Coronavirus: Three Vignettes

Sometimes, as the lawyers say, res ipsa loquitur, meaning “the thing speaks for itself”. I believe these three excepts, both individually and in juxtaposition, say a great deal about the war against coronavirus.

From Jason Van Schoor, flagged in Links yesterday:

First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare…

3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.

6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.

7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:

8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great

9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.

4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.

By e-mail, from National Nurses United:

Registered nurses are outraged to learn that the Centers for Disease Control (CDC) on Tuesday further weakened its guidance on measures to contain COVID-19. These changes include, among other things, rolling back personal protective equipment (PPE) standards from N-95 respirators to allow simple surgical masks; not requiring suspected or confirmed COVID-19 patients to be placed in negative pressure isolation rooms at all times; and weakening protections for health care workers collecting diagnostic respiratory specimens. These are moves that National Nurses United nurses say will gravely endanger nurses, health care workers, patients, and our communities…

“If nurses and health care workers aren’t protected, that means patients and the public are not protected,” said Bonnie Castillo, RN and CNA/NNOC and NNU executive director. “This is a major public health crisis of unknown proportions. Now is not the time to be weakening our standards and protections, or cutting corners. Now is the time we should be stepping up our efforts.”..

In addition to lobbying almost every federal health agency, the presidential administration, and members of Congress, and California health agencies to step up protections, NNU recently surveyed RNs nationwide, finding that the vast majority of the nation’s health care facilities are unprepared for COVID-19, with only 29 percent of nurses reporting that their hospitals have a plan in place to isolate a coronavirus patient, and only 30 percent saying their employer has enough personal protective equipment if there is a rapid surge in patients with possible COVID-19 infections.

Many hospitals and healthcare facilities have failed to provide adequate personal protective equipment to nurses working with COVID-19 patients. Some facilities are telling nurses to continue to work while asymptomatic, even though they’ve been exposed to the virus and might be contagious. Testing at hospitals has been sporadic.

From David Wang, a technology expert at a global macro research firm based in Hong Kong and Beijing, from his personal blog at Covid Observations from Beijing, March 11 (I encourage you to read the entire piece):

I see quarantine enforcement. One day in early February, a uniformed municipal employee set up a tent and a table outside my apartment compound, taking the temperatures of everyone leaving and entering. The next day, he gave me a paper slip, saying that I needed to display it every time I came in. It was a good thing that I received that entry card when I did, because I would have to go through a gauntlet of tests to be issued one today. These guards have been the chief enforcers of the quarantines, making sure that those who return from overseas or other provinces have to stay indoors. Given that everyone lives in big apartment compounds, it’s more or less possible to make sure that only approved people are allowed in or out of every residence. From where these enforcers emerged is a mystery. The source of their legal authority to regulate my entry is unclear to me; sometimes the entrance is staffed by volunteers, whom I assume are retired Party members.

I see movement regulations. Every business I enter (whether that’s a restaurant, supermarket, or retailer), someone takes my temperature and asks me to write down my phone number. Taikooli, the large outdoor mall by where I live, has blocked off most entrances to corral people into temperature check zones. Most of the enforcement is low tech: instead of digital tracking, it’s middle-aged men sitting outside apartments working with pen and paper. Digital surveillance exists too. My mobile carrier sent me a text to tell me that it can give me my 14-day location history based on my data usage….Social distancing is encouraged everywhere: at restaurants, where one can’t always sit face-to-face with people; in elevators; and in the office, where no more than a third of people can visit at any time. To enter my office building, I need to fill in a government app with self-reported health data.

I see dubious precautions. The evidence I’m familiar with states that gloves are good protection and that masks are barely so. Most people here wear masks religiously, but fail to wear gloves, and they don’t always wash hands before they eat…..

I see civic spirit….I see rousing propaganda….And I’m seeing a city on the track to recovery.

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102 comments

  1. Expat2uruguay

    I found this very interesting personal report on flutrackers:

    Something else to share, here (reproduced exactly as I received it):

    3/8/2020

    Notes from the front lines:

    I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

    1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.
    2. Co-infection rate with other respiratory viruses like Influenza or RSV is 24 hours apart.
    10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.
    11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.
    12. Health Departments (CDPH and OCHD) state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

    Feel free to share. All PUIs in Monterey Country so far have been negative.

    Martha.

    Martha L. Blum, MD, PhD

    Reply
    1. Billy

      “…The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates“?

      Is that some medical term of art for describing something that look like ground glass, or does snorting ground glass makes you more susceptible?
      i.e. Workmen around fiberglass insulation?

      Reply
  2. clarky90

    “Coronavirus ‘worse than a bomb’ on Italy, says doctor coordinating response”

    https://www.youtube.com/watch?v=9mrPHO-nkVE

    Giacomo Grasselli – a senior Italian government health official who is coordinating the network of intensive care units in Lombardy – explains the “critical” situation in Italy, brought about by the Covid-19 outbreak

    Reply
  3. Ignacio

    Consequences of widespread denialism. At home, the virologist was not taken seriously until last Monday. I advised my wife last week not to assist to some meeting in closed doors, my son not to go to a concert, a friend of mine not to travel to Switzerland. They finally conceded I was right this week. The runners chat was complaining about cancellation of events until yesterday and I have received in chats lots of hyperventilating noises. Not helpful. We are now in Madrid replicating quite exactly events occurring in Italy 7-10 days before. Expect the same elsewhere.

    Reply
    1. johnf

      I believe this situation may be even more complacent, here, in Northern Germany. The local newspaper ran an article, today, that used “comforting” three times, a first during my 15 years of readership. They interviewed someone at the main hospital who implied they were prepared, but who also confirmed, sometimes indirectly and inadvertently, that they were still on a “peacetime” setting and had nothing in reserve for the onslaught.

      Reply
    2. Ignacio

      On the third vignette I am doing exactly the same things as Dang Wang describes. I am currently working 90% on commercial activity on self-consumption PV for companies (a booming sector so far in Spain) but this week nobody is available and nobody wants to hear anything other than their own routines. I have changed mine. Now I am just gathering information I will use when time to restart comes. In the evenings I take my bike and have rides in Madrid, and on the way visiting friends I don’t see frequently in their own business.

      Reply
    3. Wukchumni

      I’d mentioned yesterday that a group of 14 people from LA had all contracted Covid-19 @ an Italian ski resort, and 3 are very ill.

      https://www.dailymail.co.uk/news/article-8094515/Doctor-treating-coronavirus-patients-LA-suburb-calls-schools-shut-immediately.html

      I’m thinking of making up some lame excuse to not go skiing next week, a phantom injury or some other malady of my imagination.

      Why not just admit to my friends that i’m afraid of mixing with a large group of people, especially so @ lunch, where we are in close proximity to a lot of other folks all milling around?

      We are still in heavy denial-myself included, in that I feel my friends will think less of me if I was to give them the real reason, in that I don’t want to die, just yet.

      An e-mail to my family regarding how bad the crisis is and will be here soon, was similar to my frantic e-mails & calls in the summer of 2008 regarding how shaky things are financially on Wall*Street, please be ready! They did nothing.

      When I related that ‘Dr Drew’ (a sister sent me a video of his-after I sent out the Bergamo doctor’s account) who claimed Covid-19 was a press engineered fantasy, was just an addiction specialist and judging from where he hangs his hat (Breitbart, Washington Examiner, erc) everything he does is politically motivated hard right, one of my sisters asked me not to politicize the matter.

      Being a Cassandra ain’t all that.

      Reply
      1. vlade

        We took our daughter from school even before they closed them, because we suspected (rightly, as it turned out), that some parents coming from midterm sky trips to Italy will ignore the quarantine.

        A friend of mine sent half of his staff WFH, and some of his business contacts see him as mad now.

        That said, majority of people here support the drastic reaction, and would be happy to support even more dramatic ones. For example, a CEO of a major movie theater chain got quite a bit of kudos today when he said that while they could keep smaller theatres open, he doesn’t see how it’s better to keep 50 people bunched together than 100, so they close it all until further notice.

        Reply
      2. c_heale

        Covid-19 is a serious illness. If you can’t speak to your friends about your fears – are they really your friends? Family is something else… …but your sister is politicizing things too…

        Reply
        1. Wukchumni

          This sums it up for me…

          You might have fears today: What if I overreact? Will people laugh at me? Will they be angry at me? Will I look stupid? Won’t it be better to wait for others to take steps first? Will I hurt the economy too much?

          But in 2–4 weeks, when the entire world is in lockdown, when the few precious days of social distancing you will have enabled will have saved lives, people won’t criticize you anymore: They will thank you for making the right decision.

          https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

          Reply
          1. Biologist

            This piece is a must-read, and should be shared more widely.

            Great break-down of the numbers, showing how and why some countries (or Chinese provinces) managed to keep the mortality at 0.5%, while in others (Wuhan, Italy) it is or was up to 4-5%.

            In the latter, strict containment measures were taken much later, with the consequence that the health system became so overwhelmed that mortality rates went through the roof (e.g. triage, other issues not being treated, patients dying in hospital corridors).

            Note that many European countries, and US states, are heading in the direction of that second category.

            Reply
      3. The Rev Kev

        ‘We are still in heavy denial-myself included’

        Know the feeling myself and it is hard to fight off. In the end I decided on a trip-wire event. About 40 minutes drive from us is a medium size city and lots of people in the town near us travel to there and we too have to make there trip there occasionally. I told myself if that if hear of any cases in there then that is the point to slam down the doors. It will not take long for the locals that travel there to bring it back here so that will be for me the final warning event that it is here.

        Reply
        1. lordkoos

          I’m not in denial… as of last weekend there is a confirmed case in our county (pop 40,000) and I’ve been down with a bad cold for three days. At least I hope it’s a cold, but so far, no fever, no cough, just upper respiratory stuff. From what I read however, the virus does not always present the identical symptoms. We are well stocked and I’ve been staying in. I’m quite glad to live in a smaller community during this event.

          Gigs in Seattle are being rapidly cancelled, governor now says no gatherings over 150 people should be allowed.

          Reply
      4. Tamsen

        As of today from the low I.Q. idiots running Marin County, California, where kids take Ski Week off instead of Spring Break and people fly to Africa to take safari photos.”

        “While Marin HHS is not issuing cancellations of large gatherings at this time, it is recommending that older adults and those with conditions that may weaken their immune system consider refraining from attending large gatherings of 100 or more people.

        Joint Statement Against Discrimination
        Joint Statement by Marin HHS and MCOE (2/10/2020)
        https://www.marinhhs.org/coronavirus

        Reply
      5. Brooklin Bridge

        I just got a call yesterday from close friends who must still think this is a joke and they wanted me to come out to a restaurant with them in about a weeks time. Six weeks ago, I would have gone. I just told them the truth, thanking them very much for being so thoughtful, and also suggesting that this was more serious than people might realize, but I didn’t go into too much detail as I’ve learned it’s counter productive. I did, however, point out that due to our for profit health care system, we will get a much greater and faster spread of covid-19 due to prohibitive costs of any health care visit. Couldn’t resist that one; talk about res ipsa loquitur. For a couple of weeks now, I have been quite up front with close friends, slightly less so with others, but refuse to go out unless I have to and can somewhat control how many people will be around (as in going to the super market very early am during the week).

        I have no illusion this behavior will guarantee anything, but que faire?

        Reply
      6. Lil’D

        Cassandra was right

        But never believed

        Is there a word for the guilt over feeling somewhat smug at having prepped effectively? I’m hating seeing unnecessary pain

        Reply
        1. campbeln

          I’ve been 2-3 weeks in front of everything thus far, and hope to stay that way. I’ve got no guilt as I’ve Cassandra’d to our close friends and family. A few have heeded the warning, others haven’t but I’m proud of my family’s preparedness and the help I’ve lent to others who have prepared.

          Leading a horse to water, and all that.

          Reply
      7. Susan the other

        this is our “oh, shit” moment; we are all going to go into a 6-week time warp and emerge less optimistic but far more responsible….

        Reply
      8. kareninca

        You visit your elderly mom, right? Tell your friends that you don’t want to infect her. That you think you would get a mild case, but she would not. My 95 y.o. father in law lives with us; otherwise I would not be directly concerned for our household. But I’m not going out to things because I don’t want to bring germs home to him.

        Reply
        1. lordkoos

          My mother is 92 and is getting a bit shaky although still living on her own. She loves going out to social events, concerts etc, so this will be tough for her.

          Reply
          1. Wukchumni

            My mom will be 95 in a few months, and i’m hesitant to visit under the Coronavirus circumstances. She really likes going out on field trips to museums et al @ her assisted living place, and that looks to be over.

            Reply
        1. norm de plume

          Ain’t that the truth. Sometimes they even seem to develop an animus toward you that didn’t exist before you were proved correct.

          I work at a medical college which has a large annual event planned for next week and I am expected to attend with hundreds of others – my role being to demonstrate the operation of and answer questions about a new system recently introduced. I spoke to the head (a doctor) and expressed my concerns but was told it’s full steam ahead. I said at least those of us who can work from home should be free to, in fact encouraged to, from now but this too was resisted. I have been chuckled at for buying baked beans and loo roll supplies, and gently chided for ‘over-reacting’.

          I am going to leave it til Monday to withdraw if there has been no govt directive to cancel events. This may be unlikely as the nation’s Chief Medical Officer yesterday described the virus as ‘a mild disease’

          Reply
      9. Oregoncharles

        I was at a local Green Party meeting last night; we have a string of large events coming up – an important one tomorrow night – where I usually mind the table, but I told them if I went to those my wife wouldn’t let me back in the house. (We’re 74 and 72.) Got some volunteers to cover, but one is just as old. Another retired guy agreed with my wife.

        I’m concerned about our nominating convention, supposed to be in this town in June. I don’t think it’s going to happen; we’ll have to teleconference it. The nearest known case is in Salem, 40 miles away, “community” spread.

        We’ve tried to stock up for a quarantine, but need to restock a couple of items, so I’ll be going out. Otherwise, staying home a lot. Fortunately I work outdoors, with minimal contact with people, so I can still work.

        Reply
        1. Wukchumni

          Otherwise, staying home a lot. Fortunately I work outdoors, with minimal contact with people, so I can still work.

          Same for me, working outdoors on our many splendored acres, with essentially no contact with outsiders.

          Reply
    4. Redlife2017

      The UK is in the same space. We had an MP who was all over Westminster last week whilst asymptomatic and then symptomatic over the past 5 days. She met with loads of people including the PM. Annnndddd….the NHS will not be testing ANYONE. I mean wow. I wonder how our numbers are so low, eh? They are refusing to test people unless they came from somewhere with it or from a “confirmed case”. Which even if it is confirmed it seems they are not testing. People are starting to get worried at the laid back response considering what is going on in Italy.

      The Mothership (big US bank) to the firm I work at is being cautious (building over the next week to 50% WFH for the foreseeable at a minimum), whilst unfortunately, my sub-firm is being stupid and not enacting the Mothership policy on Work From Home. The schedule at my sub-firm is 25% WFH / 75% at office rotating weekly. Which is an awesome way to get 100% sick (or at least quarantined). Managers just below Exec level are not even willing to defend what is indefensible. We are finding some ways around it by saying all sub-teams are small teams and going 50%/50% but on a weekly rotation. An executive also had a meeting yesterday in a stuffy room with EVERYONE from IT and Operations. We were shoved into this room and he spouted platitudes about how much he worries about people’s health, but…we need to still do work. And he really wanted to talk to us (???).

      I’m beginning to think that I should mainline gin and tonic for the next 3 to 4 weeks.

      I always go back to Dr Hunter S Thompson in my times of need:

      “I learned a long time ago that reality was much weirder than anyone’s imagination.”

      “How many times had he stood calmly back there on the duckboards and listened to respectable-looking people talk about raping the hotel penguins?” The Curse of Lono

      “Hopes rise and dreams flicker and die. Love plans for tomorrow and loneliness thinks of yesterday. Life is beautiful and living is pain. The sound of music floats down a dark street.” Letter to Gerald “Ching” Tyrrell, (11 November 1956)

      “The last half of the 20th century will seem like a wild party for rich kids, compared to what’s coming now. The party’s over, folks.” When War Drums Roll” (17 September 2001)

      Reply
      1. vlade

        All large banks had a meeting with BoE yesterday, where the discussed the WFH and other preparations, and my understanding is that most firms agreed to split the employees into three groups – WFH until further notice (where doesn’t need to be onsite, like say IT devs), WFH two weeks on/off (where they need to be on site at least now an then), and some, hopefully few, who can’t (usually involving things like having recorded lines etc. etc).

        Sounds though like it’s banks only and AMs can do what they want.

        Reply
          1. Susan the other

            this is our “oh, shit” moment; we are all going to go into a 6-week time warp and emerge less optimistic but far more responsible….

            Reply
      2. Ignacio

        Good examples Redlife. MPs also taken by surprise in Spain. Congress closed yesterday. Meetings with +1000 forbidden. Why not +50? or +25? or +10? We don’t have real data on epidemiologic development because tests are not applied massively and arbitrarily so we cannot say how many out of 100 or 1000 can be infected, incubating or whatever.

        Reply
        1. Susan the other

          something tells me, Ignacio, that there is a natural firewall between super infectious and super deadly. At some level a virus knows it cannot kill off all of its hosts. So what happens when micro-virology discovers the switch that turns off natural super infectious controls and allows a virus to just mutate and keep on going?

          Reply
            1. Jack Parsons

              Syphilis killed in 3 months when it first hit Italy in 1494. Over the next 50 years it slowed down to the grand stately pace we know today.

              Reply
          1. Biologist

            (Caveat: I’m not an epidemiologist, or a virologist).
            If there is such a switch towards less infectious (if I understand you correctly), a mutation can also cause a strain to switch back to become highly infectious again, at which point it will be able to infect more hosts than other strains, and will thus become more ‘successful’ and start spreading again.

            As to your general point, there is indeed often a trade-off between mortality and transmission. However, this is not due to the virus knowing anything (I know you mean this metaphorically), but it is due to selection: viruses that kill their host before the host infects others, will not pass on, and die with the hosts, while strains that wait a little with killing have a higher success rate (from the point of view of the virus).

            With this coronavirus, there seems to be a window (though I’m not sure!) that a person can be infected and transmitting the virus, without having symptoms, and thus pass it on. From the point of view of the virus, this is unfortunately a successful strategy, and there is no biological reason why they should evolve to become less deadly.

            Reply
            1. Ignacio

              In the stage we are now, fast epidemic progression, there is no reason to think that less virulent strains will prevail. In this phase the most infectious prevail because we are all susceptible and the most infectious will be more successful reaching all the population. When a majority of us has been infected and developed immune response is when the less infectious and virulent strains will be selected and tend to prevail. Those that in some cases can pass by without triggering a response, without our immune system noticing will be favoured. We are now far from this situation.

              Reply
      3. Phemfrog

        A very interesting AMA (ask me anything) with a doctor in critical care in the UK:

        https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwilivGT3JLoAhUDWq0KHU2NAnUQFjABegQIAxAB&url=https%3A%2F%2Fwww.reddit.com%2Fr%2FCoronavirus%2Fcomments%2Ffgfspi%2Fim_a_critical_care_doctor_working_in_a_uk_hcid%2F&usg=AOvVaw3NJTxttU2T9Hqvg3bW8Hve

        If link doesnt work, google search for “I’m a critical care doctor working in a UK HCID”

        it is on Reddit

        Reply
    5. Steve

      Yesterday we got a text from someone very close to us that their manager in medical facility is openly denying that this is an issue and saying is is a conspiracy to hurt Trump. The state they are in is one of the worst hit so far. We also have relatives that are saying the same thing and posting that it is a conspiracy to hurt Trump on FB.
      :(

      Reply
        1. Ian Ollmann

          There are a lot of people who are caught in the US vs THEM narrative to the exclusion of all else. Facts, economic self interest, the lives of their loved ones are not important to them right now. It will probably take unbearable pain as consequence from their foolishness before they believe in truth again.

          Pity them.

          Reply
  4. Tyronius

    I don’t see Americans tolerating that kind of invasive monitoring, not to mention it’s impossible in rural and suburban areas.

    It seems morbidity is reduced if hospitals are not overwhelmed, yet that seems an elusive goal.

    I’m expecting a real mess throughout America. This could well generate more domestic fatalities from a single event than anything since the Civil War.

    Reply
    1. Chris

      Oh no?

      I see Americans being very in favor of this kind of invasive monitoring and control. For “other people” of course. The bad side of town? The crime ridden areas? The places where people have to drive from to come into a city? Those will be gated off and any resources needed behind the gates put under control of different authorities. I think our leadership is easily capable of such things.

      Reply
      1. Brooklin Bridge

        What I see, due to wide spread and generational ideological conditioning, is isolation/monitoring of wealthy areas being oriented toward keeping the disease (and the diseased) out whereas in poor areas, the emphasis will be on keeping it (and the diseased) in. Kind of like face masks; whether you wear them to prevent disease from coming in or going out, you are protecting others and indirectly yourself, but there will be a big differences in terms of material, medical and official support vs. control.

        Whether or not this sort of idological triage, if occuring, can be maintained as the situation worsens towards pandemonium is another matter and will largely depend on geographical area and resources and levels of stress (infection etc.) and general corruption. There could be real upheaval in places.

        Reply
      2. Monty

        Yes. The thing that’s confusing is that Snowden told us that .gov already do this kind of invasive monitoring, but allegedly its ring fenced within the NSA. If their panopticon is half as scary as they want us to believe, they should be able to do very effective contact tracing without us installing special apps. The data is all there from everyone who owns a smart phone anyway. The queries already exist “Who did this terrorist go near, where and when?”, and can be used to report on every infected person, to generate a list of people who ought to stay at home. I thought maybe they were doing this on the quiet, but based on the spread, it appears they are not. Maybe that Fort Meade is a totally empty shell, just used for propaganda?

        Reply
      1. ambrit

        Don’t be quite so sanguine there HotFlash. Yes, Americanz do indeed have gunz, lots of them. That fact by itself is not so problematic. The problem is what those gunz end up being used for. We will see both “official” vigilante type groups set up, and fractured “local” Committees of Vigilance set themselves up. In China, the society still has vestiges of the old Party apparatus with which to build up a monitoring and control structure. What does America have of a similar nature? I will suggest the Organized Churches, (here Down South, the churches are the largest social organizations going,) the local Organs of State Security, and small, local, ad hoc community groupings. The former groups are organized along easily recognized philosophical lines. The local coppers will generally end up serving the local elites. The last category of groups will act on generally purely local and pragmatic lines. The latter groups remind me of the villagers in Kurosawa’s “Seven Samurai.” Fractuous, bickering, but generally quite dangerous to outsiders. The scene where Kikuchiyo brings out the armour from slain samurai that the villagers had hidden is a perfect embodiment of that ethos.
        What bothers me, and, truth be told, frightens me as well is that we here in our little half-horse town already have a sizable homeless population. These people are already living off of “charity,” handouts, and whatever they can steal. The first ‘thing’ that will probably go when the “hard times” really hit will be charity. Then, what are these people, and the sizable population that is suddenly thrust into penury alongside them, to do? Being cinematically inclined, the ending scene from Paul Muni’s film “I Am A Fugitive From A Chain Gang” encapsulates my point.
        See the ending: https://www.youtube.com/watch?v=ttKg62pkcc8
        Mr Cynic warns me that we will have more than a lowly pathogen to worry about.

        Reply
        1. Brooklin Bridge

          Yes, the likelihood for real upheaval is very high and not just for situations where gunz are prevalent, though, since they are everywhere, they will certainly play a part. Prisons come to mind, but I expect they will be only a small part of the potential.

          Reply
          1. Wukchumni

            There are a bunch of prisons in the CVBB here, what if the authorities decide to let all the convicts loose as Covid-19 comes calling, as in Iran?

            Reply
          2. ambrit

            At the local level, I can easily ‘see’ the Sheriffs Office “deputizing” many of the more ‘reliable’ inmates to act as support staff in a bunker in style situation. As in, who will get the unenviable job of dealing with the bodies?
            Another imponderable will be the role of criminal gangs. In some regions, criminal organizations act in an almost parallel institution role. Many gangs already have established organizational capacity and day to day functionality.
            We live in interesting times.

            Reply
    2. skk

      My instinctive reaction when I read the Beijing blog was – “You are NOT doing this to me. I am NOT a number.. I am a free man”, its as intrusive as the bloody airport security and I deride that as security “theater”, and this is around my own home which is – arghhhhhhhhhh – no wayyyy.

      I tried to consider it more objectively, more rationallly but nahhhhhhhhh, GTFOOH. Partly I’m resigned to this – my wife volunteers at the local hospital so once it explodes to the tens of thousands, as it most likely will, IMO, she’ll probably get it and then so will I I expect. Besides I don’t go out much at all – though whether I attend our Thursday wine-class and Friday card game session and a weekly happy hour – I’ll reconsider all that.

      I was imagining who the USA would act the busybodies, the little hitlers ? HOA committee members for sure I expect, and at the gated communities the private security ( that would be rather ironic ! ) ? But at apartments ? very few have a concierge.

      Its a useful thought experiment – who in the USA would be the little gauleiters around your own apartments and homes ? Perhaps they’ll set up a whole new Fed agency, modeled on the TSA ? And once set up like all Federal agencies it would become permanent. Jeez.

      Reply
  5. Biologist

    A data point from The Netherlands: authorities are saying that community transmission is taking place, at least in one province (Brabant) in the south, but so far testing is still restricted.

    Random testing between 6 and 9 March of hospital workers in this province revealed that 4% of workers with mild symptoms did in fact have Covid19*. According to a spokesperson from RIVM (the Dutch National Institute for Public Health and the Environment), this result could be explained by health workers generally being ill more often than the general population. However, according to an official: “in Brabant there is more going on compared to the rest of the country. We’re observing cases we cannot explain, and our data shows that workers have not been infecting one another. This is why we think that in some areas there is [community] transmission of the virus”.

    Already before this test, the province has been placed under stricter measures compared to the rest of the country; people are advised to stay home, if they have symptoms, and large events (>1000 people) have been cancelled / prohibited. Schools are open, however.

    They based this Brabant-specific policy on the fact that (almost?) all new cases had a link to Italy, except for cases in this province, or cases with links to this province. Note that they celebrated carnival in Brabant in mid February, with street parades, very busy pubs and many family gatherings.

    One would hope that this result will lead to more widespread testing. Unfortunately, this doesn’t seem to be the case, and it is quite unclear what the policy is. It seems that if you have mild symptoms AND have been to an infected country (or had contact with a confirmed case), you are supposed to stay home but not call the doctor, unless the symptoms get worse. In that case, the doctor (together with the local health service) determines the need for a test.

    Generally, people are only advised to call the doctor (which is the path to getting tested) or stay at home, if a) they have symptoms, AND b) have been to an infected area (north of Italy, China, Iran, Singapore, South Korea; note the absence of the rest of Italy, France, Germany), OR had contact with a confirmed / tested Covid19 patient. The rest is advised to go to work as normal.

    Note that in case of widespread community transmission, these criteria will not test anyone who is ill, as most will have gotten it from others in the community who have also not been tested. These criteria explicitly exclude such cases. Note also that these criteria are also still being used in UK, where there’s a comparable number of confirmed cases and deaths.

    I find this insane, to be honest. The goal should be, even in these relatively early stages, to ASAP estimate the number of cases irrespective of their origin. Even with limited testing capacity, random testing in carefully-chosen locations will give these estimates, even if you cannot test everyone (compare it to exit polling). Apparently in The Netherlands they have done one such experiment, which shows community transmission. I hope this leads to more widespread testing, in other countries too.

    *) Sources:
    https://www.rivm.nl/en/news/result-of-random-sample-4-hospital-staff-infected-with-coronavirus
    (in English)
    https://www.nrc.nl/nieuws/2020/03/10/brabant-niet-op-slot-wel-op-scherp-a3993346
    (in Dutch)

    Reply
    1. Maurice

      Living in Noord-Brabant myself and to me the policies still make perfect sense.
      Why do you need testing for light symptoms? Apparently the RIVM does not need it for their policies, the number of severe cases give them enough information about the current state.
      And for the persons themselves, if they would be tested positively, they would be asked to do the same as they are currently already asked to do, stay at home, but with an additional load on the health system. Also you run the risk of people testing negative who end up having it after all (one of the claims of the rivm is that the tests are not very reliable if people don’t show very clear symptoms).

      I have the very strong impression that from the start the rivm already concluded that this would probably end up in an epidemic, so everything is aimed at flattening the curve, taking the right measures at the right time.
      If you start testing everyone while you know there are only a few infections coming from other countries and their close contacts here, people will think everything is overblown and won’t take your advise seriously. And the way to flatten the curve is to get people to follow the good practices to prevent it. And as far as I can see, it is working. People around here are in general taking the rivm advise seriously, no enforcement necessary.
      How seriously the situation will get in the end, I have no idea. I still think it very unlikely I will catch the virus, but I will follow the advise of the rivm, if only as an example for others.

      One thing to add: They tested all medical personal in Noord-Brabant with (mild) symptoms which could point to corona. For 4% they found that link. This means that 96% just had the flue or a cold.

      Reply
      1. Ignacio

        I think that random testing should be useful. Those would provide REAL info on the epidemic spread and give informed reasons to decide when to increase safety measures. Is it too expensive or are we all to stupid to realise what is happening?

        Reply
      2. Biologist

        I have a lot of respect for RIVM, and I agree with most of their policies. I definitely agree that policies (e.g. restricting gatherings, forcing people to stay home, whatever) should be deployed when they are most effective. The point is, without more testing we don’t know where we are in the curve.

        Limiting testing to only people a) having travelled from an *incomplete* list of regions; or b) in known contact with a tested case; will *guarantee* that you miss community transmission, until it’s very widespread. This is truly irresponsible.

        I’m not saying everyone should be tested, given false negative rates and the burden on the testing system. But there should be widespread, representative sampling of a wider section of the population. This is not hard.

        >They tested all medical personal in Noord-Brabant with (mild) symptoms which could point to corona. For 4% they found that link. This means that 96% just had the flue or a cold.
        4% might sound low, but remember all these people are still being told to go to work, unless they develop fever (https://www.rivm.nl/coronavirus/covid-19/informatie-voor-professionals).

        The only reason we have this 4% number is because they performed this wider sampling. You can’t flatten the curve if you don’t know where the curve is.

        Reply
  6. allan

    U.S. coronavirus testing threatened by shortage of critical lab materials [Politico]

    A looming shortage in lab materials is threatening to delay coronavirus test results and cause officials to undercount the number of Americans with the virus. …

    CDC Director Robert Redfield told POLITICO on Tuesday 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 growing scarcity of these “RNA extraction” kits is the latest trouble for U.S. labs, which have struggled to implement widespread coronavirus testing in the seven weeks since the country diagnosed its first case. …

    Nigeria with nukes.

    Reply
    1. dearieme

      The performance of the CDC has been quite appalling.

      The availability of those reagents is obviously being looked at

      Why on earth wasn’t it looked at around January 20th?

      I realised that the oaf Trump was hardly likely to shine in this affair, but the awfulness of the CDC has been an eye-opener.

      Reply
      1. John k

        Gov programs don’t work well if they’re not funded. No doubt trump has made things worse, but crapifying gov is a two party goal bc markets.

        Reply
      2. allan

        > the awfulness of the CDC has been an eye-opener.

        Who is CDC Director Robert Redfield ? Thank you for asking:

        … The investigation did say that he had an “inappropriate” close relationship with the non-governmental group “Americans for a Sound AIDS/HIV Policy” (ASAP), which promoted the gp160 vaccine.[19][20] Redfield served on the board of ASAP, which gay groups criticized for anti-gay, conservative Christian policies, such as abstinence-only prevention.[21] Redfield also authored the foreword to the book co-written by ASAP leader W. Shepard Smith, “Christians in the Age of AIDS” which discouraged the distribution of sterile needles to drug users as well as condom use calling them “false prophets.” The book described AIDS as “God’s judgment” against homosexuals. [22] At the time of his nomination to head the Centers for Disease Control and Prevention, Dr. Redfield maintained close ties with anti-gay and anti-HIV activists. [23] While Redfield is a devout Catholic, he has publicly supported the use of condoms and denies ever promoting abstinence-only interventions.[24] However, in the 2000s Redfield was a prominent advocate for the “ABCs of AIDS” which promoted abstinence primarily and condoms only a last resort. [25] …

        And more.
        The Cossack works for the Czar.
        His performance at at March 7 CDC photo-op/campaign rally was … remarkable:

        … Robert Redfield, the director of the CDC, said the “most important thing” he wanted to say was praise of Trump.

        “First I want to thank you, for your decisive leadership and helping us put public health first. I also want to thank you for coming here today and sort of encouraging and bringing energy to the men and women that you see that work every day to try to keep America safe,” he said. …

        Reply
  7. vlade

    “not requiring suspected or confirmed COVID-19 patients to be placed in negative pressure isolation rooms at all times;”

    There’s 4-5k of negative pressure isolation rooms in the whole of the US. That may be enough for quite a few patients (as there may be more than a bed per room, depends I guess), but they are geographically distributed, while the outbreaks are clustered ignoring this distribution.

    IMO, placing a non-symptomatic patient in a NPIR is horrendous waste of resources even right now, as we can’t really afford (and I don’t mean montarily) to keep them there 3-4 weeks until they test negative.

    What is really disturbing though is the last para on the nurses – work if asymptomatic. It’s a pretty simple logic that high virus load => higher chances of complications and of more serious problems. One of the strategies should be to avoid high virus loads as much as possible, which, along protective gear, would mean rotating the staff when/if possible (and self-isolating mild cases where possible too).

    Reply
  8. lou strong

    Last time I wrote on NC, I was downsizing the potential effects of covid, to which Rev Kev answered with some numbers projections who made me reflect .My personal feeling at the time I posted was influenced by the fact that me and my wife , who is suffering a long-standing blood cancer and is currently under chemo , have had in the last days of February a consult with a doctor who had been very reassuring about covid, dangers and so on. Now that everything bursted out and we are locked down, I’m quite unnerved and I apologize in advance if not all I write will appear reasonable. I live NE of Milan in the metropolitan area.What I witnessed in these last days , on the real life side, is a quick escalation of measures. On the political comedy side ,these last hours are showing the back-and-forth between the Lombardy Governor is asking the national Gov to shut down everything in Lombardy and the national Gov is answering that nat Gov himself is waiting the Lombardy proposals.I can’t work , as both my jobs imply social contact and I can’t risk for my wife, but I get out for need . On one side I tend to think that the general healthcare situation is getting close to the point of collapse in Lombardy, due to the quickness of contagion, on the other side I’m not sure if all the disaster reports are to be taken literally.I really don’t know what is to be trusted and what it isn’t.Yesterday I went with my wife for the weekly chemo in Monza hospital , which is 15km NE of Milan and approx 40 km SW of Bergamo. According to the chemo nurses chatters , last week on Tuesday in Monza hospital there was one patient in ITU for Covid and yesterday there were a lot more of patients but ITU capacity wasn’t still fully exploited.Obviously relatives can’t enter the structures, so I wasn’t inside there during the chatters and I can’t argue whether chatters were spontaneous or the result of a policy aimed to calm things down .I mentioned Bergamo because I saw that a facebook post of a Bergamo surgeon went viral in Italy and abroad, and there was alink in NC too.While I have no reason to doubt about the dedication and desperation of the surgeon ( a couple of townships near Bergamo were hardly hit the last days ), I regret he found the time to criticize those papers who dared to point their fingers against private healthcare. The fact is that that the surgeon works in an accredited private healthcare giant, the Humanitas. Last November my wife needed a CT scan, waiting lists in the NHS were too long so the NHS call center addressed us to Humanitas.My wife is exempt so for a 10 minutes scan the NHS paid 800 euros to Humanitas . Incidentally, Humanitas is owned by Mr.Rocca , the eighth richest man of my country.
    After years of NHS cuts, privations and outsourcing the idea that Lombardy has an extraordinary good healtcare maybe is not so solid . I read that Italy has fewer bedside than other European countries and a lot less if compared with the time when NHS was fully established , in the late seventies.

    Reply
    1. Biologist

      Thank you Lou, for sharing this story. Sorry to hear about your wife’s illness, wishing you both all the best.

      Reply
    2. Brooklin Bridge

      All the best for your wife and thank you for your report. One of the big questions is will anyone learn anything when this is over or will privatization of common resources continue to rule the waves? As John Campbell says, “Health care should be: of the people, by the people and for the people.”

      Reply
      1. lou strong

        Thanks to you and to everybody for the wishes.
        In Italy, the bill of a healthcare of the people, by the people and for the people was introduced by a minority centrist gov in the overheated late seventies, as a part of the reforms that socialists and mostly the communists demanded in exchange of their abstention for the vote of confidence.In the nineties , with the neoliberal wave, started the trend of counter-reforms.The regionalization of NHS implied , in practice, that regions were free to privatize and/or outsource multiple aspects of healthcare.Then , after the euro crisis, the austerity ( which was on the way even before ) was tightened and cuts hit the NHS too , by the way .Lombardy , a long -time stronghold of the center-right , has moved on a lot in the path of privatization/outsourcing ,boosting her “excellence model” to which seem to believe not only innocent foreign observers , but a lot of Italians too.Needless to say historically center-left regions have done the same, only without hyping too much a supposed “excellence” as Lombardy did.The longest-serving Lombardy governor of the past is now serving an almost 6-years sentence of corruption for unlawful favours to another private accredited group ( not Humanitas ).

        Reply
    3. The Rev Kev

      Same here and I wish you and your wife well. Just try to stay inside as much as possible to reduce hazards to your wife. Good luck.

      Reply
    4. Yves Smith Post author

      What may make the data points make sense is I believe some hospitals have been converted entirely to coronavirus treatment while a few have ICU space reserved for normal emergencies like heart attacks and bad accidents. So it could be that the coronavirus-focused hospitals are in crisis while the (I infer few) others are functioning as normal.

      Reply
      1. rtah100

        My colleague’s spouse is working in Bergamo as a hospital consultant From their descriptions, Lombardy healthcare is far better than NHS in quantity and quality of patient experience (outcomes may be the same).

        All ICU patients were cleared out to neighbouring hospitals to dedicate space to COVID19 patients. The situation is worse than the public descriptions. It is like a warzone. Battlefield medicine without blood. No ICU space for anybody old pr medically frail, only the strongest contenders. Every space run was ICU, even corridor. No gauntlets or N95 masks, only surgical gloves and FP2. My colleague is living with kid and inlaws while spouse self isolates in family home. Every doctor sent their family away to mountains or beach house for the same reason.

        And unless we act hard and fast it us coming to the rest of us.

        My mother works at 75 (bad pension, no interest in retiring). She is high-risk. She is a medical secretary in a clinic doing only elective surgery. I spoke to the senior consultant, they will not close until govt announces it, they feel obliged to “follow the rules”, even after a frank discussion of the Italian crisis This mentality will kill people.

        The partner is thinking about not going skiing at Easter….

        Reply
        1. lou strong

          Rtah100,Lombardy healthcare is the local branch of a regionalized NHS,as I tried to point out above, so it makes no sense to talk about them as separate entities. If you mean that the general standards and performances in Lombardy are superior to those of other regions , and namely the South ones, this is no mistery for everybody living in Italy.
          What I see is that public description is very much the one you quoted (warzone etc ) for some local situation, like in Bergamo, and by the way the big question is whether the local warzone scenario could become nationally spread.

          Reply
  9. allan

    The Cost of Not Getting Tested for Coronavirus: a $10K ER Bill [The City]

    First Brooklyn public school teacher Erin McCarthy began experiencing potential coronavirus symptoms after returning from Italy.

    Then a doctor — wearing a hazmat suit — told her she couldn’t be tested because she didn’t fit the criteria at the time.

    But that wasn’t her last shock: She recently got a bill saying her fruitless March 2 ER visit cost $10,382.96.

    “And I wasn’t even tested,” McCarthy said.

    McCarthy is lucky: She has insurance coverage and will only have to cough up a $75 co-pay for her visit to The NYU Langone Health–Cobble Hill emergency department. …

    But there’s a happy ending, so it’s all good:

    After the city health commissioner’s order changing the protocol for testing was issued March 5, McCarthy was able to get an actual test. The results turned up negative for coronavirus.

    As of Tuesday, she had yet to receive a bill for that test, which took place at New York-Presbyterian Brooklyn Methodist Hospital in Park Slope. She said the hospital did not request her insurance information, so she doesn’t expect she’ll be getting a bill. …

    Reply
    1. Ignacio

      If the moment arrives I feel bad, with fever, cough symptoms and even some respiratory shortage I will do my best not to show up in a hospital unless in the following week I feel worse. Why? Because hospitals are now hot spots for virus transmission with high risk of high viral loads. Also, they don’t have a cure and showing up before it is necessary won’t help. It is usually a week after first symptoms when more severe conditions can develop. Do I need a test to know if it is coronavirus? No, I don’t. Just take all needed precautions trying not to pass it to the rest of the family. I wouldn’t be obsessed about the test.

      My advice is not to rush to the hospital.

      Reply
  10. Winston Smith

    Here’s a good (bad) one…my wife has a colleague in the southwest whose husband is a doctor. He took care of some COVID-19 patients. He and his family got sick. He could not get a test(!). I almost don’t believe it but on short reflexion, such situations are now to be expected.
    They are all “fine” after a very unpleasant and scary illness.

    Reply
  11. Katy

    I’m in Seattle. I’ve had 3 people here express the belief that the virus has already passed through the entire community asymptomatically, and so there’s nothing to worry about.

    Sigh. It’s hard for people to believe something until they’ve seen it with their own eyes.

    Reply
  12. Dalepues

    Nine confirmed cases en Colombia. Three added yesterday. The first case was a 19 year old girl who was studying in Italy. She flew to Bogotá with a connection in Madrid. The new cases also appear to have originated en Europa.

    Reply
  13. nbtt

    the virus seems to have very different lethality in different countries, which means there are different strains.

    the one in italy seems the worst.

    Reply
    1. Jay Money

      Not to be a jerk, but I think this point has been hammered incessantly–the death rate is a function of each country’s individual response/healthcare system capacity and the number of KNOWN cases (which is hard to tally b/c fearless elected and unelected officials of many countries are inadvertently or deliberately hampering the ability to test patients). I HAD thought this was basic knowledge.

      Reply
  14. drugstoreblonde

    Well, my trip to Shanghai was cancelled in early February, which left my fiancé scrambling for an early return to Berlin. When she returned, we self-quarantined for two weeks in order to keep paranoia and false-positives to a minimum (I assumed anyone coming down with a cold or flue would be afraid it was COVID and lay the blame at our feet). Now, we’re in a desperate situation wondering if we should cancel our Wedding in SF in a 10 days at risk of being stranded in the States or subjecting friends and family to unnecessary exposure risks.

    I know the mortality rate has been, fortunately, quite low thus far, but if this is dress rehearsal for a more serious pathogen/virus, it hasn’t been a very promising one!

    At any rate, I can only wish health and safety to all of you and your loved ones. Stay safe out there.

    Reply
    1. RMO

      We were going to go to San Fransisco for a week starting on the 17th of March. Cancelled it just over a week ago. It felt like I might be overreacting at the time, now not so much. Cancellation fees for Amtrak and Air Canada were surprisingly low though and since we were going to be staying with friends there was no hotel booking to consider which made the decision a lot easier than cancelling a wedding would be. I just didn’t want to take the chance of being quarantined on the way home or, worse yet in the US and hoping my travel medical insurance would keep me from being bankrupted if anything happened.

      Reply

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