Monday, April 27, 2020

Covid Journal 3 - Who Will You Kill Today?

Note: This is being published out of order, because I started it on April 8, but didn't finish until today.

I've just about had it with people who compare coronavirus to the flu! Ignorance is NOT bliss. Ignorance can kill.

In response to a Facebook question about going back to work and social distancing, I just posted a graph of the growth of Covid 19 cases in NH. I asked if it looked like it was a good idea to get back to work.

Within moments there was a reply that said, "Thank you art. So why don’t we shut down the state when we have 8,000 flu cases?" Then he added, "We’ve had 24+ flu related deaths this year."

After counting to 10, I took a few breath's and said, "In all the years, we've have the flu going around, have we ever had to social distance to slow its spread? Of course not, but this IS NOT THE FLU!!!
Its epidemiology is different, it's more deadly, and because it is so contagious, unchecked it would have crashed our health system.

Do you remember last year during the flu season, when NY was piling bodies in refrigerator trucks and burying people in mass graves? NO? Well, neither do I. 

If we did for Covid 19 what we do for the normal flu, the number of cases and the number of deaths would DWARF the worst flu statistics, and I don't even want to start on the shape the economy is in. 

The fact is we are peaking shortly. If we keep doing it right, we will start on the down side, but what goes down can go right back up." 

Shortly thereafter, a friend of mine chimed in and said, "Insufficient Data...The testing, both detecting presence, and those that have it, and may be immune...we don't have the data yet. The finger-prick test that could detect forensic presence (present but defeated), if rolled out enmasse, COULD give us the necessary information. but we're finding out where this virus was 10 days ago...not where it is now.."

I have no idea whether our message got through, but my question in the title, is aimed at people who don't get it. Consider John Doe, who is a symptomatic, and is not taking precautions. 

My mother is 98 years old and living in an assisted living facility in NJ. Early on, they began taking precautions. They were cleaning, social distancing, no activities, no visitors, and other precautions.  Despite their efforts, two residents tests positive. The facility went on a tighter lock down and everyone was restricted to their rooms. Then two staff members tested positive, followed by another resident. Since then the number as grown. 

During the lock down, my mother fell and couldn't get up. Even though she had the alert necklace, so does everyone else in the facility. She was on the floor with a broken hip for about a half hour before anyone got to her. The worst thing was, she was able to call my sister who also was not able to get through to alert the facility to her problem. 

My sister was 30 minutes away and couldn't get in even if she was there. She was eventually able to make contact and get staff on the phone. They found her on the floor in pain. From the position of her leg, the suspected a broken hip, but they had to wait for a doctor to do anything. It took about 30 minutes for the doctor to tell them to take her to the hospital. The preferred hospital where she had been treated a number of times, had no beds and she had to be taken to a less desirable hospital? 

24 hours earlier, she was a completely independent. Now she is confused a 98 year-old, in terrible pain. She needed a hip replacement and was extremely high risk just for the operation. She is on Plavix and has only one kidney. 

She is from hearty stock and came through the surgery the operation fine.  She is now in rehab now, but in a few weeks will be going back to assisted living. Both the rehab center and the assisted living facilities have positive Covid patients. 

There is an up side to this story (at least so far). They were going to put her into a rehab center that might have been her death sentence. It had 82 confirmed cases and 14 deaths! My sister was able to do the leg work and got her into the facility we had suggested which has only 7 cases on 0 deaths. Someone was looking out for her, because when she called, they had just one bed available.

When we open up, there will be more case and more deaths than if we sheltered in place. Of course, we have to open up some time, but it needs to be based on science.

Covid Journal 6 - Who's Data is Accurate?

A friend posted this video saying it was fake science. It is base on what she and I both agree is a erroneous extrapolation to arrive at a death rate figure. 

I watched this yesterday and was temped to turn it off after the death rate calculation, but I decided to watch it all, because the simple fact is that without adequate testing the actual death rate is impossible to evaluate effectively and I want to get all views in order to form my own opinions.

I'm a biology major and like looking at the data. Right now there is enough data to make predictions that are as accurate a hurricane landfall predictions when the storm is still well out to sea. So I am willing to listen with an open mind to anyone who has more knowledge than me. It helps me come to my own conclusions.
I do like that they tried to stick to the data and not let their bias be front and center or assign blame. The conference actually spread over two videos. The second part was 12 minutes long and their bias did come through as the camera rolled after the official press conference came on. To that end, I will try to do the same here.
Their extrapolation is no less valid than the projections being posed by those on the other side of the argument. You really have to listen with an open mind, because they repeatedly say that these are real figures based "on what they are seeing." In other words, they are saying this is what is happening where we are. Your situation may be different. The other side of that coin is that they point to the difference between Sweden and Norway as being statistically insignificant, but their study is no more or less statistically significant.
You may have turned it off before they said that isolation and shut-down was absolutely necessary. Their point is that is it time to begin opening up. where they are. They recognize and acknowledge there are other parts of the country where that is not the case.
Getting back to their point about the figures being valid for their situation, I don't discount their position. The shut down was never intended to end the virus, but simply to slow it so that our systems are not overwhelmed.
The other point I question is their contention that our immune systems will suffer as a result of the isolation. To that point, even as a bio major, I don't have enough expertise to make a judgement. I know some immunity is for a life time. Others have a shelf life much shorter.
Make no mistake about it. From day one, for many this was simply a question of weighing the effects of the shut down on the economy against the number of deaths which will result.
They are real doctors, but had they done a different extrapolation, I would have been more likely to accept more of their argument. They did what others have done, just in the other direction. The fact is, we still do not have a handle on the death rate. If you calculate it based on the number of test given, it is ridiculously high. If you base it on the total population it is ridiculously low.
A few things appear evident to me.
1) Testing has sucked from day one, but we are making progress.
2) We will never go back to the way it used to be. Social distancing will be with us for a significant period of time.
3) We will be opening up (slowly I hope) at some point. When that is, is beyond my capabilities of predicting.
4) Things were NOT done properly in the early days and we are paying a price for that.

I mentioned their bias came out in the last minutes of the second part of the conference. So, to be fair and balanced, I will let my bias be know through this post I made 5 days ago, which coincidentally, was the same day I posted this blog.

Wednesday, April 22, 2020

Covid Journal 5 - For want of a nail and a swab...

Here in NH, we have not felt the pain of major cities, and the urge to reopen the economy is sparking some debate on local Facebook groups. Recently, someone posed an article about Catholic Medical Center furloughing over 400 employees. That got me to thinking about why this is happening.

If we go with the President's idea that we are at war, simply put, they are collateral damage caused by failing to engage the enemy in a timely and strategic fashion.

Have you ever heard the ancient story that starts, "For lack of a nail, the horse was lost"? This version was penned by Ben Franklin.

For Want of a Nail
For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the message was lost.
For want of a message the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.

That's what is going on today. The nail in this case could be swabs, the horse would be test kits, and so on.

The CMC employees are out of work because of lack of testing. Had the Defense Production Act been used as it should have been, and testing ramped up as it should have, it's possible if not likely, that elective surgery would never have stopped in NH.

There are plenty of elective surgery centers not in hospitals. There are elective surgeries done in doctor's offices. They are not in the battle against coronavirus. If testing was widely available they  might be opening now.

Testing ramp up was a month late in coming. We are at the very least suffering in a shutdown that is going to be a month longer than it need be, and it's impossible to tell how much damage it has done to our economy.

At this point someone chimed in with the opinion that nail was PPE that was needed and Ventilators that weren't needed, both were depleted by our previous administration causing the use of the DPA for those items.

The problem with playing the blame game is that it does nothing to solve the problem that exists today. The PPE and ventilators have nothing to do with testing. In the nail and swab analogy, they have no real status. Test is what it critical to opening the economy. Even if there was an abundance of PPE and ventilators, we would be in the exact same place we are today.  Pointing fingers doesn't save lives!

My contention was that the most important thing we need is this fight is DATA. Data can only be collected with adequate testing. Our testing is nowhere near where it needs to be. A look at the testing supply chain sees it is broken in many places. Without swabs, you can't test. It's like having a million horses waiting to be shod.

I don't think the poster understood the supply chain dynamics or the point I was trying to make. More importantly it doesn't appear he understands the nature of a pandemic, because he said, "I agree but if this were a pandemic they could use these people to assist in helping patients like they are in NY. They're saying they have empty beds. That's because we don't have the cases NY does (thankfully) but now elective surgeries are on hold for nothing at this point."

"If this were a pandemic?" It's not a bomb that's dropped on us. It infiltrates our ranks and spreads from there. I doesn't pop up out of nowhere. It has to be carried by someone. Once it enters an area, without proper testing and social distancing, it will grow exponentially.

As far as elective surgeries being on hold for nothing at this point, I say elective surgeries are NOT on hold for nothing. It goes right back to the swabs. They are on hold because we have no way of knowing if the doctors and nurses treating you have covid 19 and visa vera. That's is a formula for disaster. If we could be test whenever needed, elective surgeries might not be on hold.

When it comes to opening up, the people in state government are doing one of two things. They are either doing what they feel is best based on the data and erring on the side of caution, or they want things open, but are covering their asses. If they open early, and things go wrong they know they will be out on their asses for opening up without the data that EVERYONE acknowledges we need. If the testing was in place, their asses would be covered, because when things go wrong when they open up, they can blame bad data.

To that the the poster said, "Art Wolinsky but isn’t it up to them to procure and perform the tests for their own data. It’s not up to the Fed to do this. Even Cuomo agreed."

The poster left out one small detail. In order for states to be able to procure their own tests, there have to be tests for them to procure. If there is no product, we have stated bidding against each other for what little there is. ONLY federal government can use the Defense Production Act to get supplies into the supply chain so that states can procure the test.

I finally got some agreement when he said, "But haven’t they? Yesterday there were 50,000 testing kits sent out to states."

He was making my point for me, because 50,000 test kits is a drop in the bucket compared to what's needed. On top of that, they were sent out yesterday, but should have been shipped a moth ago. What we should be doing right now is antibody testing. The covid test kits will soon be there for those with the symptoms meeting current protocols, but the antibody tests are what are really needed in order to open the economy again.

The reply was, "I know I know. I’m saying it’s a good start."

Really? I would agree if a one month late start is a good start. I have always said there are students who blossom because of teachers and there are those who blossom in spite of them. We will come through this and we will blossom, because of who we are as nation. We will blossom in spite of the early failure of the federal government to take the lead.

The retort? "I think it’s unfair for you to think we are one month late based on bad information. Its a weak argument at best."

To answer that, I pointed to the fact that during the past few press conferences when asked what actions were taken in February, Trump answers were attacks on the reporters. He also claimed he has hardly been out of the White House in the past two months.

Then when questioned about the campaign rallies, he couldn't remember them. I went to a Trump rally and I will NEVER forget it. He held FIVE in February and doesn't recall? Was he lying or is it time for Article 25? He certainly wasn't inspiring confidence or gaining the trust of the public. What information would you like to share that shows we were doing a good job?

I then pasted a post which orginated with Robert Braunstein, right after Trump claimed he was distracted by the Impeachment

Dec 18th - House Impeaches Trump
Jan 8th - First CDC warning
Jan 9th - Trump campaign rally
Jan 14th - Trump campaign rally
Jan 16h - House sends impeachment articles to Senate
Jan 18th - Trump golfs
Jan 19th - Trump golfs
Jan 20th - first case of corona virus in the US, Washington State.
Jan 22nd - “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
Jan 28th - Trump campaign rally
Jan 30th - Trump campaign rally
Feb 1st - Trump golfs
Feb 2nd - “We pretty much shut it down coming in from China."
Feb 5th - Senate votes to acquit. Then takes a five-day weekend.
Feb 10th - Trump campaign rally
Feb 12th - Dow Jones closes at an all time high of 29,551.42
Feb 15h - Trump golfs
Feb 19th - Trump campaign rally
Feb 20th - Trump campaign rally
Feb 21st - Trump campaign rally
Feb 24th - “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”
Feb 25h - “CDC and my Administration are doing a GREAT job of handling Coronavirus.”
Feb 25h - “I think that's a problem that’s going to go away… They have studied it. They know very much. In fact, we’re very close to a vaccine.”
Feb 26th - “The 15 (cases in the US) within a couple of days is going to be down to close to zero.”
Feb 26th - “We're going very substantially down, not up.” Also "This is a flu. This is like a flu"; "Now, you treat this like a flu"; "It's a little like the regular flu that we have flu shots for. And we'll essentially have a flu shot for this in a fairly quick manner."
February 27: “One day it’s like a miracle, it will disappear.”
Feb 28th - “We're ordering a lot of supplies. We're ordering a lot of, uh, elements that frankly we wouldn't be ordering unless it was something like this. But we're ordering a lot of different elements of medical.”
Feb 28th - Trump campaign rally. “This is their new hoax.”
March 2nd - “You take a solid flu vaccine, you don't think that could have an impact, or much of an impact, on corona?”
March 2nd - “A lot of things are happening, a lot of very exciting things are happening and they’re happening very rapidly.”
March 4: “If we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work — some of them go to work, but they get better.”
March 5th - “I NEVER said people that are feeling sick should go to work.”
March 5th - “The United States… has, as of now, only 129 cases… and 11 deaths. We are working very hard to keep these numbers as low as possible!”
March 6th - “I think we’re doing a really good job in this country at keeping it down… a tremendous job at keeping it down.”
March 6th - “Anybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful…. the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”
March 6th - “I like this stuff. I really get it. People are surprised that I understand it… Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”
March 6th - “I don't need to have the numbers double because of one ship that wasn't our fault.”
March 7th - Trump golfs
March 8th - Trump golfs
March 8th - “We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus.”
March 9th - “This blindsided the world.”
March 13th - [Declared state of emergency]
March 17th - “This is a pandemic,” Mr. Trump told reporters. “I felt it was a pandemic long before it was called a pandemic.”
March 18th - "It’s not racist at all. No. Not at all. It comes from China. That’s why. It comes from China. I want to be accurate."
March 23th- Dow Jones closes at 18,591.93
March 25th - 3.3 million Americans file for unemployment.
March 30th - Dow Jones closes at 21,917.16
April 2nd - 6.6 million Americans file for unemployment.

I was then corrected about my response to bad information when he said, "I’m saying bad info from China." and he pointed to the fact that only about 100 people were dead in February.

Seriously? Bad information from China, really? You mean President Chi wasn't being transparent? I think any 5th grader could have tipped him off. When have we EVER relied on China giving us good information? We didn't push and we praised them for their efforts. Good thing the WHO did the same thing, because that allowed Trump to defund them for doing exactly what he did. He didn't listen to his advisors or the intelligence. As far as the number dead goes, I have two words. EXPONENTIAL GROWTH. The ramp up should have started BEFORE we had our first case, not after we had our 100th.

The conversation then turned to the number of tests needed when someone else said, "...sadly, there are 325 million of us in USA. You need to be conducting 10 million a day to test everyone in a month. The response from the poster was, "...that’s just stupid to think EVERYONE needs to be tested. Absurd."

Finally a point of agreement, and I said, "On this one we actually agree. Testing everyone is absurd and I don't know of a single expert who supports that. What is needed is widespread testing to the extent that we can test anyone who needs a test and get results quickly, but we are nowhere near that. Dare I mention the word swabs?

Check this quote, and follow the link for a better idea of what is needed in testing. "We're only able to do approximately 1,000 to 1,200 tests a day because of limitations in supplies like swabs ... chemical reagents that actually do the test," said Dr. Bruce Meyer of Jefferson Health, which operates 14 hospitals in and around Philadelphia, in an interview with NPR Tuesday. "So our capacity to test is really limited."  Read the full article here

That's where things left off yesterday.  This morning there was a new development that aplifies the need for adaquate testing. A phenomonon being dubbed Covid Toe, is starting to look like a way of identifying asymptomatic Covid carriers. Unfortunately, there is no testing of these people and there is no way of determining if this can be used as a solid indicator. Here's the full article.

So who wants to take the literary challenge and write the poem, For Want of a Swab?

Sunday, April 19, 2020

Covid Journal 4 - Ben Carson Has a Problem with Math!

The lack of leadership and action from the top, and the conflicting or erroneous (being nice with that adjective) information coming from the White House, is staggering. We've all see the timelines and flip-flip statements about the President's actions or inactions, but here's one that hasn't gotten the attention is should.

Ben Carson said that 98% of people recover from Covid 19 and we can't operate out of hysteria.  I agree that we can't operate out of hysteria, but it patently obvious the he and the president are working out of ignorance.

He is absolutely right. We can't operate from a position of hysteria. However, the rest of his statement is wrong on so many levels.

I can't help but wonder where he got his figure. The last time I hear mention of 2% was when news of the Italian health system collapsing. I don't think he have a handle on the survival rate, because we have no idea how many cases there actually are. If we examine the statement a number of different ways, his math just doesn't add up.

First, let's apply truth in advertising to the statement. If 98% survive, that means 2% don't. Then his statement would say, 2% of the people with Covid 19 will die.  We know the mortality rate of the flu is 0.1%. By Ben's calculations, a 2% mortality rate make Covid 20 times more deadly than the flu, and that is AFTER social distancing.

Right now there are 73,988 cases of Covid 19 and 38,928 deaths. That's not 2%. That's 5%!!!

I'm sure Ben knows there are more cases not identified, including deaths and asymtomatic diagnosed, because we have inadequate testing and reporting. That should come as no surprise to anyone but our president.

Assuming Ben's mortality rate is correct, and 2% die. That would mean there have to be just about 2 million active cases RIGHT NOW.

The chances are that he is wrong, and that the actual death rate will be less than 2%.
That's good, but only in the sense that the number of unnecessary deaths will be fewer that he is projecting. You know what's bad? Political clowns treating daily pandemic briefings into campaign rallies. 

The American people need, and deserve better!

Thursday, April 16, 2020

Did I Find Bernie Dodge's Senior Picture?

The fact that I'm writing this is testament to the cabin fever of Covid 19 social distancing. The fact that you are reading it confirms your situation as well.

I just came here from Facebook, where I was going to reply to the post from Bernie Dodge on the left. It set off a bizarre chain of events that just couldn't be typed as a Reply, mainly because I'm incapable of writing a long post inside FB without accidentally posting it 15 times before I finish typing.

I'm giving the Reader's Digest version, because the chain of events continues beyond the topic of this post. The full version is something for a much longer post or series of posts that will put most people to sleep, but may be of interest to a few.

By now you have read Bernie's post. When I read it, something clicked and my mind went back to an unsolved mystery from the late 90's. It took place on the K-12 Admin mailing list. A debate was taking place about the nature of schools and change between the Sages on the Stage and the Guides on the Side crowds. Then along came Ditherhead.

Ditherhead was definitely aligned with the Guides on the Side. He was an in your face kinda member who came out of nowhere. His opinions were not take well by the Sages, but what bothered them most was the fact he didn't identify himself in any way.  They demanded to know who he was, but he never said.

The debate became more heated, not about school change, but about Ditherhead's anonymity and his lack of respect for their opinions and PhD's in their signature lines. Ditherhead was relentless in putting forth his vision of schools, and the Sages were relentless in their attacks on him.

Then things took a turn for the better or worse, depending on your perspective. Ditherhead began toying with them about his identity.  One day, in response to the demands that Ditherhead reveal himself he said that he wouldn't say who he was, but would post a picture of himself.


Note: There is much more to the chain of events that unraveled as a result of Bernie's post. I've heard nothing from Ditherhead in more than 20 years, but I have run into this photo in context of my work, including an interesting discussion with an FBI agent and his familiarity with it, my first meeting with Tom March, the discovery of a long lost video, and a 9 year search for a decent haircut in NH, but those are all stories for another day.