacks ants and turns them into zombies to spread the fungus.
Speaking of which, I’ve often wondered with some food cravings whether it’s us craving the food or our little friends.
German genetics. They are truly superior people.
Actually, the reverse might be the case. Many of the deaths occur because the victim has a very strong immune system. It could be genetic that Italians are dying in higher numbers because they have more robust immune systems.
Really? Is there a source that I can study on this?
What puzzles me is less the rate, for the reasons you mention, but the absolute number of deaths compared to France (450) and Spain (1,093) which started their upsurge at the same time as Germany which has only 68 deaths as of today.
Yeah. My friend Tim. He’s a doctor. That’s all I got. Others have mentioned that an immune over-response is one of the reasons people can die from this. I’m not a doctor.
You’re referring to a cytokine storm. According to this article:
Thanks @skyler for bringing up this issue.
Oregon’s latest WuFlu death occurred today in the hospital where my daughter works. (Not yet picked up in statistics.)
Forbes has just been asking the same thing. This is interesting….
https://www.forbes.com/sites/guymartin/2020/03/20/with-its-covid-19-caseload-spiking-to-14000-heres-why-germanys-mortality-rate-is-002-or-4000-times-lower-than-italys/#615ab80977ad
That the first Germans to get the virus were skiing in Italy. So they are younger and fitter than most who have caught the virus, which is why they have proved more resilient.
This article from The Atlantic contains more information on how the coronavirus can initiate a cytokine storm, as well as a lot more info on how it actually works once within the human body.
This is absolutely correct and I completely forgot about this in my first comment. And I should have known since many of my friends were off skiing that week! (I was supposed to be off skiing this week…..)
This touches on another point: it’s not only the fact that returning German ski vacationers are younger and fitter, they also spread the virus to many different places simultaneously. You would actually think that’s a bad thing, but I’ve noticed something interesting in the geography of the virus: the death toll seems to be highest when there’s one big outbreak in one area, not lots of small outbreaks all over the place. If you look at the relative distribution of coronavirus in Germany versus France or Italy, the outbreak seems to be much more concentrated in a few regions for the latter two countries.
I’m a molecular virologist by training and not an epidemiologist, so this is just a wild guess. But I hope some real epidemiologists are looking at this (and I’m sure they are somewhere), because this type of information could be very informative for the US.
This suggests that a lock down strategy may not be optimal?
Maybe those Spring Break college kids will be heroes when they return to their various communities around the country.