Friday, April 3, 2020

Just Saying

Hey kids, remember this from waaaaay back in last week?:

Allow me to mention:

Write this on your hand with a Sharpie:

1) I don't lie to you
2) I'm not "scaremongering" nor advocating panic
3) I'm providing you with the best analysis I can, based on the best information I can get, to allow you to make rational preparations based on what's possible, and what's most likely
4) I'm doing this out of pure altruism and goodwill

I don't know any other way to do that than by giving you the truth, and showing my work.
If you spaz, or go into denial, or irrational delusional psychosis, you've got bigger problems, and they're not mine to solve. Seek professional help, and medicate yourself heavily. (And STFO of my blog.) And once again, we're still giving this to you ahead of the Usual Suspects, and we're still hitting it right down the fairway.

As are several other sites as well, but most of them aren't.  Draw your own conclusions on who to listen to, going forward.


The Gray Man said...

Here in my ER (and in most of the ERs in my little area of Florida) we are still not hit hard. Yet. Been quarantining ourselves at home for a little while now, but Florida is on “lockdown” as of 13 hours ago. List of “essential businesses” is a mile long, though. So good luck with that.

Aesop said...

Even here, it's been a half-assed quarantine as well, but it seems to be doing the trick. L.A. is not NYFC, Nawlins, Atlanta, or Joisy.

No malls, no big gatherings, no restaurants except drive-through/take-out.

If anything, it shows how much society brings disease on itself.
But now the focus shifts to "for how long?"

No one has a good answer for that.

Anonymous said...

Back about March 12 Aesop predicted 1200 cases. With 40000 on 4/1 Roughly doubling every 4 days. On 4/1 the Johns Hopkins blog shows 245000 cases with an unknown time lag. Aesop had not picked 250k patients about 4/12. So if anything he has been optimistic in his opinion. I think the beginning of the end of this will be when there are fewer than 1000 deaths a day from the chi-com virus or if a prophylactic dose of HCQ proves effective and widely available. I am taking zinc phosphate daily. I had seen several references to it's use in cold and flu treatments. It apparently won't do any harm.

wtcreaux said...

Ran across this on another site. May help to explain some responses we see.

Dr Peter Sandman and his MD wife Jody Lanard are risk communication consultants: they WERE happily retired, but got "unretired" by the reporters and agencies calling them. One of their very useful concepts is the difference between apathy and denial.

From here:

Apathy versus denial
First and maybe foremost, it is crucial to distinguish people who are truly unconcerned about COVID-19 from people who are so frightened (or so depressed) that they are at risk of being unable to cope emotionally, so they have tripped an emotional circuit-breaker and are now in denial.

Denial is far from optimal; people in denial don't take precautions. But denial is preferable to panic – and denial is why panic is rare.

In normal times, apathy is far more common than denial. People who claim to be unconcerned should usually be taken at their word. But in times of crisis, genuine apathy becomes less common and denial becomes more common. This is one of those times.

The distinction matters because the right way to cope with apathy and the right way to cope with denial are opposites. If people are apathetic, the task is to scare them. Information helps only insofar as it's alarming information – stories work better than statistics, for example. Emotional arousal is what does the job.

But people in denial have already blown their emotional fuses. Frightening them further will only push them further into denial.
Also, as you note, people in denial work hard to avoid content that threatens to alarm them. They'll try not to see what you're showing them or hear what you're telling them. Or they'll misperceive it. Or they'll come up with reasons to mistrust it or arguments to rebut it.

All this is diagnostic. When "unconcerned" people get less concerned instead of more concerned when you tell them scary things (assuming you tell them in empathic, credible ways), the odds are they’re not unconcerned at all, but rather more upset than they can bear. So stop trying to frighten them, and start trying to help them bear their fear (or sometimes their misery).

Annabel Lee said...

So far Charm City has not exploded in terms of virus. The National Guard is hunkered down near our two stadiums waiting for a native uprising, huge body count, and/or food distribution. I’m a little surprised and relieved, but expecting the worst due to our huge Jewish population. The AIPAC virus as TruNews calls it, must surely have infected a number of our (((citizens))). There are close ties to NYs Jewish population as well as politicians.

Nick Flandrey said...

A lot of this crisis is happening "somewhere else" and to "someone else" for the vast majority of people in the US. Being so geographically large, means that this thing is really spread out.

I'm sure that contributes to the difficulty some people are having acknowledging that it's real.

If anything, I'd like every local news team to visit their local ER and either show the preparations in place, or the influx of patients.

That might bring it home to people.


wtcreaux said...

For some of us though (DFW), our EDs are "empty". We're figuring we're about 2 weeks behind NYC, so this is the calm before the storm. Much like a tidal wave sucks the water away from the beach, only to slam everything, we're expecting the same.

I have acquaintances that have already lost their jobs, and their health insurance to go with it. So in 60-90 days, we're going to be slammed. Either with COVID19 or with patients who've been out of their meds for the past 2-3 months. Think CHF (heart failure) exacerbations, COPD (emphysema) exacerbations, cardiac issues, uncontrolled diabetes.

And we are starting to have the sore throats showing up - "And just what emergency do you have that brings you here in the middle of a pandemic?"

Anonymous said...

I'm surprised any hospital or clinic isn't already turning away the junkies, alcoholics and hypochondriacs.
My biggest concern right now is when do the truckers decide going into NYC or Balmer is not worth the risk? When do the big distribution centers lose too many employees to the bug and grind to a halt?
Avoid crowds.

Hope@ZeroKelvin said...

The major cities in Texas have been essentially locked down for several weeks and they are planned to be until at least the end of April, except for "essential services" which is very narrowly defined per EO of our governor.

Our hospitals in Houston are all on the same page in terms of managing these patients and have prepared as well as can be expected for the surge. We have 5 big hospital systems as well as 1 cancer hospital and a children's hospital network. They are all working together so the processes/information is uniform. I get about 20 emails daily, it is definitely been a very fluid situation.

Suspected patients in the ER, which is the 1st point of contact, are immediately put in a different part of the hospital or sent to a designated facility and tested. The goal is to keep PUI (persons under investigation) or known positives out of the main facility. It will also conserve PPE as the most worrisome patients are concentrated in a few places and not spread through these hospitals. I guess the staff in those facilities are getting hazard pay, I don't know if that is so, but it should be.

So far about 10% of the people tested in Texas are positive. We have approx. 4,700 cases and 70 deaths. I only have numbers for 3 big systems - about 6 to 10 hospitalized patients each so far. Most of the hospitals are already integrating HQ + Azithromycin in their protocols. One hospital is involved in the trial of immune serum.

The only surgeries allowed are true emergencies or procedures that would result in loss of life or limb. Most of the surgical sub-specialties have issued guidance on what is reasonable. The goal is to free up ICU beds and ventilators and conserve PPE resources.

The hospitals have gone to a no visitor policy with very few exceptions - dying patients, laboring woman, minor children. They have been restricting access to 1 or 2 entrances and these have local police at the door along with the medical screeners.

All hospital based personnel and rounding physicians are now required to mask. You are issued a mask upon entering the hospital and have to hand it back at the end of the day. They are sterilizing these overnight to preserve them. If you are going to be in contact with a PUI or covid19+, you are issued the gown, mask, face shield, gloves. I don't know if those are sterilized and reused, I doubt it.

The hospitals are also tracking all respiratory medicines and meds related to ICU like sedation on a daily basis.

Most practicing physicians in the community have gone to Telemedicine or just shut their doors. Our practice is cancer medicine and we have limited our services to those patients on active treatment or new cancer diagnosis only. We screen at the door, have rearranged our offices to have social distancing, all staff wears masks and so far so good. We have a good supply of gowns/masks/gloves anyway as our chemo nurses are required to wear them when administering chemotherapy. Cancer medicine in Houston is about 75% based in the outpatient setting. I don't know what the hospital based oncologists/hematologist are doing. I did have to send 2 new diagnosis of acute leukemia downtown and they were accepted, so that was good because treatment of acute leukemia is a not a community hospital diagnosis in the best of times. We are not very active in the in-patient setting, acting as consults only when our patients get admitted, or for new diagnosis or hematology problems. I am senior and don't round during the week but my weekend call is this weekend. I am not looking forward to it.

So far, so good, we are as prepared for a surge as well as we can be. Our geography and lack of any meaningful public transport as well as canceling the Houston rodeo and other major events in Feb-March may save us, I hope.

Eaton Rapids Joe said...

Executive summary: Michigan case count and Michigan deaths show a six day time lag based on correlation. Using deaths/(case count six days prior) suggests a 10% fatality rate if your symptoms were severe enough to warrant a test.

Garbage analysis because the numbers are garbage. But that is all there is to work with.

Wm. Duand Dupon said...

I value your perspective...visit each day. Measure it against other sites and you are early, truthful and correct. what a trifecta!! (and there is a difference between correct and truthful)

Anonymous said...

@Unknown 10:57

Agreed, and I would add the quality of some of the comments here as well is outstanding.

ThatWouldBeTelling said...

the scanning electron microscope images of this bug shows an IDENTICAL outer shell to a 2018 coronavirus, but the inner DNA has additional components. It is IMPOSSIBLE for a natural mutation to achieve that outcome. Any mutation in Nature that affects the inner DNA also mutates the outer shell of the virus.

Besides the not minor detail of this being a RNA virus, the above is arrant nonsense, genome changes can have significant physiological differences that are far too small to discern with the resolution of a scanning electron microscope. Plus the inner generic material also codes for proteins inside "the outer shell".

[Trucker's will] keep delivering right up to the point where this thing is confirmed to be full blown airborne.

Unless you believe the group that thinks it has an R0 of way over 10, the infection rate data we're seeing is not consistent with it being "full blown airborne" like the measles, with its R0 of 12-18.

That said, we're getting more inclined to believe it can be spread by just speaking, which produces particles with an average size of 1 μm, quite big enough to include several SARS-CoV-2 viruses, and "six feet of separation" is the usual level of competence in infection control we've become accustomed to hearing from the CDC.

Nick Flandrey said...

@Hope@ZeroKelvin , thanks, that is the most complete and succinct rundown of Houston preparations I've seen or heard yet.

CinVA, SOMEthing has to wake up the sheep. If body bags in trailers won't do it, because it's in NYFC, and "they probably do that every day anyway", then something dire closer to home might work. But, if there isn't anything dire in the ER, then I guess NOT showing the calm might be prudent. But then I'm advocating spinning the news, just in my favorite direction...

I spent the day shelving food and organizing the pantry. I think that's probably the best use of my time at this point.

I'm glad the signal to noise improved, even if I did have to set up a new account to match my persona.

People keep looking for reasons why it can't actually be this bad, why it's really not a big deal. That is a religious argument at heart. While it can be fun to argue points of dogma, no one is ever convinced to change their mind on religious arguments. At best you get resigned acceptance.

I'm going to quit trying unless it's clear that there is simply a lack of access to appropriate info sources.

My pile of stuff to do is too big to spend any more time arguing religion.

@aesop, stay safe, get some sleep!


Anonymous said...

"They'll keep delivering right up to the point where this thing is confirmed to be full blown airborne"

Um, no they won't, because this is going to get a lot worse and the chimp out is one late truck delivery away. Once that starts, no on wants to be Reginald Denny reincarnate.
Look at what happened during the BLM riots and others.
Besides, most inner city cultural specialists have no idea what the difference is between airborne and contact transmission.

Glad to be in the boonies; hope you are too.

FredLewers said...

Lots of numbers being tossed around out on the net. They all come up bad or worse...
All equations = epic shit storm
Oh well, Romans 8:28 still applies.

Avalanche said...

Honored ... wtcreaux ... to be quoted quoting my all-time fav consultants! (And at Aesop's blog! Definite brush with greatness!)

Peter Sandman has built up a huge site with deeply effective advice and suggestions for dealing with 'upset.' Sandman's position is: Risk = Hazard + Outrage. You cannot "solve" outrage by teaching more about the hazard.

From his "12 outrage components" on this page:
Chronic vs. catastrophic
Chronic is perceived as less dangerous. This is why car-related deaths are consider less newsworthy than airplane-related deaths. The car deaths are spread out over time and location. Companies too often focus on making the probability of occurrence lower, and not on reducing the hazard. A low probability times a high hazard will equal high outrage. You must focus on reducing the severity to lower the perceived risk. People want the probability to be lowered, but especially the severity (magnitude) of the hazard reduced.

Companies must talk honestly about the worst-case scenario. This goes against all company desires. They want to downplay the worst case because it's (one hopes) least likely. To gain the trust of the public you must address worst case. A chemical company fought against meeting with the public and talking about the true worst-case. Against their desires, they did it: they told the public what the worst, worst, worst case could be, how many 1,000s of people would be killed and injured, and all the likely damage. The public and the activists agreed it was the worst case, but since it was so very unlikely, they wanted to talk about the more likely, less severe cases. Instead of mistrust and accusations of covering up the worst possibility, the company and the public were about to work together on the more possible cases. (If the company cannot be trusted to come up with an ACTUAL worst case scenario, how can the public trust the company to protect against it?)

This is why all the comparisons of corona-chan to "regular flu, common flu, every year flu, everybody gets the flu, take-yer-vaccine flu, blah blah blah" gets absolutely nowhere with the public. Regular flu is chronic, happens every year like clockwork: boooooring! (Like car crashes: "Turn the channel, honey.")

Wuhan flu, China flu, Kung flu is catastrophic! It is making changes such as we have never seen! Lock-downs? Social distancing? Economic crash! Terrifying! (Like a plane crash or a terror attack! Laser focus! "OMG! we need to buy toilet paper!")

Then this one is "Here's our situation in 2020!!" (Elenor is the Boeing employee who wrote the report on a Sandman seminar.)
Knowable vs. unknowable
Knowable is better. The public is much less tolerant of uncertainty than are engineers or scientists. The public prefers a lower "highest possible damage" with a higher likelihood of occurring to a higher "highest possible damage" with a lower likelihood of occurring.

Elenor’s comment: This may not be logical but it's SO! You must recognize that rationality doesn't matter -- how the public perceives the risk is what you must address (outrage, not hazard).

{Back to Sandman:} Part of the "knowable" component is detectability. It would be so much easier if radioactivity were purple. At TMI, it was the first time anyone had seen reporters hurrying a press briefer -- 'hurry up and get us further away from here.' When asked why, after all, the reporters had been in wars and earthquakes and riots, they were in such a rush to get away from TMI, a reporter said, "At least in a war, you know you haven't been hit yet."

We don't KNOW we haven't been infected yet -- that massively increases the fear, the outrage, the desire to DO-something-dammint!

Sandman and Lanard's site is well worth a read around!

Loco Gato said...

just curious. Has anyone anywhere looked at the possibility that this virus attacks a certion gene in the dna make up of the folks who have died? Also what is the common demoitor that all those have in common?
You've seen the difference or have heard of the wise difference between age groups and health.
A certain gene? The blood type is b.s. as you well, or should know. And, most importantly, why is noone raising the question of maybe it is gene related due to, tin foil hat here, a bio-weapon?

Nick Flandrey said...

People have looked at both of those things. There was talk of ACE-2 receptors, inhibitors, or something like that.... lots of talk about bioweapons, esp. given the location of the outbreak.

As it spreads, more people are exposed and a wider population gets it. So we have kids, babies, old, and young. Healthy or with comorbidity. Wider potential pool, wider range of people getting sick. STILL, looks like it's more deadly if you are older, and sicker to start. But being young and healthy won't keep you from GETTING it.


Night driver said...


There is an online history of this outbreak/pandemic that is about a thousand 40 post pages where you could find discussions of the HIV-like portions of the genome on this wonderful RNA strand, and some fairly well-documented discussions as to carefully CRISPR'd disease/bioweapon/etc.If you would like I'd be more than happy to ship you a link.

Night Driver

Irish said...

This clip is from 2015.

From the Rair Foundation- In 2015, Italian state broadcaster RAI aired Leonardo, a show dedicated to science, which revealed that Chinese scientists had created a pulmonary “supervirus” from bats and mice “for study purposes” that is capable of attacking humans. Salvini and other party leaders are demanding to know if there is a connection with the research featured in the 2015 documentary and the Chinese coronavirus, which has wreaked havoc on Italy. In the scientific documentary, Chinese researchers in a laboratory in Beijing managed to graft a surface protein of a coronavirus found in bats onto a virus that causes SARS (Severe Acute Respiratory Syndrome) in mice.

The video is here:


ThatWouldBeTelling said...

You'd be surprised at the resolution possible with a scanning electron microscope.

I operated one for 3 years straight for IBM. How much experience do you have with them?

Then you should be able to tell us the lowest practical resolutions.

Also, I'm no virologist, but I'm betting big money you aren't either. If you were, you wouldn't be wasting your time here on this blog.

I'm retired, so for all you know I could be a virologist. But I'm not, $$$ forced me off the science track before I could finish my bachelor's degree.

You could post the link if you feel like it. Since HIV is a retrovirus, I'd be interested to know about its capabilities to convert RNA into DNA.

Through reverse transcriptase, which is the RT in RT-PCR testing. PCR is one of the biggest developments in the history of biology, it allows the amplification of a tiny bit of DNA into however much you want. Since this is a RNA virus, the first step in testing is to use reverse transcriptase to copy some viral RNA into DNA, then PCR is used to create enough DNA to be detectable.

I'd also love to hear an explanation of how an RNA virus somehow got combined with a DNA producing retrovirus in nature. From what I'm told that's statistically impossible...and yet that's apparently what we're seeing.

This is not something I've examined in detail, because the virus is what it is, incomplete bioweapon, gain of function experiment, or an informal example of the latter, putting pangolins into small enclosures for smuggling them into the PRC and before they're sold could do the same by forcing a coronavirus through a series of them. And I need to spend some months coming up to speed in the field. My best guess is the middle example, being done in less than the required BSL-4 lab, which is much further away from the wet market than a lab a few blocks away which has at most a BSL-3 lab.

I've just come across a claim that the known, published in papers PRC gain of function bat coronavirus research was done in a BSL-2 lab, which is entirely inadequate, and doing that sort of Mad Scientist research in the US, with bird flu and ferrets resulted in a Federal funding moratorium. Which was followed by another due to scientists in the US trying the same with coronaviruses.

The short sequences that look like HIV in Corona-chan? The usual suspects insist this couldn't happen randomly, that's less convincing in the context of gain of function experiments where you're forcing a bat virus to change by passing it through a series of animals to get it to transmit better in normal mammals. Actual deliberate splicing of gene sequences as the video Irish refers to claims for a short cut in gain of function research? Wouldn't put it past a culture that produced the guy who claimed to have used the crude CRISPR technique on human babies.

idahobob said...

Personally, I thank you for the info that you put out.

chewbacca said...

Sore throats are an early associated symptom with the virus...

lineman said...

So just got word that the guard and DHS just took ventilators from a hospital in Rochester to take to NYC...

ThatWouldBeTelling said...

lineman, this is not anything secret or conspiratorial, Cuomo is open about how he's using the National Guard "pick ... up across the state" unused ventilators and PPE from upstate New York, but don't use the word "seize", "it's a harsh word", "it’s sharing of resources."

You can not make this stuff up, although I suppose Ayn Rand did a good enough job in Atlas Shrugged. And further evidence of that New Yorker cartoon viewing the rest of the world from 9th Avenue, the NYC authorities would strip the entire world of resources to fail to handle the probably soon to be Wuhan level crisis they've created, and continue to enlarge.

And rumor has it they have quite a few unused ventilators in reserve.

lineman said...

Didn't say it was secret or anything of that matter just giving out info... Always love people that want to try and school me...When you want to meet f2f to try and school me let me know...

RSR said...

ThatWouldBeTelling -- Was talking w/ an HHS Under-Secretary (Dept of, US dot gov) in early March, and his theory (freely volunteered, didn't ask) was that it was an escaped weaponized virus, but in development, not fully developed. He additionally mentioned that it was good to know what China was working on before they utilized it as a weapon. Make of that what you will.

ThatWouldBeTelling said...

RSR: I tend to discount that theory because I assume that sort of work would be done in one of their secret biowarfare labs ... but of course we outside of the intelligence community have no idea where those are located. And like our Fort Detrick in the D.C. area, you'd expect them to be in a major metro areas where there's already a lot of biomedical research, so Wuhan would be a natural place for such a facility, it's also further from prying eyes than the big cities on the coasts. We can also assume they aren't sensitive like we are about dual use facilities.

And of course one of the first steps to making a coronavirus bioweapon is to get it to effectively transmit. Going further, hiding that under the guise of civilian gain of function research would make sense. So the theory is plausible.