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Messages - Sam

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1
Consequences / Re: COVID-19
« on: Today at 04:33:20 AM »
...
Now - of course - humanity may fail to extirpate this virus. In that case, we will lose 4-12% of the population over the next year or two, ...
Sam

Sam, I'd appreciate if you could please tell us how you came to that very high figure, and range!

In Nothern Italy, the highest lethality is 1% of population, and that is in municipalities that have a very old population on average (around 45 years iirc), and with many lifestyle diseases. I would say that 1% lethality is proven under such circumstances of old people and many comorbidities, but cannot see what can contribute to an even higher figure than that?

So why should we expect even higher lethality on a global scale?

Sam will give a better explanation but here is my take on why 10% is possible.

1 - it isn't going anywhere. There are too many carriers without symptoms, it is global and it spreads easily. Even lockdown don't truly stop it. As soon as a lockdown is removed it reappears.

2 - there is a growing body of work that is beginning to suggest that immunity either doesn't happen or disappears quickly.

3 - Without decent medical treatment, a lot more people die. It appears that about 1% of people die when treated well but it leaps up quickly when hospitals are overwhelmed. And soon, it will hit countries with inadequate medical services to begin with.

4 - give the above, the virus can potentially do the rounds over and over again in the same people until they die.

5 - with a mutation rate similar to flu, there is a chance that it will mutate every two years. If that happens, it becomes a flip of the coin as to what it does next.

To me, it is not unreasonable to see a significant ongoing event that will cause many problems for a long time.
I am not saying this will happen..... but it isn't out of the realms of possibility. And if it does happen, 10% will be on the low end of victims.

Precisely.

Round and round and round she goes, until no one susceptible dies anymore.

Meanwhile, the virus is morphing into new forms.

Sam

2
Consequences / Re: COVID-19
« on: Today at 01:40:57 AM »
A press release from Cambridge University reveals that:

Quote
Researchers from Cambridge, UK, and Germany have reconstructed the early “evolutionary paths” of COVID-19 in humans – as infection spread from Wuhan out to Europe and North America – using genetic network techniques.

By analysing the first 160 complete virus genomes to be sequenced from human patients, the scientists have mapped some of the original spread of the new coronavirus through its mutations, which creates different viral lineages.

“There are too many rapid mutations to neatly trace a COVID-19 family tree. We used a mathematical network algorithm to visualise all the plausible trees simultaneously,” said geneticist Dr Peter Forster, lead author from the University of Cambridge. 

“These techniques are mostly known for mapping the movements of prehistoric human populations through DNA. We think this is one of the first times they have been used to trace the infection routes of a coronavirus like COVID-19.”

The team used data from virus genomes sampled from across the world between 24 December 2019 and 4 March 2020. The research revealed three distinct “variants” of COVID-19, consisting of clusters of closely related lineages, which they label ‘A’, ‘B’ and ‘C’.

Forster and colleagues found that the closest type of COVID-19 to the one discovered in bats – type ‘A’, the “original human virus genome” – was present in Wuhan, but surprisingly was not the city’s predominant virus type.

Mutated versions of ‘A’ were seen in Americans reported to have lived in Wuhan, and a large number of A-type viruses were found in patients from the US and Australia.

Wuhan’s major virus type, ‘B’, was prevalent in patients from across East Asia. However, the variant didn’t travel much beyond the region without further mutations – implying a "founder event" in Wuhan, or “resistance” against this type of COVID-19 outside East Asia, say researchers.

The ‘C’ variant is the major European type, found in early patients from France, Italy, Sweden and England. It is absent from the study’s Chinese mainland sample, but seen in Singapore, Hong Kong and South Korea.

The new analysis also suggests that one of the earliest introductions of the virus into Italy came via the first documented German infection on January 27, and that another early Italian infection route was related to a “Singapore cluster”.

Here's the associated paper:

"Phylogenetic network analysis of SARS-CoV-2 genomes"

3,160 strains analyzed in a near real-time phylogenetic tree, by country, by clade, ...
https://nextstrain.org/ncov/global?l=unrooted

Sam

3
Consequences / Re: COVID-19
« on: Today at 01:38:57 AM »
In case anyone's interested. I'm registered and there are some interesting datasets and participants. Starts tomorrow.

https://albertainnovates.ca/impact/newsroom/covid-19-hackathon/
Quote
COVID-19 Hackathon April 10-May 18
Win prizes, help flatten the curve and assist in economic recovery using COVID-19 datasets

Knowledge is power! COVID-19 is a global pandemic, and “flattening the curve” is a critical approach for slowing the spread of the disease so as to not overwhelm healthcare systems. We can use open data to create analyses and visuals to help “flatten the curve”, as well as map the economic recovery from COVID-19.

Together with our partners Cybera and the Pacific Institute for Mathematical Sciences, we invite you to participate in a virtual open data science hackathon from April 10 to May 18 to building data-driven perspectives derived from COVID-19 datasets.

Goal
The goal of the hackathon will be to collect and curate worldwide open data and to refine, transform, and link that data to provide a visualization regarding the impact of COVID-19.

We will look at two themes:
  • overall understanding of the efforts to flatten the curve
  • economic recovery especially for Alberta and Canada
This is about providing a better understanding of the story, through data.

I am still of the opinion that they have completely missed the obvious.

1) this virus is extremely communicable.
2) the moment containment is let up, absent severe controls, the virus will once again explode in the population.
3) flattening the curve is essential to prevent hospitals going into saturation and exploding the death rate.
4) flattening the curve is a short term strategy ONLY. It is tactics, not strategy. It is NOT a solution.
5) the economy cannot recover until the virus is extirpated
6) flattening the curve does NOT extirpate the virus
7) an explosion of new cases will require immediate reimposition of quarantine controls which requires business restriction. Business restriction will result in bankruptcies and failure with increasing rates until the virus is confirmed to be extirpated.
8 ) hence - failure to do the things necessary to extirpate the virus prior to relaxing controls results not in economic relief and recovery - but precisely the reverse, to horrible economic failure. Focusing on the economy as the primary concern assures failure, failure assures destruction of the economy. Until leaders and decision makers get this, they will continue to focus on solving the wrong problem, and as a result in destroying the very thing they care most about - the economy and profit.
9) add to that, failure to extirpate the virus means ultimately killing the maximum number of people (shy of the added deaths that occur when the hospitals go into saturation)

The answer has to be to focus on the primary problem which is to extirpate the virus. That includes many of the aspects of the solutions used in China, New Zealand, South Korea, and Japan.

If there is some as yet unidentified magic in Germany that is actually reducing the death rate, not just reducing the reported death rate, that too might play a role. There is however NO evidence so far that the Germans are actually reducing the lethality of the virus, or that the strain(s) in Germany is any different from anywhere else. The highest probability is that all of the strains of the virus are roughly equal in lethality everywhere on Earth, with the obvious dependencies on age, and on availability of adequate care.

Treatment interventions (drugs, herbs, ...) may play a large role. They will not substantially change the problem - extirpation of the virus and controlling its spread. This will take time to develop and assess. It will not likely be a strictly positive story.

Vaccines have a greater chance, but they will take time - lots of time. And they may not succeed at all. If they do succeed, the immunity conferred may be seriously limited.

Plasma or other interventions may play a huge role - or not. It will take time for those to be assessed. There will be negative aspects. Those likely won’t be large. However, this might not be an actual treatment solution. It is nine the less hopeful.

Inbound border control with 14-28 day quarantine, testing, isolation and ongoing follow up will be required. For countries that fail to control the virus and extirpate it, travel and trade may be all but impossible for years - or longer. Restrictions on ship crews in the same way will be mandatory. I.e. - no shore leave - for at least years. This includes major countries and groups like the US and the EU. Failing to extirpate the virus can be nationally fatal to trade.

Widespread rapid testing, tracing, follow up and isolation are essential to any solution.

Population tracking will create huge social impacts. These are essential for success. Yet, they are likely to fail due to societal objection and resistance - violent resistance.

And lastly, delay favors the virus. The longer it is around, the greater the chances are that it either mutates in ways that make it uncontrollable, more lethal, more infective, less obvious (silent transmission in some people), or that it moves into some animal reservoir that serves to make it impossible to extirpate.

Now - of course - humanity may fail to extirpate this virus. In that case, we will lose 4-12% of the population over the next year or two, and it will become an ongoing predator, culling the old and infirm, the unhealthy, and the weak. In time, those who are genetically less vulnerable will prevail and have children, lessening the impact of the virus; and conversely - suppressing those genetic lines that are less able to withstand its ravages.

Sam

4
Consequences / Re: COVID-19
« on: April 09, 2020, 10:33:52 PM »
Researchers Identify Six Drug Candidates That May Help Treat COVID-19
https://medicalxpress.com/news/2020-04-covid-drug-treatments.html

An international team of researchers has tested more than 10,000 compounds to identify six drug candidates that may help treat COVID-19.

The research, involving University of Queensland scientist Professor Luke Guddat, tested the efficacy of approved drugs, drug candidates in clinical trials and other compounds.

Professor Guddat said the project targeted the main COVID-19 virus enzyme, known as the main protease or Mpro, which plays a pivotal role in mediating viral replication.

"This makes it an attractive drug target for this virus, and as people don't naturally have this enzyme, compounds that target it are likely to have low toxicity.

Inhibitors (drug candidates):

ebselen
cinanserin
disulfiram
carmofur
shikonin
tideglusib
PX-12
TDZD-8

Open Access: Zhenming Jin et al, Structure of Mpro from COVID-19 virus and discovery of its inhibitors, Nature (2020)
https://www.nature.com/articles/s41586-020-2223-y

Shikonin is a major component of zicao (purple gromwell, the dried root of Lithospermum erythrorhizon), a Chinese herbal medicine with various biological activities, including inhibition of human immunodeficiency virus (HIV) type 1 (HIV-1). G protein-coupled chemokine receptors are used by HIV-1 as coreceptors to enter the host cells.

Ebselen (also called PZ 51, DR3305, and SPI-1005), is a synthetic organoselenium drug molecule with anti-inflammatory, anti-oxidant and cytoprotective activity.

Cinanserin (INN) is a 5-HT2A and 5-HT2C receptor antagonist which was discovered in the 1960s. The molecule is an inhibitor of the 3C-like protease of SARS-coronavirus

Disulfiram (sold under the trade names Antabuse) is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol (drinking alcohol).

Carmofur (INN) or HCFU (1-hexylcarbamoyl-5-fluorouracil) is a pyrimidine analogue used as an antineoplastic agent. It is a derivative of fluorouracil, being a lypophilic-masked analog of 5-FU that can be administered orally.

Tideglusib (NP-12, NP031112) is a potent, selective and irreversible[1] small molecule non-ATP-competitive glycogen synthase kinase 3 (GSK-3) inhibitor.
https://www.alzforum.org/therapeutics/tideglusib

Excellent finds. And interesting target candidates. Hopefully one or more of these or related compounds can become a low-toxicity highly-effective treatment.

Sam

5
Consequences / Re: COVID-19
« on: April 09, 2020, 08:15:19 AM »
I have seen this sort of worthless data posted on line to many times already thanks.
 
Quote
NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

The bureaucratic delay inherent in such sources makes reference to them meaningless for a month or two yet.

Nice visualization see here >>

From here >> https://www.reddit.com/r/dataisbeautiful/comments/fxau85/the_recent_drop_in_us_pneumonia_deaths_is/

That is by far one of the best visualizations I have seen portraying the delayed reporting of data - which posts into the correct time period in the past.

It is awfully easy during an event (of many major different types), or even in industrial production, to grab data and trend it believing it is meaningful; even though it actually isn't - precisely because of this sort of information lag.

During the early months of the HIV pandemic in the 1980s I was following the data at first on a daily basis, then weekly, then monthly as CDC shifted their reporting. It was pretty easy to see that the data behaved in a mostly predictable way, with data coming in late and being posted into the correct time era in the past in a mostly repeatable manner.

The data in the graph shows similar behavior. Back in the 80's I developed a predictive algorithm in Lotus 1-2-3 to 'adjust' the reported data to estimate the likely actual data. The same appears to be possible here.

However, in the case of flu, the data is uniform enough that you can almost use the prior years as the guide to the error in the current data. By directly trending how the data changes over time, and then adjusting it based on that algorithm independent of prior years specific data, it is possible to get an early warning that things may be trending away from the prior year norms.

In the HIV case, the data always showed a rising trend (damped exponential) that turned downward at the end in the most recent reporting periods.

Perpetually the news reported that it looked like maybe we were at or near the peak. They never then went back to report that they had erred, and that no such thing had happened, and that instead that they and those who advised them had been deceived by this temporal reporting problem.

I saw this so often in my career that it is one of the first things that I look for. This especially happens when there are human reporting systems involved.

I do not believe that is what we are seeing now with COVID. It is likely that plays a role though.

It appears to me that the sheltering in place and distancing has made a serious dent in the transmission rates. This does not however mean that it will trend to zero as the models suggest. That is an artifact of errors in the assumptions in the models.

At the same time, there are clearly both unreported cases (both asymptomatic AND presymptomatic), and deaths whose causes are misassigned for any of several reasons. In some strongly rule based cultures, this is an artifact of the rules. It isn't YYY until you prove it is YYY. But absent the necessary capacity for testing, testing corpses is a low priority, so the data is corrupted; deaths assignments are recorded and reported wrongly. In those cultures, the error 'may' show up by looking at excess death rates. However, the dramatic change in human behavior from sheltering also changes the underlying statistics, so that too is not reliable.

At the same time, unattended deaths may be arbitrarily assigned any number of causes from heart disease, to pulmonary failure, uncontrolled diabetes, flu, COVID, or others based on a best assessment by a physician, or the coroner. In the US, many corners are only charitably called that. This isn't all that different from months, years, decades and centuries gone by. We just like to pretend we are better at it now than we often are. A century ago, many people died of "heart failure" who actually died of other causes. What was apparent was that the persons heart stopped beating. Absent any other cause --- heart failure.

All of that impacts the data. And as the count of cases rises, it becomes a larger and larger problem. In some ways it is akin to the "fog of war".

I don't say any of this to be critical. The reality on the ground is often different, sometimes greatly different, than we imagine or wish it to be. As a result, the data is often flawed in important and potentially deceiving ways. It is important to recognize that this is or may be happening, and not to take the data too seriously without ground truthing.

Back in the 1970s-1990s there were huge efforts at using statistical quality control, statistical process control and the like. In industrial processes, these helped. But even more than providing more and better data for controlling processes, they actually had as their purpose taking the freaking managers hands off the controls. Managers love to think they understand (when they don't) and to "prove" their worth by "fixing" things. The statistical tools forced them to take their hands off. When they finally understood that was what the tools did, they subverted the tools. This too is often a problem. Donald Trump is a prime example of that sort of stupidity, and an exemplar of how severely it can distort the data and the response; and from that the success or failure of the response.

Humans are silly creatures. We tend to believe what we want to believe, no matter the reality. The old saying "Seeing is Believing" is actually quite often precisely backward. Quite often what is seen is ONLY what is believed, and the proper saying is "Believing is Seeing", meaning that those involved not only ONLY see what they want to see and what they want to believe to be truth, but more over - they simply cannot see anything that runs contrary to their beliefs and desires. They will not even entertain the possibility that the reality is other than what they believe it to be. They can and do change the data to match their beliefs. This happens in dozens of unique ways.

It is in my experience quite rare to find people who see what is, and adjust their beliefs to match the reality, while all the while challenging whether that is the real reality, or whether the tools and systems have embedded within them preconceptions, presumptions, unstated assumptions, beliefs and biases, misunderstandings, and other failings that cause the data to portray one thing, while the reality may not be anything like that at all. And more than that - who watch for the people involved to be willfully mucking things up, even while they think they are "fixing" things.

And this doesn't even get to the willful modification of data and information to conceal things that are viewed as being contrary to the career interests of the manager(s) involved.

Sam

6
Consequences / Re: COVID-19
« on: April 09, 2020, 02:24:41 AM »
If the plasma is proven effective, as I hope it will, it is very likely worth the risks.

The risks:

Quote
Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion associated circulatory overload (TACO) was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion related acute lung injury (TRALI/possible TRALI), anaphylactic, and hypotensive reactions were noted in 0.08%, 0.02%, and 0.02% of transfusion episodes. Minor reactions, including febrile non-hemolytic and allergic, were noted in 0.62% and 0.29% of transfusion episodes, with 30–50% reported to the transfusion service.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559198/

I really don't mean to be rude, but I don't think you understand this article.  The article is discussing "blood transfusions."  A plasma transfusion is *very* different.  No red blood cells, nor white blood cells, are transfused.  A plasma infusion is far, far safer.

Now, if you can find an article showing the hazards of fresh-frozen plasma, that would be relevant.

It isn’t just red cells and their proteins, or white cells and theirs that are at issue. Those are potentially very important for transfusion reaction. For the vast majority of people these do not come into play at all in terms of risks. For a small fraction of us, that is not so clear cut.

Plasma is also sterilized for pathogens. That does not assure that viruses are excluded or entirely inactivated. Neither does it always assure the all fungi and certain other organisms are eliminated. And neither does it or even can it prevent prion transmission.

These are not huge risks in the calculus for people with life threatening need for these products. And those involved have done a reasonable amount of diligence. However, that does not then translate to widespread giving it to healthy people.

Also, doing so would require a hugely expanded infrastructure to handle the added blood products. Lacking that, people who critically need these products would be denied them. More over we do not yet have very high confidence about the degree of immune protection provided. This is as yet untested.

More than this, we know that the elderly who have been exposed to more things in their lives are dying not from the virus directly, but from their own immune systems reaction to the virus as a cytokine storm damages the hearts and floods their lungs. It is not yet clear that boosting their immune response is at all the right thing to do.

Sam

7
Consequences / Re: COVID-19
« on: April 09, 2020, 01:16:41 AM »
I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

Be careful what you wish for. That is how the Hep C pandemic came about - the largest single catastrophe of allopathic disease transmission known.

An explosion of Hep C, Hep B, and a dozen other diseases could result. Most of those can be detected via screening. And standard sterilization techniques should eliminate them. “Should” being the operative word. However, a lot of other infections cannot be easily detected. A lot aren’t even identified.  Neither are a whole host of immune factors. The explosion of autoimmune diseases a year or ten later will be startling, and devastating.

Caution is warranted.

Sam

All of this is seriously overblown.  Fresh-frozen plasma (FFP) is very commonly administered for a range of conditions, including the many causes of hemorrhage.  Serious reactions are rare, transmission of pathogens is very rare, and I've never heard of a late autoimmune reaction.  Risks from such therapy is minuscule compared to the risk of Covid infection in high-risk individuals.

Plasma is as carefully screened for pathogens as are whole blood transfusions.  Transmission of pathogens is very rare.

As for A/B/O blood type incompatibility, this concern is also overblown.  First, it's easy to test before infusion.  Second, reactions from such incompatibility are usually mild.

"Because plasma contains ABO antibodies, ideally, fresh-frozen plasma should be of the same ABO type as the recipient. If ABO type-specific plasma is not available, plasma of a different ABO group may be used as long as it does not have high titers of anti-A or anti-B."
https://www.sciencedirect.com/topics/medicine-and-dentistry/fresh-frozen-plasma

Unfortunately - not overblown - in my case. I have an underlying autoimmune disease that has left me with a hyperactive immune system. I am doubly weak D, and weak e through a very unusual antigen, as well as Co(a+b+). For whole blood transfusion, fatal transfusion reaction is a distinct likelihood. I seem to also have an unusual HNA. It is not something I am willing to gamble with given any alternative.

Broad use of plasma (IF IT ACTUALLY WORKS TO TRIGGER AN IMMUNE RESPONSE) makes possible sense in patients with COVID. Doing so willy nilly in those without the virus risks unnecessary injuries.

In the case of Hep C, the physicians thought they knew what they were doing. They didn't. The result was millions of cases of Hep C that then propagated world wide, through IV drug use, sexual contact and for 30% of cases - no known mechanism of transfer.

In the 1950s and 1960s, millions of people were inoculated with Polio vaccine that unknown to those who developed it was contaminated with Simian Virus 40. I lost friends to that. They died of brain cancers in their 40s. I am in that cohort. And I may well have received the tainted vaccine. I likely did. If I did, I was lucky. I survived it.

Blood is complex. There are myriad factors involved that we do know. And there are myriad factors that we do not know. Blood transfusions are routine, as are plasma, platelets and other factors. These have been tremendous in their saving of lives. They have also cost lives in the process because of things we did not know.

There are many unknowns involved. Jumping to answers can be quite dangerous. Caution is in order.

That said, for those with serious illness from COVID the calculus is quite different. The risk is worth taking. For the general population, NO.

Sam

8
Consequences / Re: COVID-19
« on: April 08, 2020, 09:55:37 PM »
I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

Be careful what you wish for. That is how the Hep C pandemic came about - the largest single catastrophe of allopathic disease transmission known.

An explosion of Hep C, Hep B, and a dozen other diseases could result. Most of those can be detected via screening. And standard sterilization techniques should eliminate them. “Should” being the operative word. However, a lot of other infections cannot be easily detected. A lot aren’t even identified.  Neither are a whole host of immune factors. The explosion of autoimmune diseases a year or ten later will be startling, and devastating.

Caution is warranted.

Sam


9
Consequences / Re: COVID-19
« on: April 08, 2020, 08:45:03 PM »

Convalescent serum is shaping up to be a highly effective treatment (unsurprisingly):

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
https://www.pnas.org/content/early/2020/04/02/2004168117

This treatment (or any effective treatment) is a game-changer for the global trajectory of this pandemic.

Especially since rapid testing results are being rolled out, a treatment approach can be used to dramatically reduce severity and mortality of infections.  That is, when a person with serious symptoms or high risk for a bad outcome is found, that person can promptly be given an infusion.   We can anticipate a dramatically reduced severity and duration of illness, dramatically reduced deaths, and dramatically reduced demand for ICU beds and ventilators.

Supply of convalescent serum will be an initial constraint.  However, a unit of plasma can be divided among 4 recipients,  and donors can give plasma weekly.  (the red blood cells are returned to the donor, so time between donations can be much shorter than for whole blood donations, and volume donated is also larger).

The technology used is pretty low-tech.   This treatment approach has been used for a century.  Even extremely poor nations can do do donations, centrifugation, and infusions.

This treatment (or any effective treatment) can transform this pandemic from a disaster to something not much worse than a bad influenza season.

We just all need to stay alive for the next month or so for this to be widely available.

There are a number of caveats.

1) There need to be enough donors
2) It needs to be shown to be effective (as yet unproven)
3) There needs to be sufficient testing capability (a severe and very serious limitation)
4) The donors and recipients must be matched for plasma type.

Plasma donation and receipt work differently (backward from) whole blood.

Type AB is a universal donor for plasma. Type O is a universal receiver.

The normal cross reactivity issues with blood should not apply. E.g. for me - I can only receive whole blood from about 1 person in 7,600. I have an extremely rare blood type. For plasma, I should be able to receive from almost anyone.

People with other blood types have other issues. Someone with type AB+ blood can receive whole blood from almost anyone (there are rare exceptions), but plasma only from people who are type AB.


10
Consequences / Re: COVID-19
« on: April 08, 2020, 07:33:51 AM »
There are 4 ways out, in order of preference:

1. Vaccines.
2. "a scalable treatment tolerated by a large segment of the population thats easy to give to people"
3. Virtual extinction through quarantine followed by universal masking and intensive testing/tracing/isolating
4. Herd immunity. Let it burn. Maximum fatalities occur and long term consequences are unimaginable.

4 may be out of the question if 1/3 of immunes become susceptible.

Agreed.

A vaccine doesn’t yet exist. At least six different (and possibly as many as twelve) vaccine candidates are in the works. They will take time, likely at least 12 months and more likely 18-24 to develop. There is no guarantee that any of them will result in a successful and safe vaccine.

Treatment has some hope. However, so far there is no magic bullet for treatment.  A few things help now to varying degrees - azithromycin (and possibly cefazolin) [antibiotics that also bind the spike protein and act as antivirals], tocilizumab and related IL-6 inhibitors, remdesivir (and related antivirals), then to a lesser degree hydroxychloroquine {note: 4/10 - it is now clear that Hydroxychloroquine presents an unacceptable cardiac risk; and Chloroquine is even more dangerous}, quercitin, rutin and other flavanoids and flavonoids (each of which binds the spike protein or other parts of the virus thereby inhibiting its function). Ciclesonide may be important for asthmatics. Honeysuckle, Forsythia & Scute, possibly with other herbs like Bupleurum may be useful as well.  It seems likely that a multipronged approach will be needed combining compounds that bind the spike protein, compounds that inhibit IL-6 and possibly other immune system factors, compounds that bind the ACE2 receptor reducing viral access, and targeted short lived locally acting steroids, plus support for cardiac and kidney function and protection.

A better approach might appear. With extensive modeling and targeted design, it is conceivable that a targeted compound might be developed that either binds to the virus rendering it inert without causing harm, or a targeted enzyme might be developed that cleaves the virus into nonfunctional parts. These are as yet not even theoretical. They will also require testing if they are developed. And that too will take time.

Plasma treatment from recovered patients might prove to be a viable treatment as well. Early tests are in progress now.

In a year and a half from now, or longer, option 1 and 2 may play a major role. For now option 2 plays a limited role in treatment.

That leaves options 3 and 4. Option 4 is clearly unacceptable in its several variations. Yet that seems to be the chosen plan in most nations on Earth.

Option 3 has several variants as well. The Japanese approach was valiant. It’s not succeeding. The South Korean approach has also been valiant. But it too is mostly a guard action. The Taiwanese approach worked initially and is now in trouble.

The Chinese approach has worked, though it is a model most nations seem entirely unwilling to follow.

That brings us to New Zealand. So far their approach is working. Can they maintain it?  Will it go the way of Japan and South Korea?  Time will tell.

Both the Chinese and New Zealand approaches are clearly superior to the failed approaches in most countries.

The sub option of option 4 of of putting a malignant narcissist imbecile in charge and letting him randomly decide based on what he thinks makes him look good, or what profits him or his friends is clearly failing. That is a bad model for any country to follow.

It is also important that any option(s) taken must complete in less than two years. The duration of natural immunity from recovery from this virus is as yet unknown. For SARS1 the immunity most often seemed to last about two years with a weakened resistance in the third year. Some individuals appear not to build lasting resistance. Any option(s) requiring more than two years to complete will not be able to eradicate the virus.

It is also vitally important that whatever option is taken that it allows for support of individuals and small businesses throughout the control and eradication period, and that allows a resumption of near normal business activity in a period less than 4-6 months long. Most cases of option 4 fail that test. The option to allow the disease to immediately infect the entire population would meet this criteria, but at the horrible and unacceptable cost of killing more than 10% of the population.

This brings us back to some extremely aggressive version of option 3 combined with aspects of option 2, as we await development of option 1.  And that again brings us to China and New Zealand.

Sam

11
Consequences / Re: COVID-19
« on: April 08, 2020, 02:24:40 AM »
Here is why Jacinda Ardern is one of my heroes.

New Zealand isn’t just flattening the curve. It’s squashing it.

https://www.msn.com/en-us/news/world/new-zealand-isnt-just-flattening-the-curve-its-squashing-it/ar-BB12gstI?li=BBnbfcL

It is possible to beat this virus. Doing so requires wisdom and diligence. New Zealand is now one of the few success cases.

The US due to the actions of many though not all the States has greatly reduced the growth rates. New York and Washington in particular have made great strides. These are as yet far from success. But they are better. That shows up as the current confirmed infection count now being five days behind my projection based on the rates two weeks ago. Those rates will likely slow more.

However, this is only a slowing. This is in no way success. Once the people tire enough of the restrictions and begin to venture out more, the viral transmission will again rise. This will cause the infections to continue for the long term, requiring ongoing shelter in place for month after month after month, destroying the economy in the process. And the longer this goes on, the greater the chance that the virus mutates into an even more virulent and/or an even more lethal form.

If this problem is to be solved, either solutions like those used in China, New Zealand, or possibly South Korea (though that is less successful), OR herd immunity will be required. Achieving herd immunity while not overwhelming the hospitals means that we stay under the current restrictions for at least another year, and possibly as long as two years. That means economic suicide for businesses large and small, for individuals, and for the nation.

Worse though, achieving herd immunity means that a tremendous number of our neighbors will sicken and die.

Just how long will it take our moron in chief to understand this? That’s a rhetorical question. He is entirely incapable of ever understanding or accepting that. Neither is he able or likely willing to understand the necessity of following the path Jacinda has lain out. Moreover, there is no way in hell that he will follow a woman’s lead. So we are stuck here until he is out of office. And that means an ongoing large death toll month after month until then.

Sam

.... and it begins.

A ‘Liberty’ Rebellion in Idaho Threatens to Undermine Coronavirus Orders

https://www.msn.com/en-us/news/us/a-liberty-rebellion-in-idaho-threatens-to-undermine-coronavirus-orders/ar-BB12gfO9

Stupid is as stupid does.     This is why we can’t have nice things.

But then on the success side of the ledger...

China lifts 76-day lockdown on Wuhan as city reemerges from coronavirus crisis

https://www.cnn.com/2020/04/07/asia/coronavirus-wuhan-lockdown-lifted-intl-hnk/index.html

Eleven weeks of lockdown - then recovery.

Addenda: This is not going to resolve as Dr. Fauci thinks or wants to optimistically believe. He is being foolish or self-deluded. This bug is as contagious as Chicken Pox. If we fail to eradicate it or totally contain it, it will immediately come roaring back. This is an extremely dangerous biosafety level 3 agent.

Under current strategies. Schools will not reopen in the fall. Neither will businesses.

The models are wrong in showing a peak then a decline to zero. They only go to zero, because the modelers included on-going highly effective controls in their models. You only get a decline to zero if you achieve herd immunity, or you maintain conditions that prevent transmission sufficiently to accomplish the same AND you do extensive contact tracing and isolation BEFORE releasing controls. Do anything less and it comes right back.

Worse, we do not yet know how long immunity to this bug lasts. The history from SARS1 suggests two years on average with a weak immunity in year three. But, some people exhibit a weaker immune response and can contract it again almost immediately.

This thing is not going to just “be around” as Dr. Fauci suggests, it is a violent virulent predator waiting for us to let our guard down in the least to devour people and ravage the nation - again.

12
Consequences / Re: COVID-19
« on: April 01, 2020, 09:53:19 AM »
Yes.
This is a horrible pandemic.
We must look back to the 1918 influenza to grasp its severity. 


For some perspective, there were about 50 million dead from that flu in 1918, and the global population was about 1.7 billion people.
So a death rate of close to 3%.

The C19 will kill a few million people out of a global population of about 7.7 billion people. A death rate of maybe 0.3%.
C19 is roughly about 1/10 as deadly.
And it will not even dent the incredible population growth going on at the same time as this pandemia: "The current average population increase is estimated at 81 million people per year."
https://www.worldometers.info/world-population/#growthrate

Please stop trying to minimize the danger of this virus. It is vastly more lethal than you want to believe. And a whole lot of people are going to get sick over the next two months with an immense number dying. Cut it out.

We get that you do not want to believe the facts in front of you. That is just plain stupid.

Sam

13
Consequences / Re: COVID-19
« on: April 01, 2020, 09:51:37 AM »
China may not be done yet. They are just now past 10 weeks of quarantine. But ...

From the Guardian.

https://www.theguardian.com/world/live/2020/apr/01/coronavirus-live-news-us-deaths-could-reach-240000

"Authorities reported 130 new asymptomatic cases on Wednesday, bringing the total number of such cases under observation to 1,367."

Sam

14
Consequences / Re: COVID-19
« on: April 01, 2020, 05:49:25 AM »
Another Clusterfuck In the Making: Defense Secretary Won't Yet Evacuate Virus-Hit  Aircraft Carrier
https://www.axios.com/pentagon-wont-evacuate-coronavirus-hit-carrier-f5c6ff7e-1122-4dd7-ab59-54c23883261f.html

Defense Secretary Mark Esper told CBS' "Evening News" Tuesday he doesn't think "we're at that point" of evacuating a nuclear aircraft carrier docked in Guam with more than 100 crew members infected with the novel coronavirus.

The big picture: The captain of the U.S.S. Theodore Roosevelt has asked the U.S. Navy for more resources. Esper said he'd yet to read the letter in detail, but they're trying to contain the virus aboard the ship. "We're providing additional medical personnel as they need it," he said. Acting Navy Secretary Thomas Modly told CNN earlier Tuesday they were working to remove most of the 4,000 people on board the vessel

https://mobile.twitter.com/CBSEveningNews/status/1245122122042785793

... “The Diamond Princess was able to more effectively isolate people onboard than TR, due to a much higher percentage of individualized and compartmentalized accommodations onboard for paying customers. Their measures still allowed hundreds of people to become infected," Capt. Crozier wrote.

“Keeping over 4,000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care," Crozier wrote.

The captain asked for “compliant quarantine rooms” onshore in Guam for his entire crew “as soon as possible.”

On Friday, there were reports of at least two dozen positive cases. But by Monday, a senior officer aboard the massive aircraft carrier told the Chronicle between 150 and 200 sailors had tested positive.

... "We have been working actually the last seven days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now." - Acting Navy Secretary Thomas Modly

----------------------------

Update: US Navy Evacuating Aircraft Carrier Infected by Coronavirus
https://www.defenseone.com/threats/2020/03/us-navy-evacuating-aircraft-carrier-infected-coronavirus/164254/

The U.S. Navy says it will remove the majority of USS Theodore Roosevelt’s crew so the aircraft carrier can be disinfected, one day after its commanding officer sent an urgent message asking for help controlling a COVID-19 outbreak.

A skeleton crew will man critical stations while Theodore Roosevelt is disinfected pierside in Guam, Acting Secretary Modly said.

“The spread of the disease is ongoing and accelerating,” Crozier wrote in the March 30 letter, which was obtained by the San Francisco Chronicle. “Decisive action is required.”

... Modly said that testing aboard the Roosevelt was initially limited to about 200 sailors per day. He said that will soon be increased by sending tests elsewhere for processing.

A tougher environment to disinfect can scarcely be imagined. A Nimitz-class carrier has more than 3,000 spaces — “rooms,” to non-sailors — that hold all manner of complicated and dangerous machinery, up to and including nuclear reactors.

----------------------------

At 5 a.m., the total number of known DoD cases — currently infected, deaths, and recoveries — was 1,295, up 19% from yesterday.

As well, cases being treated at Veterans Affairs hospitals and facilities more than doubled over the weekend, to 1,166

Oh my. Trying to sterilize the engineering spaces while keeping the reactors operating. Oh my. Oh my. Best bet. Tie up to shore power, go to minimum ops. Station security in full mop. And shut down the reactors. Sterilize everything. Then bring in the {gold|blue} crew - whichever wasn’t on board - after verifying that none of them are infected. They might have to go to a blended crew.

Sam

Addenda: added point. Trump’s stupidity has now affected the readiness of the fleet at sea and our national defense in the process. Well done bozo. Flailing and failing on every front - Health, Commerce, Defense, State, Veterans, Interior, the Environment, Treasury, Justice, Ag, Labor, HUD, Energy and Homeland Security, FBI, Customs - you name it. He has messed it up. All that King dipshit touches turns to crap.

15
Consequences / Re: COVID-19
« on: April 01, 2020, 01:32:26 AM »
Vox,

I won’t upstage you by posting the links to the breaking news stories. Actually I am steaming just a little too much to do it. ....

The chief turd after two months of delay and denial, deflection, insults and harangues, and a near endless stream of self serving lies now finally tells the US today to prepare for a terrible two weeks, and potentially 100k-240k deaths.

As you all here know I have been projecting far worse than that for quite literally months now. This wasn’t a surprise. This wasn’t unexpected. This wasn’t unavoidable. This is a Trumpian induced catastrophe. It took Trumpian levels of gross incompetence to kill this many Americans. Other nations have their own equivalents.

I am disgusted in the extreme. I said before that the data and numbers would ultimately tell the tale. Well, we are nearly there. And even now, finally saying the catastrophe will be enormous, they are still grossly downplaying the reality, the horror, of what is about to happen.

Worse, they are gaslighting everyone by showing their pretty (but entirely wrong) Gaussian projections of 1.5 - 2.2 million deaths (that they never shared before) flattening out to 100k-240k with the implication that they did great things to reduce the death toll. But they cannot even keep their story straight. Dr. Birx stands in front of that chart. And separately another chart with a fat right tail from the actual (but still horribly wrong) models. Those wrongly show the case counts going to zero sometime in June or early July.

What is it? Two weeks? No. 30 days? No. Two months? No. Two and a half? Still No!  They cannot even keep their gaslighting story straight.

Fuck you Donald Trump. You did no such thing. Any reduction came from the States acting on their own independently of you and your stooges, with daily and even hourly opposition, stonewalling, deflection, and impedements from you personally and from your administration, fighting you every fucking step of the way. 

And yes, even now, at this very last moment they could save millions of lives if they would just face the truth honestly and act swiftly. They cannot do it. They cannot bring themselves to do it. All they know how to do is double down on PR and lies. Burn in hell bastards.

Be safe everyone. Keep your loved ones and friends safe, safe as you can. Duck. Duck now. The shit is beginning to hit the fan in a big bad way.

For any of you who are first responders or critical staff in any role - THANK YOU! in advance for the risks you are takling for all the rest of us.

Sam

16
Consequences / Re: COVID-19
« on: March 31, 2020, 09:48:45 PM »
If you can not get masks spray the virus away.
Masks and hand sanitizer are unattainable here all stock sold out long ago due to hording.
I use methylated sprints* mixed with a little water and detergent in a spray bottle
Every surface I touch out side of home gets a spray before contact  when possible.
Obviously not possible in shops
In that case I take care to limit contact and spray my hands, car keys ,door handle, steering wheel bank card etc and all goods as soon as I can .
We have good distancing and shops are only allowing limited  persons to enter at a time.

*Methylated spirits Denatured alcohol  is almost pure ethanol here with bittering agent and color added .  water to slow the evaporation rate down, detergent as a surfacent.
It is probably not good for my hands to wash them in almost pure alcohol but who cares if it stops me getting sick or dying. 
 

Add a bit of skin softener (aloe, calendula, ...) and add just a bit of water (~1 part water to four parts alcohol) to get the alcohol down to 70% by volume plus anything you want for fragrance. Peppermint or lavender are excellent, lemon balm, lemon myrtle, ... are also very good. And they add a tough of antiviralness of their own.

70% alcohol is the ideal concentration for denaturing viruses. And it is more gentle on your skin.

If liquor stores are open near you, you can also buy 190 proof grain alcohol. Everclear in the US, other names elsewhere. It will work as well.

Denatured alcohol usually has methanol in the blend as well.

Sam

17
Consequences / Re: COVID-19
« on: March 31, 2020, 08:55:44 PM »
Sam, Good story ! I would rather swim with sharks .
Yesterday I talked with some friends who I have known long enough to watch as their children have grown and had children of their own. Husband wife , grandmother and three children were here taking care of their chicken coop. They came to talk as I was out hoeing weeds in the garden. Everybody knows to keep a distance !  I asked about PPE and explained how to use them . Apparently even gloves are hard to find. Alcohol wipes gone for awhile now. I gave them a dozen pair of gloves and a big new bag of alcohol wipes.
 I keep meeting people who are completely unprepared for what is happening. Or maybe they are just more ready to accept what I am trying to fight. Without adequate PPE for both the medical community and the public, and without good consistent messaging about how to use PPE there remains a huge percentage of the American public walking around naked agains’t this pandemic.
 Like others here I am pessimistic about outcomes and that is a reflection of what I am seeing when      I ( rarely ) venture out. It is a reflection of what I am hearing from friends and neighbors. It is very close now , +twenty in north county SB yesterday. Ten ICU patients in just one hospital. Not seeing evidence of masks or gloves. Wuhan,  NYC, Lombardy , Madrid are just the first big hits. This is going to keep ramping up here in S.Cal unless something like a real quarantine gets implemented. Not just here either, everywhere .
 

That all is concerning. However, information alone can save lives. Knowing how easily the disease spreads, it is easy to minimize contact. Knowing soap and water are excellent at removing and destroying it, combined with knowing that once you touch anything ’out there’ that you need to consider your hand contaminated until you clean it, and to not touch your face - can save lives. It’s the simple stuff that is really important.

But then too, this applies in thinking about how this ends. I looked through one of the models that Dr’s. Fauci, Birx, and others are relying upon. The model is vastly better. They took their hands off the settings and let the data adjust the model. This is good in so far as the data is good. When the data isn’t good, the model goes awry. Still it is better.

And it is good in so far as the model is constructed well. Unfortunately the model is not constructed well. There are presumptions built into it that cause it to fail. These are clear and obvious.

What is most obvious is glaringly obvious, yet has been missed. The model shows a peak in mid-April to mid-May in all locations. It then declines to zero cases by June! That is NOT going to happen. 

They comment on the model that they presume that self-isolation, distancing ... continue through then. That is an assumption, and a critical one. But, that is not sufficient to get to zero cases. What is clear is that the model fails to adequately assess just how infective this disease is. It then falsely and wrongly has it burning out by June.

That simply isn’t going to happen. The pandemic will, even with restrictions in place, continue to burble along.  And the moment the restrictions ease, it will explode again, and again, and again.

What is required to stop it is to 1) Go into hard medical quarantine. This requires that all those critical staff of all types take much enhanced precautions. Even then, they alone will keep the infection chains alive.  2) Massive testing to find the contact chains, to isolate them, and extinguish them. 3) Contact tracing to support 2). And it will take time. The infectivity of this virus is such that in the wild it requires 90+% of the people to have had the virus and to have recovered for it to die out on its own. With self-isolation ... that might be something like 50-60%. But the model doesn’t reflect that.

The model being wrong as it is still projects 100k-200k deaths. That is catastrophic enough. But continuing the infection chains will cause the death toll to be much higher.

Without recognizing these flaws, the experts, and hence the decision makers cannot see that the self-isolation phase will have to continue for something like a year. That is economic suicide.

So what to do. Save the economy by lifting restrictions? That is immoral, unethical, and just plain stupid. It would kill millions and bankrupt the nation. 

The right answer is what it has been since the beginning. Tell the people as plainly and clearly as possible what is required. Seek their help. They will help. Tell them what they can and must do for us to all win. And then and only then impose the strictest quarantines possible. At the same time ramp up production of masks, PPE, ventilators etc...  Push heavily in investigating treatments. Field those early, as early as possible. Push hard on vaccine development, though not crazy hard. Consider other options too.

The right answer will look a lot like China. Get over past animosities, hatreds, and stupidity.  Get over racism, economism, and all the other mental straightjackets. Use what works.

Otherwise, we are caught here in an endless nightmare.

On the flip side, enormous good is, or may, come from this. The environment is improving with our absence. Well that is if we can stop the morons from using this as an opportunity to gut environmental laws. The liars and miscreants are becoming plain. Unfortunately the pain and suffering will have to be very much greater to break their stranglehold on the body politic. And yes I am referring to the dear leader and his supporters, and lackeys. And it may require many of them contracting the virus and dying of it, for real change to happen. But they do not want that change. And they will do everything they can to hold on to power - until their hands are beaten bloody and ripped from the levers of power.

People are having the opportunity to stay home and to be together. They/we are learning what is truly important in our lives. Yes, there is enormous economic hardship. That will lead to massive changes. A lot of people will suffer horribly and unnecessarily. That suffering will no doubt drive demands for different approaches, for change.

Work will likely not return to what it was. Work from home will be vastly more common. The arguments against it have been destroyed.

Etc...

More than this, the modelers seem to have entirely forgotten the lessons of the past, particularly the lessons from the 1918-1920 flu pandemic. This virus, like that virus, is mutating rapidly. The longer it remains in the world, the more likely it is that somewhere a variant will come into existence that will make this version look mild. When (not if) that happens, the second more fearsome wave will start. Then the third. Then the fourth. The model presumes this does not happen - entirely without basis for doing so.

It will be fascinating to see just what changes finally come from this. And it will become a time to mourn.

Sam


18
Consequences / Re: COVID-19
« on: March 31, 2020, 06:52:53 PM »
Harpy,

I know this us useless and I am wasting my breath.

Please stop being a racist.

Sam

19
Consequences / Re: COVID-19
« on: March 31, 2020, 06:51:19 PM »
Covid-19 had similar symptoms to the illness that was caused by vaping.

Vitamin E acetate found to be the reason for vaping deaths

Link >> https://marketrealist.com/2019/12/vaping-deaths-caused-by-vitamin-e-acetate-cdc-says/#adnrb=900000

Not vaping per se is causing these problems, but the wrong use of Vitamin E acetate in vaping liquid.

Kari,

Blumenkraft got it exactly right. Your question is a good one. The symptoms are similar in some ways. This is because both vaping with Vitamin E acetate and the SARS-COV-2 virus cause damage to the same parts of the deep tissue of the lungs and to somewhat the sane degree. They do their damage in different ways.

We have alluded to how SARS-2 does damage, though we haven't directly talked about it. Mostly this is through the immune system itself causing the damage through interleukin 6 (IL-6) and a huge reaction with cytokines (a so-called cytokines storm). The drugs and herbs that work against SARS-2 work in a bunch of very different ways.

Some like azithromycin work by binding to the spike protein of the virus making it hard to mate to the ACE2 receptor. The ACE2 receptor is how it invades the cells.

Others like the inhaled steroid Alvesco work by locally suppressing the immune system (cytokines, interleukins, chemokines, etc...).

Others like many of the herbs and some of the drugs work by either binding to the ACE2 receptor, or by looking like the ACE2 receptor and acting as a sort of decoy for the virus.

Others yet work by interfering in various parts of the immune response (especially IL-6) to slow or stop that and in so doing to slow or stop the damage.

Etc...

For vaping, the problem was different. Vitamin E acetate has two parts. The first part, the vitamin E, is generally good for health. However, vitamin E isn't one substance. It is instead eight substances. These come in two forms tocopherols and tocotrienols. These are slightly different chemical forms that the body can use. Each of these can exist in four different orientations or configurations. Long story there, but it's not important. They are labeled alpha, beta, delta and gamma. One form of each are quite important for health. The tocotrienols are generally good and important for health. The tocopherols generally aren't, and can cause worsening health. The form that is best for each is not usually the form found in supplements.

Ok that was long, but the gist is this. Vitamin E isn't always beneficial. And the form used in vaping fluid very likely wasn't helpful, and may have been somewhat harmful. But that wasn't the key. Focusing on the vitamin E likely caused misdirection away from the real problem.

They key is the other part, the acetate. When the Vitamin E acetate enters the delicate cells deep in the lungs it separates into its two parts - Vitamin E, and acetic acid. That last part is vinegar. But this isn't vinegar like you are used too. This is concentrated. And there in lies the problem. Concentrated vinegar is a powerful corrosive destructive acid.

My personal opinion is this. And it is only my own personal opinion. This is not a medical diagnosis. I am not a doctor. Neither is it backed up by scientific research. It is born from my own personal experience having inhaled both glacial acetic acid vapors and concentrated ammonia. Do not ever do either of these. You -will be- seriously injured! That I escaped injury is equal parts luck and -extreme- experience.

What seems to have happened is that the vapers inhaled enough acetate to chemically burn the deep tissue of their lungs. That burn continues until the acid is neutralized or diluted. The obvious easy treatment that I haven't heard that anyone tried was to inhale very very low concentration ammonia. Ammonia, which is a caustic, causes lung damage as well. Intentionally inhaling that is a really bad idea. However, if you are being eaten alive by inhaled acid, you have to stop that.

Without stopping the acid or diluting it, the acid continues to chemically burn the tissues. The body responds to that by engorging the tissues with fluid (diluting it), and by recruiting every aspect to fight it as if it were a severe infection. This then acts a lot like what happens in SARS-2.

Sam

20
Consequences / Re: COVID-19
« on: March 30, 2020, 10:23:08 PM »
Is it too early to call daily peak globally (at least for this season)? I think so. There has to be at least a couple more days of a downward trend. But at least after weeks of fear, quarantines and horrible news, we are starting to see some good news, or more like a light at the end of the tunnel.

Not even close.

Sam

21
Consequences / Re: COVID-19
« on: March 30, 2020, 09:09:55 PM »
I don't know about Seattle, maybe the infection rate has dropped from 2.7 to 1.4 only, but in Europe, the drop must be so much bigger. Car traffic has fallen by 70%, public transport use by 80-90% in Budapest, no kids go to school, most people work from home, etc.
 
Even if the original R0 was 3, it must be very significantly below 1 by now. Same probably true for most of Europe. Europe is peaking right now (except for idiots who wouldn't do quarantine)

“Must be” doesn’t enter into it. That is an emotional driver. There is what is and what isn’t. That is what matters.

Sam

Addenda: I should also note that in real events conflicting information is frequent. Sorting out what is meaningful and real is critically important. Until that happens, all of it has to be considered potentially credible and acted upon to the degree possible, with caveats.

Many real world disasters and catastrophes were made vastly worse because key decision makers locked up at key points and chose which information they wanted to believe. Chernobyl is one of those. Often the decision makers in those cases decided that the right information “must be” XYZ. 

22
Consequences / Re: COVID-19
« on: March 30, 2020, 09:08:41 PM »
Quite an effort to keep track of sam’s various projections for the US death toll.  25 million, 5 million, 12 million.

We have Dr. Fauci now using a range of 100-200k.  You would expect him to not be the type to exaggerate, so perhaps this is on the low and uncertain side.

Despite some of the generalizations here that the US population is flouting guidance and society is operating BAU, a large number of Americans have been under some degree of physical distancing and/or stay at home orders.  There is some evidence in a few larger metros of case growth slowing.  Too early to draw conclusions, and yes that spreads out the effect over time until there is a vaccine.

I’m in an urban area of Florida, and expect a very bad April and May due to demographics and slow adoption of measures across the state.  Even so, in the absence of data or facts I wouldn’t expect the catastrophic tolls statewide or nationally that some here are pushing.

The future is constantly in motion. As events change, as new data comes in projections (these are neither forecasts nor predictions) do change.

People get hung up on numbers. In catastrophes, projections form a key tool in assessing where things are headed so that experts, decision makers, and all of the emergency managers, planners, responders can prepare and work to CHANGE conditions to reduce the future projected impacts.

Do NOT ever make the mistake of thinking that any of these projections are cast in stone. The only projections that are close to that are the near term projections that account for the lag time between infection and confirmation. Even these have large uncertainties. And don’t think of those as uncertainty bounds. This isn’t statistics, and we have nothing like a representative or full sample assessment. The larger the base of information, the closer the projections are likely to be.

Also, do NOT allow your emotions, wants or desires to enter into this. Doing so if you have any influence at all gets people injured and killed.

Sam

23
Consequences / Re: COVID-19
« on: March 30, 2020, 06:51:41 AM »
Sam, sources don’t seem to back your claim of 35-50 % hospitalization rate. I remember seeing 20% by the WHO and below source states 20.7 - 31.4 % in the US.

https://www.statista.com/statistics/1105402/covid-hospitalization-rates-us-by-age-group/

We need to remember children have extremely low rate of hospitalization.

Possible, but sorting out presymptomatic from asymptomatic is vital along with a temporal follow up. Did the people in the study ultimately go to hospital or not? And what are the statistics for their outcomes. There is nothing simple about answering these questions to get truly meaningful data in the midst of a rapidly expanding pandemic.

Sam

24
Consequences / Re: COVID-19
« on: March 30, 2020, 06:22:45 AM »
Thank you Sam for this and other thoughtful posts, painting the oncoming catastrophe.
I keep trying to think what could make the expected catastrophe go away, and I don't mean actions in this sense, but what major piece of data could turn out to be the crucial factor that makes actual reality less dire than the predictions. IMHO the direr the predictions, the more important this thought exercise becomes.

In other words - where could you be wrong in your predictions?

This is crucial. It is a huge part of figuring out what is real, and what is wrong. It is also crucial for finding vulnerabilities to try change the course of events in beneficial ways, and to avoid horrible paths. I would love to be wrong!

Quote
The only factor I can find so far that could make a large difference is the number of asymptomatic cases. If if turns out that for each diagnosed case there are 10 or 20 undiagnosed mild cases that go nowhere and generate immunity, then the total fatalities and total hospitalizations should be much lower than expected in the dire scenario, and the disease will peak much earlier as it runs out of available hosts. How sure are we of this factor?

This would be wonderful if it were true. And a lot of folks want it to be true. Wanting doesn’t make it so.  We have extremely little data about this so far. The two data points we have suggest a ~65:35 or ~50:50 of non-hospital vs. hospital cases. We will know more in the future. But for now, it is crucial we not bet on such speculation. The downside risk of horrible outcomes makes making any assumption along these lines extremely dangerous. Even taking the 65:35 ratio as a guide is quite dangerous. It may lead decision makers to take less strenuous actions that that and we cannot recover from.

We also have no data on what the disease course or severity is for the non hospitalized portion of the infected population. They may have less disease (mostly due to age and health), or they may be very similar to the hospitalized portion.

We seriously need more data here. Gathering it is difficult.

Also, it is common for some fraction of the population to be relatively invulnerable to various diseases. Often the why of that is not known. In the case of norovirus, people who genetically lack a particular enzyme are wholly unaffected. The virus cannot get into their cells. There might be some portion of the population that is invulnerable or natively immune to this virus. I have seen no data to suggest this is true though.

Quote
Other factors that keep being thrown around:
The climate or weather or seasons - doesn't seem so far to make much of a difference, looking at countries around the world. but bears to keep an eye on.

This is possible, but seems highly doubtful. If it were true, we would expect to see major differences in countries based on their latitude and current weather. Those don’t seem to be at all apparent.

Quote
An effective treatment - from what I've seen so far there is no magic bullet in existence. This will take time and will likely be available only after the main global wave of fatalities is over.

I actually have more hope here. The supercomputer modeling work is very promising. A number of likely existing compounds have been identified. Quercitin, Luteolin, and Yerba Santa, plus several prescription drugs with low toxicities and side effects are promising starts. Azithromycin alone or in combination with Hydroxychloroquine also may play a role.

The prescription IL-6 inhibitor Tocilizumab looks extremely promising for critical patients. Other IL-6 inhibitors may also be hugely important.

Remdesivir and Favipiravir, as well as others, also look promising for early treatment.

Most fascinating is the potential for BCG vaccine to play a major role in decreasing vulnerability.

Quote
An effective and safe vaccine - as above, this will take time and will likely be available only after the main global wave of fatalities is over.

Yes, particularly conventionally developed vaccines. The new constructed vaccines are as yet unproven but have tremendous potential.

Quote
Variations between populations - that the Italians and the Chinese and the Americans are more susceptible due to pollution and malnutrition - doesn't seem to bear out so far. Nearly all countries exhibit the same data trajectory.

I would love to hear your and others' input on this.

This will be interesting in retrospect. It likely won’t play a major role.

Sam

25
Consequences / Re: COVID-19
« on: March 30, 2020, 12:42:05 AM »
Ok, thanks for your honest responses, Sam. I will note that many voices in the media and among what I will called "the recognized experts" are advancing the narrative that getting to that first plateau is "great news" and evidence that there is clear light at the end of the tunnel. The standard narrative is that once the big first flush of cases subsides a bit and the daily multiplier starts dropping from say 1.4x to 1.2x, the "worst is behind us".

In no way saying this is right, only that it is very widely stated.

As in war there are battles and campaigns and fronts in this struggle too. This plateau is a victory in a battle. It doesn’t mark the end of the war. There is a long way to go. As with war, winning a battle can lead to over confidence resulting in losses and setbacks.

Just as in war there are tremendous logistical issues, tactical issues and strategic issues still ahead.

Sam

26
Consequences / Re: COVID-19
« on: March 29, 2020, 11:04:57 PM »
In the meantime, cursing is no reason for me to stay inside. I intend to go to work tomorrow at the university. The canteen will still be open.

So - cursing offends you. But the huge death tolls don't. Man that is quite the set of values and priorities you have.

Sam

27
Consequences / Re: COVID-19
« on: March 29, 2020, 11:03:28 PM »
Before this is done, it now looks like this virus will kill between 1.5% of the populations in countries like South Korea, and 4% of the world generally, except China, as the medical systems are destroyed globally, ERs are overrun, and the ICU treatment fails under the load. Sam

Ok, let me make my query more explicit. Italy has been at about 800 fatalities a day for the last 8 or 9 days. Italy has a population of about 60M. 4% of 60M is 2.4M. It would take 3000 days at 800 fatalities a day to reach 2.4 million.

So, is the current plateau a false one? Will something change to make the daily rate skyrocket in the future? That's what I'm asking.

I suspect it is a little of both. They are working like hell to curb the thing. That is a part of the plateau. No doubt reporting problems are also a part.

But, how long can they keep up this level of control? Is the control tight enough to stop the spread?

If it isn't tight enough (a la China), then the first question is only a matter of timing. When the controls are relaxed even a little the deaths surge. If the controls are held then for the next 12-18 months things stay as they are with the enormous carnage continuing.

Sam

28
Consequences / Re: COVID-19
« on: March 29, 2020, 10:59:55 PM »
There is a very slight glimmer of something, that the US rates appear to be slowing. The timing is right for this to be a reflection of the stay home efforts. This doesn’t fix anything. It only spreads out the damage, lessening the impact on hospitals (still catastrophic) while increasing dramatically the duration of the economic destruction.

Sam

This appears to be the case in several places.  Italy appears to have reached a peak in its new infections and new deaths. They are bouncing around a bit, but not increasing day over day.  Can you explain where you think it might go from here?  The health care system in Lombardia is deeply stressed, but not collapsed. I don't think other areas of Italy are far over capacity.  It seems like the hospitals should be able to now mostly keep up, and perhaps start to get some breathing room if the rates slow a bit more.

Obviously that leaves a long slog to go, but is catastrophe guaranteed?  Can you lay out a time line that you expect to see?

dnem,

I wish I had a clue. Exponentials tend to run away rapidly if you don't aggressively control them. That is equally true in nuclear reactors, chemical reactions leading to deflagrations and explosions, and biologic growth. The details are different for each of these classes, but the principles are the same.

Riding on top of an exponential and trying to control it is delicate and dangerous. You have to have intense negative feedbacks built into the system that work at speeds faster than the exponential driver. Humans aren't nearly fast enough. In nuclear reactors this is accomplished in several ways. Yet every now and then the control conditions are exceeded or people intervene to do stupid stupid things, and in nearly the blink of an eye things go all pear shaped at the very best and catastrophically destructive at the worst.

For chemical reactions it is even dicier though with smaller consequences. Riding the edge of a thermal kinetic reaction is scary - terrifying actually. When they run away the result immediately is a BLEVE (that is a terrifying thing you never ever ever want to experience), detonations (well, you likely won't survive that), or if you are really lucky - deflagrations. You might survive that, maybe, with massive experience and a huge dose of luck. Following the initial event, there may be subsidiary events. Flee! And there are often toxic releases that are vastly more catastrophic than the initial blast.

For biologics, well - you are now living through one of those. They are perhaps the scariest of all and have the largest most catastrophic consequences. They are also the slowest to develop. They too may have secondary and tertiary effects and follow on waves of new infections with similar or different properties that evade most of whatever we learned in the first wave.

Riding on an exponential to try to control it goes as you are seeing it now play out with COVID. If you are really really good, brutal, and fast, as China was, you might just control it - if you are very very good and very very lucky.  Staying in control is like riding a bucking bull bare hand on the deck of a small ship at sea in the midst of 150 foot crashing waves from a hurricane while a team of snipers is shooting at you.  Good luck with that. Catastrophe is all but assured.

And that is where we are now. The catastrophes are playing out in over 100 countries. The experts are behind the curve and applying tools honed for mild seasonal epidemics and ill suited to rapidly spreading pandemics. This thing is moving far faster than anything the vast majority of them were ever trained for. This is a run away.  By that I mean it is running away on its own & your best answer is to run away from it as fast as you possibly can, slamming doors behind you as you go.

When people understand things like this, they act accordingly. I was once involved in an actual activation of a criticality alarm at a US Government site (a detected nuclear run away). It turned out to be a false alarm triggered by a technician working on the alarm system - live. ALL of us ran faster than we have ever run in our lives to flee the area. I saw a coworker quite literally jump over a 12 foot fence on the dead run without ever touching it. Stress can cause you do do amazing things.

For this, we cannot run away. There is no "away" to run to. We have to stand and fight. That fight in this case means sheltering in place until the danger passes. But, this will take long enough to pass that some of us will have to brave it out. These are the heroes. These are the emergency workers of all types and kinds from the obvious from line - the doctors, nurses, EMTs, and their support staff - people like the janitors who are heroes in this battle - to clearly visible people like grocery clerks and staff - to the nearly invisible - the postal workers and delivery people, the long haul truckers, the farm laborers that keep the crops coming in, the restauranteurs and others who keep people paid and working in ways no one planned for, and the emergency operations people who work long hours behind the scene working the logistics to make things happen.

Then there are the people who think they are important and who demand praise - and their front men and women. These are not generally heroes, with exceptions like Governors Cuomo and Inslee. Mostly they are buffoons, cowards, conmen, thieves, and idiots like Trump, Pence and three score dozen (now less) of other Governors in the US. Other nations have their equivalents. (corrected)

As to where this goes and what the time line is?.... well that very much depends on the actions each country, and region choose to take, how well they implement those, and how clearly they think the problem through.

It doesn't matter whether anyone thinks they have the right answer. It will be crucial to watch the data, seek the data, and act on that. By that I absolutely do NOT mean the usual scientific methods. Those are mostly wonderful for proving things, though even there they have terrible failings in dozens of ways. What I do mean is using real time data to make real time decisions and to take real time actions. That involves a good deal of estimation and guess work. It will be at least slightly wrong all of the time. Most of the time it needs to be close. And those "working the problem" must constantly be seeing new insights, new information, new analyses to gauge where they have gone wrong, where they and we are vulnerable - to act - boldly and quickly - all the while knowing that you are going to make mistakes. Some of those will be terrible. And you have to keep moving. You cannot stop or even pause for long.

If all of that goes well, you get the outcome China had. Societally that has huge negative repercussions that will take decades to work through. And it too can go all pear shaped in a whole lot of ways. A political revolt to those limitations during the response can lead to utter collapse and catastrophe. Overly suppressing such feelings can result in equally dire outcomes. The Chinese deserve huge credit for threading the needle in this crisis. Will that ultimately work out well? Who the hell knows? That depends on the leaders involved and on the mass of the populace. If the leaders can avoid the tendency toward authoritarianism - perhaps. If the public can be patient and do their part - perhaps.

The West lacks many of the tools the Chinese had. Can we lead people by example to get them to adhere tightly enough to what is needed to succeed? I sincerely doubt that. One need only look to Donald Trump's followers to see that in spite of direct evidence they believe insane things and act on those beliefs. You can see some of that here.

Desires and core beliefs have to change to succeed. I do not see that happening.

As a consequence, I suspect that most of the world will either let the virus mostly run free with an enormous death toll and financial and economic consequences, OR they will try to ride herd for a time, then ultimately give up (a la Donald Trump deciding to let up before Easter). Depending on how long that takes or how quickly, that too will have even more devastating effects.

Ultimately what is likely to bring it to an end is either of two things.

1) The virus burns itself out having infected 90% of the population. That leaves behind the huge death tolls that are now so obvious.

2) Vaccines are successfully developed and deployed. I do not see that happening in less than a year.

Some nations and places will no doubt try other strategies. And we will ge two see how effective those are and what consequences they bring with them.

One such that seems likely is having everyone over a certain age (55-65) ordered to shelter and stay sheltered for at least six months, likely longer. And then allowing the rest of the nation to intentionally get the disease to try to burn it out of the population through herd immunity. They then also support the older population by bringing things to them while they are isolated.

Would that work? Who the hell knows? But I can envisage some nation trying it.

In the mean time, we can work like hell to try to soften the blow and limit the damage.

Sam

29
Consequences / Re: COVID-19
« on: March 29, 2020, 08:51:38 PM »
Is Sweden now the only country that's going for group immunity ?

Is there any other way? Does any country believe they can hold out until mass vaccination would be available? Or a cure?

I watched https://www3.nhk.or.jp/nhkworld/en/ondemand/video/5001289/
In that Japanese video, the government expert was not confident that they would be able to avoid overshoots of the healthcare capacity.

I am happy not to be locked up. Cycled to a café in the countryside for coffee and cake.

China.

30
Consequences / Re: COVID-19
« on: March 29, 2020, 08:36:54 PM »
Well, I find you quite unfair with Taiwan. +15 is not a lost of control for a country with almost 24 million inhabitants.

If you look at the situation in South Korea or Japan, I think also that it is early to say that they lost the control. Maybe they had a bad day.

Well, if these countries loose control, I guess we'll go all for herd immunity.

Added : maybe confinement is getting difficult to support for some people and this could create some more infections, but if most of the people are careful, this could be just like I said a few bad days.

Perhaps, I am being unfair.  Both countries have a slim chance of regaining control. But it is a very slim chance. The next two to three weeks will be key. If they follow China’s approach, they could regain control. Otherwise, they have lost.

The same holds true around the world. The US has days to make a meaningful difference. But with the current leadership, there is no real chance that anything will be done to meaningfully alter the course. Italy and Spain are likely beyond the point of no return.

Others have a chance, a slim one as well, to make a substantial difference in the outcomes.

The key in all cases is for the leaders and experts to face the brutal truth, and act boldly in accord with what we now know. I won’t hold my breath for that. (That is an American expression that may not translate well. It means - I don’t hold any hope at all.)

There is a very slight glimmer of something, that the US rates appear to be slowing. The timing is right for this to be a reflection of the stay home efforts. This doesn’t fix anything. It only spreads out the damage, lessening the impact on hospitals (still catastrophic) while increasing dramatically the duration of the economic destruction.

Sam

31
Consequences / Re: COVID-19
« on: March 29, 2020, 08:14:47 PM »
Going through the data this morning, what is absolutely clear is that one nation, and one nation only has done well in fighting COVID-19. That is China. They have shown the way. Will anyone else follow? They have offered help? Will any nation truly accept it?

Taiwan did good, and has now failed. They have lost control and are now on an exponential trajectory.

Japan has likewise now lost control. Their cluster tracing worked to slow things. It failed.

South Korea stomped on the virus spread. They are holding it down as it creeps through their population. They will have to maintain current conditions for years to prevent it from exploding. That is an economic disaster. I do not believe they can sustain that. So they face a choice, do as China did and truly squash the outbreak, or commit economic suicide that eventually allows the virus to run rampant as it does elsewhere with huge death tolls.

There may be a handful of island enclaves that have escaped (so far). Otherwise, the rest of the world is on variations of the same trajectory - disastrous spread, death, and disability as the virus tears through the populace.

China meanwhile has closed their borders. Controlling ports of entry during the next two years or more as vaccines are developed and fielded will be key to keeping the virus out of China.

Before this is done, it now looks like this virus will kill between 1.5% of the populations in countries like South Korea, and 4% of the world generally, except China, as the medical systems are destroyed globally, ERs are overrun, and the ICU treatment fails under the load. I suspect the total ultimate death toll will end up being about a quarter billion, with another half a billion suffering life long disabling injuries that greatly shorten their lives. The US portion of that looks to be about 12 million dead give or take. The toll in Africa may make these numbers somewhat worse.

Also, these are only the direct deaths due to the virus. The indirect death toll from all those who could not get adequate care as the health systems are overwhelmed greatly raise the death toll from the virus. But they will never be counted or accounted for in the totals.

The economic consequences will be horrific. They will last through at least the next decade and likely the next two or three decades. We are entering a global depression. The death tolls that flow from that, from starvation, depredation, famine, and no doubt wars will also never be properly accounted for or attributed to this virus.

And having failed to stop it, the virus will mutate. There may well be some even more deadly variation yet to come in a second or third wave. That too won’t be properly and fully assessed as being the consequence of the failure of leaders the world over.

Sam

32
Consequences / Re: COVID-19
« on: March 29, 2020, 08:02:03 PM »
Dr. Fauci will be thrown under the bus as things get worse:

At 4:30 he advises against wiping packages or merchandise. He hesitates to mention how long the virus can last on surfaces and goes on to downplay the threat. "at least 3 hours" he says. 

B fucking S.

We know the virus can last at least 3 hours in the frigging air and more than 24 hours on various surfaces, particularly at low temperatures. Evidence for that has been shared on this thread many weeks ago.

What does this mean? The risk of contagion in a room accumulates in two ways. The number of people exhaling particles into the room and the time of viability of the particles.

The longer people are inside the room, the more contagious is the room. The longer the particles "live", the more contagious is the room.

Masks and cleaning campaigns reduce both issues significantly. Here he is advising against both, or at least not strongly advising both, as he should be.

 Ask Elon, every little gain count. Masks and cleansing campaigns are not small gains.

I believe Dr. Fauci is an honest man being actively deceived by elements inside the administration to control the narrative and trapped in a cult to the leader that will get hundreds of thousands of Americans killed.

Dr. Fauci is working with an evil megalomaniac malignant narcissist. He is having to shade his professional opinions in egregious ways that are pure bullshit. At the same time, that is allowing him to do some good, such as keeping Trump the terrible from imposing ‘let them die alone’ quarantines in NY, CT and NJ.

https://www.cnn.com/2020/03/29/politics/fauci-trump-quarantine-white-house-discussions/index.html

Personally, I don’t think that is nearly enough good to compensate for the evil. I would far prefer that he went on national media, laid out the truth as best he knows it, and denounced Donald the dumb for the evil bastard that he is.

As it is, simply for showing the slightest human reaction to Trump’s stupidity, the Trump supporters have excoriated Dr. Fauci as being some part of a deep State cabal seeking to discredit their dear leader. Screw then. They are deluded bastards one and all.

Sam

33
Consequences / Re: COVID-19
« on: March 28, 2020, 09:53:04 PM »
EC wrote: " IF and WHEN we have cheap, rapid testing either by Abbot or anyone else, wouldn't you say that the problem is mostly solved?"

Probably not, at this point. Testing and tracing can be very effective steps at the very beginning and toward the end of a pandemic. In the midst of it, as we are now in much of the US and other places, is basically useless...we have to assume that nearly everyone either has it or soon will, so what's the point?

Yes, in medical facilities it would be helpful, and it may be useful to have widespread testing for antibodies soon, to know who has already had it, often without realizing it, and there fore is presumably safe or reinfection at least for a while. But otherwise...not at this point the most important thing to do. The most important thing to do now is STAY THE F*** AT HOME :)

But, as has been pointed out, the very earliest these tests will be available will likely be months away or longer, and yes, by then it may be useful.

Wili,

Remember that they have to manufacture the tests. That takes employees and raw materials. Then they have to distribute them.

The mail and parcel services are run by human beings. They are getting sick too. And they like all of us are afraid for themselves, their families, their coworker's and their customers. They are already stressed to the limit and collapsing, and we have just started the horrible part in earnest.

We haven't yet introduced comprehensive medical quarantine to stop the spread. But Donald the jerk and asshole is already talking about isolationist, cut them off and let them die alone quarantines. Shipping through those barriers will be hard.

Sam

34
Consequences / Re: COVID-19
« on: March 28, 2020, 08:44:33 PM »
Crude, rude, blunt, and my sentiments precisely... you have been warned.
 
Stay the *$&#% at home!

https://m.youtube.com/watch?v=8BA9eTXwGIk&feature=youtu.be

Sam

35
Consequences / Re: COVID-19
« on: March 28, 2020, 12:11:31 PM »
Another thing I have yet to find is any information on is how asthma impacts on people's risks with COVID-19, or how that impacts the course of the disease.

I have several friends with asthma who are very concerned for good reason. Ditto for autoimmune diseases of various types.

If any of you have stumbled on these I would be most interested and grateful to hear what you found or heard.

Sam

36
Consequences / Re: COVID-19
« on: March 28, 2020, 11:49:35 AM »
Johnm33,

Yes - thank you for the graph. Everyone looking at it should be cautious to note the change in scales on the left for the various age groups. The differences are very large.


Sam

37
Consequences / Re: COVID-19
« on: March 28, 2020, 11:46:47 AM »
Maybe a stupid question, but would it be possible to destroy something like the flu ? I have been reading here that it also spreads over animals. But what would be the effect if you could cut a piece out of the chain ? I will give an example. A few weeks ago i needed a document from the doctor. So i went to the doctor. And we were talking a little bit. And at some point he told me that he was using that alcohol gel for 3 to 4 years now. And before he had a cold like 3 times a year. And now not a single time in 3 to 4 years. And that's pretty remarkable. From 3 times a year to zero times in 3 to 4 years. And that only by using some handgel. And now with the coronavirus, the use of that stuff will probably go up in the next years.

Alexander,

It's a good question.

The difficulty is in trying to eradicate flu in wild species that also harbor/suffer from flu virus infections. Even if we could completely eliminate all flu in humans, it would still circulate and mutate in birds (and other animals) in the wild. Beyond birds and pigs, other animals also can and do harbor flu. So eradicating all of the wild sources is nigh on impossible by any means we know today.

What looks more realistic is the development of a vaccine against the seldom changing parts of the viral genome. That has been under development for some time now.

Just as flu circulates in birds and swine, the corona viruses in the SARS group circulate in bats, pangolins, civet cats and others.

There is enough difference in the ACE2 receptors between us, bats and the others that it is harder for the virus to be truly multi species as flu is. So, if we can eliminate this particular SARS variant from all humans, it us likely gone for good.

However, as SARS1 and MERS showed us, this whole group is very closely related, and has the ability to jump species pretty easily. Zoonoses from them to us with recombinations with other viruses are increasingly likely with humans expanding farther into their ranges. This will not be humanities last encounter with terrible viruses from this group.

Interestingly, the terminology needs to change to help change the thinking. We still have a very homocentric view of things. We think of "them" (animals) as being sources for infections to jump to humans. In truth, the virii don't care. The jumps occur between species of all types when opportunity and chance allow. We would be better off to think of it in those terms.

Sam

38
Consequences / Re: COVID-19
« on: March 28, 2020, 11:26:46 AM »
Sam, I hope the best for your friends. This may sound stupid and obvious but it is the only advice I have on this. Have them take vitamin C in any way they can. It is what I use at home. It is not a cure, but I'm convinced it helps me.

Thanks Archimid,

Depending on the form and source, it might. Quercitin is a part of the vitamin C complex in rose hips and others. Quercitin is known to have helped patients with SARS1. And the supercomputer modeling done by the US Department of Energy identified Quercitin, Luteolin and Yerba Santa as three things that had some of the highest affinities for the ACE2 receptor.

Yerba Santa helps me with lung stuff a lot. Most over the counter or even prescription things do not. I lack a series of critical CYP450 enzymes to convert those to their active forms.

As a result I have had to find pharmacognicolgic solutions (plant source rather than pharmaceuticals). For me in general for lung stuff, Quercitin helps. Yerba Santa helps more. Yerba Mansa too. Sage is somewhat helpful. And oregano seems to be very helpful. But that might just be my love of fish tacos with cabbage and lots of green tomatillo salsa that is about half oregano and cilantro. Then too it might be the cilantro. Cilantro and flat leaf parsley have wonderful medicinal properties.

For pain Corydalis Ambigua (Yanhusuo) is great. So are California Poppy, Tree Peony Root, and magnesium as taurate or glycinate, or skin applied magnesium oil (magnesium chloride hexahydrate). These are all hugely helpful for me. Be careful of taurate with kidney issues. That is not an issue for me. Wild Lettuce should be very useful too, though I haven't tried that. Ditto for myrrh and frankincense.

For vitamin C, sodium ascorbate is better for me than vitamin C proper. It's much easier to tolerate. And an extremely high dose blast of that plus natural vitamin A and D stops coughing. Careful with that though, you can hurt yourself if you don't know what you are doing.

I did recommend Quercitin to them. It is widely and easily available, and well tolerated. It has a very short biological half life. I have yet to find literature or reports, anecdotal or studies detailing success or failure of that, and if successful, at what sort of dosages and when those were helpful.

I am not a doctor, and these are not recommendations for anyone but me.

Addenda: Something I have not seen any data on yet is the differences in CYP and related enzymes, and other genetic differences in the people who have survived versus those who died, or in the various treatments. This is a relatively new but hugely important area.  The CYP450 enzymes (and others) are hugely important in affecting the metabolism of drugs in the body. This can and does have dramatic impacts on choices of medications. Yet the vast majority of people have not been tested for their enzyme statuses, and the physicians have not generally been trained in this yet. There are specific exceptions to that.

Likewise, natural variations in immune function can have huge importance, as can the HLA and HNA typing. I have seen no data on that either. One example here is that certain genetic variations allowed some Europeans to survive the Black Death. Their genetic descendants have often inherited that same native resistance. And that also provides huge resistance to HIV.

This is a double edged sword though. Bacteria and Virii adapt as well. Many important autoimmune diseases have as their origin the HLA genetics and this ancient and on going war.

We do know from studies on this outbreak that people with blood type O are considerably less at risk than types A, B or AB. There have been hints about rhesus blood types too, though I haven't seen that confirmed. I have heard nothing at all about the many other blood group families (e.g. Colton, Kell, Kidd, Lutheran, ...) and whether these cause any differences in susceptibility or disease progression.

There was suggestion early on of a dozen snps associated with the ACE2 receptor that might give indications of differences in susceptibility or disease severity. I have not seen any follow ups on that.

Sam

39
Consequences / Re: COVID-19
« on: March 28, 2020, 02:42:55 AM »
Quote
Tonight [White House coronavirus task force member] #DeborahBirx stated that models anticipating large-scale transmission of COVID-19 do not match reality on the ground.

This is simply Bullshit of the highest order. Dr. Birx has destroyed her own credibility. Hopefully her career will now shift to shit shoveler at her neighborhood sewage plant. She can rot in hell with the rest of them.

And as far as Hair Trump wanting the Governor’s to appreciate him. Kiss my ass you son of bitch. You sir desperately need to contract this virus and experience everything it has to offer to the bitter end.

The Guardian gets it right.

https://www.theguardian.com/commentisfree/2020/mar/27/trump-narcissism-american-blood-coronavirus

Sam

40
Consequences / Re: COVID-19
« on: March 27, 2020, 09:53:20 PM »
Worldometers reporting Italy posting 919 deaths today, eclipsing previous daily high of 793 six days ago.

After shutdown begins the infection chains are mostly broken except for home infection. Hopefully, this is the last wave before the quarantine yields the expected results. I pray they are using as many masks as possible and have a good plan to restart the economy while testing and quarantining like crazy.

Looking at the data — self isolation is NOT working.

Quarantine, real quarantine is required.

Sam

41
Consequences / Re: COVID-19
« on: March 27, 2020, 09:22:56 PM »
USA hits 100,000 cases
https://www.worldometers.info/coronavirus/


Woo hoo!  American exceptionalism! We’re #1, We’re #1, We’re #1!!

What do you mean that’s a bad thing?

We need some structural changes to encourage different behaviors - lots of them. One such: all unattended deaths not from homicide or attributable accident are assigned to the Hospital or medical clinic whose district it is. Period. Rate the maximum of what the administrators are allowed to be paid by that rating.

No throwing people out, curbing them, or dusting them off to other places or institutions. One instance of that as CEO or COO and you get fired and fined $500,000 personally. On a second instance, jail and barred from life from ever serving as a corporate officer AND the Board of Directors and all other corporate officers get fined $500,000 personally. Third instance, all corporate officers and members of the Board get jail sentences and are barred from ever serving as an officer or Board member in any organization of any type - for life.

Etc...

Sam

42
Consequences / Re: COVID-19
« on: March 27, 2020, 08:47:31 PM »
I heard from my friends.

Despite being at day 8 of showing symptoms, running a 102.5 F fever, being short of breath, coughing like crazy; they were told that they aren’t sick enough yet to go to the hospital!

Welcome to the once great now failed United States of America’s, where we have an illness profit system, that occasionally accidentally heals people.

Sam

43
Consequences / Re: COVID-19
« on: March 27, 2020, 07:08:28 PM »
Long time lurker, first post.

Good overview and summary of papers up to date, commenting on their strengths and weaknesses.

COVID-19: Describing a new disease (Meyerowitz & Richterman)
MGH Division of Infectious Diseases

Harvard Joint Infectious Diseases Conference
March 25, 2020



Twitter:
https://twitter.com/AaronRichterman/status/1242811276763582464

Slides: https://docs.google.com/presentation/d/1shQ8m7kX2qFyj6PByY_DxM37fcyxLjSBojmTpFJN4kU/edit#slide=id.p

Bonus to anyone who can find the HHS/Emory presentation they mention at the end.

Sigma_squared and Neven,

Thank you !!!

Huge amount of excellent information summarizing major findings from almost 2,400 preprints and papers.

My take aways:

1) Finally we may have some information to begin to assess admitted CFR versus population level FR. From one paper re: Wuhan, population level FR ~1.4%, admitted CFR known separately for this population is about 4.2%. This suggests roughly a 2/3rd to 1/3rd ratio of carrier transmission without admission (symptomatic or not) outside of admission to admission.

Separately I learned yesterday of a study in Iceland using IgG that suggested a 50%:50% ratio. But from this presentation, IgG is not a good indicator. IgM is better.

Addenda: You CANNOT use the simple deaths/confirmed ratio to get a meaningful CFR! We’ve gone over this. During the exponential phase of the disease this drastically underestimates the true CFR. Using that as the CFR is at best wishful thinking and an incredible and dangerous bias.

2) Chloroquine is not a good choice for treatment. It seems to be ineffective. Hydroxychloroquine (HCQ) appears to be slightly effective. HCQ combined with a azithromycin (tradename Zithromax) is effective. Azithromycin in addition to being an antibiotic has very positive impacts on lung function.

3) For critical patients requiring ventilator support (at least) ... tocilizumab (an IL-6 drug used for rheumatoid arthritis) in a very limited study appears to be highly effective at terminating fever and restoring the patients with ultimate release from hospital. This group tends to proceed to death. The 400 mg dose they cite if paid for out of pocket runs about $2,350 in the US. All things considered, that is a bargain.

4) There is still a great deal of uncertainty about assessing asymptomatic versus presymptomatic. So it is premature to overgeneralize the 1.4% FR. Hopefully that is correct. But we shouldn’t bet the bank on it yet.

If we apply that to the entire US population of 340 million, with 90% contracting the disease over the next many months, we are looking at 4.3 million dead. Add the hospitals going far into over-saturation which increases the CFR for that population to possibly as high as 12%, and the combined result is a terrifying 11.4 million dead - 1 person in 30. Note: this entirely excludes the compounding add-on effect of every other type of critical care patient being impacted by the ICU beds being full. A large percentage of those patients will now die as a result. Those deaths though not from COVID are directly caused by impacts from the failure to quarantine and limit this disease spread.

Addenda: Note please that the vast majority of these deaths will occur during a ~ one to two week period at the end of April and beginning of May. If there is no positive change toward massive quarantine, we are headed for an incredible blood bath in a fortnight. If instead President dumb-ass does as he suggests and directs the lifting of quarantine, AND the Governors go along with that, the number who die will double or worse.

If on the other hand, we instituted a truly effective mass quarantine for 6 weeks with comprehensive testing, contact tracing, and isolation - we might limit that to 25-50,000 dead. But that would have to be implemented today and be truly comprehensive.

Addenda: The above presumes that the current testing captures the current state of affairs. With the grossly inadequate and incredibly slow reporting of test results in the US, I have understated the low end risk. It is most likely that the lowest death count we could achieve with immediate mass quarantine is 10 times these numbers - a quarter to half a million dead.

With use of the two known treatments that are apparently affective, these numbers could be reduced farther saving a whole lot of lives.

Final take away: The complete and utter failure of Donald Trump, Mike Pence and their cadre of miscreants will in all likelihood cost 5 to 13 million Americans their very lives. These people have bucket loads of blood on their hands.

Addenda: IF YOU HAVE NOT ALREADY SELF-ISOLATED OR GONE INTO QUARANTINE, DO IT NOW! PLAN TO BE ISOLATED/QUARANTINED FOR NOT LESS THAN 10-12 MORE WEEKS! Do not plan to be out of isolation until Father’s Day. And that is if things go well. Good luck to us all. We are going to need it.

Sam

44
Consequences / Re: COVID-19
« on: March 27, 2020, 07:25:58 AM »
Terry,

No down side. I am now having to advise friends who have tested positive and who are running 102.5F fevers to bloody well get to the hospital.

There are vastly more people symptomatic in the US than the confirmed numbers show. The US is in the deep end of the muck. Trump brought the swamp to DC with him, and his swamp creatures are killing us.

Sam
Should they go to protect the others in the family, or to get treatment? I feel that I'd be better home than in an overcrowded hospital.
Etienne

They are at day 7 showing symptoms that may rapidly degrade into ARDS. They are in their late 60s. The next three days are critical.

Based on clinical reports, their lungs have likely been shredded by the virus greatly reducing their lung capacity. The deep lung areas are likely filling with fluid as well. And heart and/or kidney issues may be involved. I am not a doctor. I couldn’t and wouldn’t begin to try to assess any of those.

At this point some of the handful of known meds that have been shown to help may be needed. Remdesivir, ...  the only chance they have for those is in critical care. Over the next three days, either or both of them may need to go on a ventilator. Those are in critically short supply. They are needless to say quite scared.

Another friend on the other side of the country in Portland, Oregon visited a friend. They met for ten minutes, no contact. The next day her friend began showing symptoms. A couple of day’s after she did as well. Her friend has now been confirmed positive, yet she hasn’t been able to get tested. She is apparently about day 4. Classic symptoms plus a splitting headache. Worst she’s ever had by far. Scared. Terrified actually.

This is a terrifying disease. Do not underestimate it. It spreads easily and rapidly without contact from people with no symptoms. 

And what is the great moron doing to help? He’s telling Cuomo he doesn’t believe he needs all the ventilators Cuomo says New York needs.  The great manipulator, conman extraordinaire is far out of his depth. Soon he will have blood on his hands. The time has come for both he and Pence to resign and let others lead the nation out of this catastrophe. Donald Trump is a failure. Mike Pence is every bit as bad and equally guilty.

Sam

Addenda: Tomorrow is the big day in Trump’s failed pResidency. The US will exceed 100,000 confirmed cases. Resign bastard. Resign now.

45
Consequences / Re: COVID-19
« on: March 27, 2020, 04:26:02 AM »
3 principal strategies to fatten the curve:

1. Propaganda. Without it Trump fanatics might lose sight of the carrot.  "it's just like the flu" and "but, but, but, the economy" does the trick. Soon you have people wanting to get it to please their emperor

2. Botched testing. testing leads to contact tracing which could have stopped the disease without much fuzz but it would have hurt the market for a bit.

3. The most important part of the plan to fatten the curve. No masks. Mask would have slowed the spread to a crawl, and even let the economy keep going.

The three things above would've saved a lot of lives but it might have lasted many months, perhaps all the way to election day. Nope, that was too slow. Fatten the curve.

Sure they are sending ventilators. Sure they'll make a hospital here or there. But keep spreading as fast as possible so that we are done by April, regardless of the body count.

What a disastrously stupid plan.

Oh I see ... fatten the curve. Trump’s always had a very short attention span (goldfish short), and he only ever hears what he wants to. That explains a lot.

He likes things to be fattened. He doesn’t like things that are flattened. So, of course he heard fatten. Wow. That really does make it so clear now. Thanks Archimid. You’ve cracked the code and solved the great mystery behind the administrations COVID policies.

Sam

46
Consequences / Re: COVID-19
« on: March 27, 2020, 02:57:01 AM »
Terry,

No down side. I am now having to advise friends who have tested positive and who are running 102.5F fevers to bloody well get to the hospital.

There are vastly more people symptomatic in the US than the confirmed numbers show. The US is in the deep end of the muck. Trump brought the swamp to DC with him, and his swamp creatures are killing us.

Sam

47
Consequences / Re: COVID-19
« on: March 26, 2020, 10:48:18 PM »
South Africa : 402
Egypt :  327
Algeria : 201
Morocco : 134
Burkina Faso : 99
Tunisia : 85
Senegal : 67
Cameroon : 56
Nigeria : 36
DR Congo : 30

3 days ago, it's not going in the right direction.

South Africa : 927
Egypt : 495
Algeria : 367
Morocco : 275
Tunisia : 200
Burkina Faso : 152
Ghana : 132
Senegal : 105
Cote D'Ivoire :96
Cameroon : 75

That puts South Africa at a 1.32x/day growth in line with the EU and US. Egypt by this data has a much more leisurely growth rate of 1.17x/day.

Sam

48
Consequences / Re: COVID-19
« on: March 26, 2020, 10:22:13 PM »
Weekly expert survey in the USA:

https://fivethirtyeight.com/features/experts-say-the-coronavirus-outlook-has-worsened-but-the-trajectory-is-still-unclear/

Quote
How many people will die in the U.S. due to COVID-19 this year?

The expert consensus is that COVID-19 will cause 246,000 deaths [in the USA] in 2020, higher than last week’s estimate of 200,000 deaths. The consensus estimate ranges, though, between 36,000 and 1.1 million. That’s quite a span

...

How many total COVID-19 infections were actually in the U.S. on March 23?

The expert consensus is that the real number of cases [in the USA] was somewhere between 83,000 and 1.8 million, with 362,000 being the most likely number.  In other words, they thought that only 9 percent of all cases had been reported

Steven,

—— for the US ——

With just two additional days of growth at the current growth rate of 1.31x/day, plus 12 days from infection to confirmed count status and a 5% death rate of those confirmed (who definitely are a part of the CFR analyzed group), and taking the yesterdays confirmed count today as 83k - the death toll is 180k.  I choose 5% not 4.5% as we are already seeing hospitals going into saturation. That is an under estimate already.

There is no way any additional controls are likely in the next two days that will mean anything. Instead Trump is trying to assert control to go the other way - to less restrictions. 12 of the 18 “experts” predict a death toll for the year of ~180k or less. So they are wrong and we can discard them from further consideration.

If we have just seven more days with current policies rather than two, so through next Thursday, then the committed death toll is at least 700k. That then exceeds the remaining six “experts” opinion. And we can discard them as well. There is zero chance that we will go into a total lockdown quarantine in the next week.

So then, just how much is this “expert” opinion worth?

Sam

Addenda. Even if the growth is actually slowed to 1.25x/day in the US, that just adds 5 days to reach 180k dead, and another 6 to get to 700k dead.

49
Consequences / Re: COVID-19
« on: March 26, 2020, 09:39:46 PM »
Since when have people decided that only old people die from COVID-19? Are we scientists or not?
It's all a question of percentages.
South Korea statistics are quite accurate as they have done extensive testing, also of asymptomatic cases, and their hospitals were not overwhelmed. So these are very reasonable to optimistic stats. Please bear in mind many cases in SK have still not resolved, so death rate could still go up even under these assumptions.
They show roughly (see image for stats updated to March 16):
0.1% for ages 30-49
0.4% for 50-59
1.4% for 60-69
5.3% for 70-79
9.2% for 80+

These may seem like negligible percentages but multiplied by big numbers they add up to hundreds of thousands. Actual CFRs may vary based on luck, medical know-how, prevalence of preexisting medical conditions, general health of the population. Total case counts and transient case loads will vary based on quarantine and other policies.
My little spreadsheet says over 2 million dead expected in the US, assuming 70% total infection rate and using SK CFR. I think that's quite a lot of dead people.
Add hospital overwhelm and deaths could easily double or triple or even quadruple, depending on infection patterns and management strategy.

To all, make your own assumptions as you please - but please don't throw numbers around without calculating them based on your assumptions.

https://www.statista.com/statistics/1105088/south-korea-coronavirus-mortality-rate-by-age/
https://www.statista.com/statistics/241488/population-of-the-us-by-sex-and-age/

Oren, those numbers would be correct if 70% of the population contracted the virus.  Using the same South Korea numbers, slightly less than 0.02% of the total population contracted the virus.  Total case are on the decrease in South Korea, with active cases 30% below the peak number two weeks ago.  All told, the peak number of cases occurred four weeks after the virus started spreading rapidly.  Using the South Korea infection rate would yield substantially fewer deaths.  By comparison, Italy is on pace to reach ten times the infection rate of South Korea (it currently stands at 0.12%).
Thanks for the response.
So what is your own estimate for the total infection rate expected in the US? 0.1% 1%? 10%?

Remember please that the percentages Oren cites are from reputable literature, BUT that study was based on a 2.3% CFR for the population. We know that the CFR for the hospitalized population is double that. So - double ALL of the numbers in the table.

I admit my guesstimates at the moment are very probably at the high end. Normally, I would not go there. But in this case, we have two dominant factors that make things vastly worse.

First, there is a significant portion of the science community including the epidemiologists who are under representing the hazard of the disease in terrible ways. They under-represent the CFR by a factor of 2. And the under represent the R0 by a factor of 3-5. That is a horrible combination of errors.

Second, we have leaders who take those estimates and then downplay them dramatically. They want to stay in their own mental box of beliefs. They are at best in denial. At worst they are in malignant malicious criminal denial. (e.g. let the old folks die, the economy is more important).

These combine with an understandable desire by many to believe that there is a large pool of uncounted people who have mild symptoms throughout and that because of them the fatality rate is not just less, but dramatically less than the CFR. A part of this no doubt came from early modeling estimates that suggested such things. A part is no doubt also from a natural desire for bad things to not happen. Desire is not reality. Looking away, wishing away, hoping away not only will not work, they will in point of fact make things much much much worse and very quickly so.

In emergency response, leaning toward those sorts of things is a grave danger. The reality may cover a range from there to the far other end. With exponential growth, the place to be is not at the low end, nor even at the mid point, but instead to target closer to the 95% UCL of the likely outcomes. Only by doing that can we assure that the horrible outcomes do not happen.

Doing otherwise runs grave risks of truly catastrophic outcomes.

What we have been seeing in Italy, and now Spain, and soon the US is exactly that - catastrophic outcomes.

So where is reality? We do not and cannot know that yet. The data isn't good enough. It seems to lie well above the midpoint of potential scenarios.

Another factor that many seem to forget is that in the earlier stages of the disease spread (the first 1/3rd to 1/2 - which we are still in), with exponential growth, there is a huge non-seen part of the infected population who have become infected, but who have not yet shown symptoms, let alone reported to hospital. It may well be that it is this majority of the infected population that the models suggested, not a separate infected and unseen part of the population. I.e. The problem is temporal not structural.

For the US, I suspect that the most likely death toll will be about 5 million. I cannot see it being less than 1 million. The high end is likely 25 million.

The high end comes about from presuming that there is not some large unseen portion of the population that never shows anything other than mild symptoms and is never tested; plus presuming the 4.5% CFR is accurate and representative for the hospitalized portion (who then represent everyone); and that half of those requiring intensive care die as a result of the collapse of the hospital systems when they become over run. That last part adds about 7.5% to the CFR of 4.5%, hence a 12% death rate. Italy is already seeing close to that. And they aren't through the worst of it yet.

The US continues to scream upward in the numbers infected with an average growth rate of at least 1.31x/day. That is an R0 of about 7.5 - vastly higher than the 2.4 used in most models.

That growth rate is easily understandable from human behavior. I now have friends who have tested positive and are in quasi-quarantine. One pair of them showed symptoms six days ago and tested positive yesterday. Yet it isn't until today that they have reduced going to market, stores, seeing clients, patients etc... For the last six days they have been spreading the virus. Even now, they are not in strict quarantine. They are not at all alone in behaving this way. These are intelligent people. And still...

During disasters with the potential for run away it is essential to err toward the high the end - far toward the high end. This isn't a matter of being accurate in prediction. This is a matter of saving lives. Doing anything less has a huge probability of costing lives and causing disaster. And with that comes immense economic impacts and hardships, impacts and hardships that go far beyond the short term analysis.

History is replete with examples: Bhopal, Seveso Italy, Michigan Bromine, Chernobyl, Fukushima, to name but a few. Each of these shared a common failure to understand this key tenet of emergency response, with absolutley catastrophic consequences. An infectious disease is a worst case example of this. It doesn't just run away of itself, it is infectious and contagious and exploits us to make things incredibly vastly worse and harder to control. Add to that all of the myriad of usual human weaknesses, failings, belief systems, desires, and it is a wonder these sorts of pandemics don't come around more often.

Sam

50
Consequences / Re: COVID-19
« on: March 26, 2020, 08:51:20 PM »
Social distancing and quarantine should be reducing the number of "Influenza like illnesses", car accidents and work-related deaths. 

It is sad that the world has a leadership vacuum. This is the perfect moment to irradicate influenza. If we can get away from this whole mess with influenza eliminated, whatever economic losses were incurred will be made up for a long time gains of eliminating influenza.

Unfortunately - no.  Colds from the corona virus family - Yes.

Flu is a multi-species disease. It exists in birds and pigs especially, and cycles between them and us. We learned back in the 1970s that the seasonal start of flu originates from birds defecting as they fly south down the flyways. Then it spreads among people. The birds re-aquire it, circulate it and fly north again sharing with others in the massive breeding grounds, to then fly south the following year to other parts of the world.

Large pig farms play a roll too. The pigs harbor the virus and it mutates in them along with us and the birds. With multiple strains running at all times, the strain recombine and new versions and variations develop from that and from the usual slow mutation of the viruses.

We will not be able to eradicate flu until we can find a way to eradicate it in birds. Then there is a chance. Until then - no.

Sam

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