Archive for March, 2020

Where’s the Fucking Data?

Sunday, March 29th, 2020

I am sick and tired of seeing only what journalists have managed to pull out from random published reports – especially when that consists of summary statistics based just on numbers by nation. But even when someone has the wit to give us numbers per million I would prefer to be able to choose my own list of countries and/or look at other data than mere reported infection rates.

What I really want is an easy link to a complete database of all confirmed COVID-19 diagnoses including fields for:

  • date of first suspected diagnosis,
  • date of confirmed diagnosis,
  • estimated time from infection to suspected diagnosis (based eg on severity of symptoms at time of diagnosis)
  • political jurisdiction (as closely as possible),
  • employment exposure level (medical worker, other public-facing service, non-public-facing worker, other, none)
  • possible source from infected contact (family, workplace contact. medical workplace contact, known community, known traveller, unknown)
  • severity (asymptomatic, non-hosp flu-like, hospitalized, ICU, fatal)
  • outcome (recovery, death)
  • date of outcome determination

Why isn’t such a thing easily available to whomever wants to study it?

Sources:

The Man’s a Fucking Idiot!

Tuesday, March 24th, 2020

Before Trump started talking about choloroquine, health experts were looking into it as part of the solution. But now the drug is flying off the shelves in pharmacies and it’s so scarce that pharmacists are saying they don’t have enough in stock for people who actually need it for things like arthritis and lupus.     Choloroquine is poisonous if taken improperly, so there’s an understandable hesitation on the part of health officials to tout a drug that hasn’t been tested for covid-19, knowing that people will seek it out and could harm themselves.

A man in Arizona died and his wife is in critical care after they treated themselves with the choloroquine they use to clean their fish tank. It had the same active ingredient as the malaria drug. The woman told NBC News that she heard Trump talk about the drug and that they “were afraid of getting sick.” Hospitals in Nigeria are also treating a flood of people who are suffering from choloroquine poisoning.

Source: Coronavirus Updates from The Washington Post

 

Mitigation vs Suppression

Sunday, March 22nd, 2020

There’s been a lot of rather loose talk recently about the distinction between “mitigation” and “suppression” which are really just expensive words obscuring the simple difference between “make it grow less fast” and “make it shrink”.

The basic fact is that in most of the world, the number of as yet undetected cases of COVID-19 may already be so great as to overwhelm our intensive care capacity when the expected percentage of them become critical. This means that we need NOW to do whatever we can to minimize infection rates and actually make the infected numbers go down. Making it grow less fast is not enough.

But even making it go down is not enough. If we start it going down next week that won’t mean we can just relax. We’ll have to keep it going down for some time. And even if we eventually make it go down almost to zero, that will still not be enough if there are still parts of the world where it exists more strongly. We will need to be able to catch and stop any new cases that come in through our borders or that pop up from the few remaining undetected cases at home.

But the other side of this coin is that we may not have to eliminate it completely. If enough of the population (in this case apparently about 70%) is immune, then any local outbreak is expected to shrink. (This is sometimes referred to as having “herd immunity”.)
One way to make people immune would be by vaccination, but we don’t yet have a vaccine (and don’t expect one for at least 18 months). Another source of immune people might be those who have had and survived the disease. So the best bet might be not to try to kill the disease completely, but rather to keep the number infected at a constant level that is just below what would overload our intensive care capacity.

In the language of suppression and mitigation, this would be to suppress as quickly as possible until the acute care need becomes manageable, and then relax restrictions just enough to keep making almost full use of our IC facilities until either the “herd immunity” level is reached or an effective vaccine is developed.

See: COVID-19 « alQpr

(328) Alan Cooper’s answer to Why is capital more important than labor? – Quora

Tuesday, March 17th, 2020

This is a poorly phrased question because it uses the ill-defined term “important”.

But it is one that is often asked so maybe it needs an answer.

The word “important” is used in many ways. If you value human life, then even an economically unproductive life is important. And even in strictly economic terms, a hunter-gatherer may survive by picking fruit and catching frogs without the need for any physical capital besides access to a productive environment (and perhaps the “intellectual capital” of information passed down from previous generations about what is and is not safe to harvest). So capital has not always been even economically more “important” than labour.

But in the *modern* world we rely very much on both accumulated knowledge and built infrastructure to enhance our productivity – so much so that anyone who has access to and control of these things that we call “capital” can easily purchase any necessary labour from those who do not “own” the capital by offering them a small share of the product which will, though tiny, nonetheless vastly exceed what they could produce for themselves without access to that capital.

This raises the obvious question of in what sense it is in any way appropriate, fair, or right that some few people should by birth be assigned a hugely disproportionate share of the world’s accumulated capital while the rest are reduced to bargaining their increasingly unnecessary labour for a tiny share of the product.

So far as I can see, that obvious question has an obvious answer. It’s not! There is no argument that I can accept which justifies the present state of affairs and it’s long past time to fix it.

Source: (328) Alan Cooper’s answer to Why is capital more important than labor? – Quora

Covid 19 – Flattening the Curve

Monday, March 16th, 2020

It seems clear(?1) that the pandemic will proceed in each community until about 70% of the population has acquired immunity by having survived the infection. The question is just how many will not survive.

The good news is that the proportion of young and healthy people who will die is very(?) small. But the potential cull of their parents is much higher. For those over 70 the death rate appears to be around 10%, with the actual rate being strongly dependent on the availability of suitable intensive care.- especially mechanical ventilators which, not being so much needed in the normal scheme of things, will be in short supply when the peak infection rate hits.

Since there is as yet no way of reducing the actual number of people who eventually get the disease, the key to minimizing the losses is to lower the peak infection rate so that all those for whom the disease is critical have access to the best possible treatment.

This means that old people (and young ones who are not too desperate for a quick inheritance) may benefit from any behaviour which slows down the progress of the disease, and, by spreading the demand over a longer time interval, makes it less likely for people to die due to not having access to optimal treatment. (See this Washington Post Article for a good explanation of how “social distancing” works to keep down the peak number of active cases – and also this Medium article for more detail on some of the actual history of the pandemic – and this report form a team at Imperial College in London which apparently was istrumental in persuading the UK and US governments to adopt strong measures of social distancing.)

I must admit that my first reaction on hearing of the disease was (despite being over 70, and so in a relatively high risk population myself) to say “well let’s just get it over with and take our chances – like dealing with the pain of pulling off a band aid”. But on realizing the significant life-saving potential of high tech medical equipment, and seeing the numbers in need of that equipment quickly overwhelm the capacity of a relatively modern medical system in Italy, I have changed my tune and now favour as much social distancing as we can stand for as long as we can stand it.

However I do have a novel suggestion to add for dealing with this novel Coronavirus.

Perhaps, given the very low risk of serious harm to an identifiable sub-population, it might be helpful to ask for volunteers to undergo early infection and quarantine – after which they would be free (nay, even encouraged) to get out and mix with others as much as possible.

The main reason for bothering to slow it down (as opposed to taking the “rip off the bandaid” approach) is the fact that if all the infections happen quickly then the small percentage who get critically ill will still overwhelm our intensive care capacity and so suffer losses which would otherwise have been avoidable. But if we could increase the immune population by selectively infecting and isolating people at low risk for complications, then the peak IC burden might be lessened. Does it make sense therefore, to use the now empty cruise ships, hotels, and holiday camps to offer free luxury accommodation (and guaranteed access to whatever critical care might be needed) to groups of healthy young people who can expect to spend part of their holiday under the weather but who will be free to mingle among themselves throughout both their brief (usually mild) illness and also a substantially longer period of normal health?

For my own part it might have made sense to get it early if I could have been sure of getting in there with access to the best available care before the big rush made it likely for me to end up gasping without a ventilator. But sadly, I think it may be already too late for that.

(?1)NB (added March19) The success of China in suppressing transmission sufficiently to bring a halt to new internal cases leaves a large unexposed population still vulnerable to potential infection unless at least the borders continue to be very closely monitored with mandatory quarantine of every new arrival until fully confirmed with non-carrier status.

(?2)NB The claim that for the young and healthy this has a death rate that is “very” small may be understating the risk since a fatality rate of 0.5% per year would be about the same as that of US troops deployed to combat in Iraq in the early 2000s. (But perhaps asking people to expose themselves to that probably inevitable risk just earlier rather than later, and for the purpose of reducing the risk for others, is at least no more callous than asking them to do so in order to achieve a political goal which may have been mainly just to maintain control of a massive oil supply.)