Month: July 2020

Oshkosh (EAA AirVenture) would have started today

by philg

Pilots of homebuilt, antique, and retired military aircraft would have been gathering in Oshkosh leading up to today’s official opening of EAA AirVenture.

The event, of course, would have been shut down by the governor even if the organization had tried to proceed. So we’re left with memories from last year. Here’s Bo Feldman, age 18, who made it to Oshkosh, Wisconsin by powered parachute…. from Florida!

Who wants to bet on whether coronapanic shuts down Oshkosh 2021? (WHO: “I would say in a four to five-year timeframe, we could be looking at controlling this.”)

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How are Florida and Texas (“New Sweden”) doing with coronaplague?

by philg

Perhaps due to the persistent refusal of Swedes to go into the ICU and die from Covid-19, despite two months of hysterical predictions and headlines, Florida and Texas seem to be in the news daily with dramatic “spikes” of “cases” (i.e., positive tests).

Given the drumbeat of media coverage, I would expect that most people in FL and TX are actually dead as of today. Yet, this dashboard from Texas shows that not many are even hospitalized:

The 10,658 hospitalized (in a state of 29 million) might include some folks who are actually suffering from something else, primarily, but happy to test positive for Covid-19?

Science tells us to expect an exponential growth process on a finite planet. The virus will never run out of suitable hosts, for example. Yet Texas, after weeks of “spiking” and exponential growth in positive tests, seems to be on a plateau as far as hospitalizations are concerned. Could it be that the plague is actually near a peak right now in Texas?

Florida, a state of 21 million, had 87 deaths reported yesterday, a somewhat higher rate than in Maskachusetts, which we are told has done a fantastic job of getting the virus under control (17 deaths reported yesterday in a state of 7 million).

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Irish Hedge Schools can be the model for 2020-2021 American K-12?

by philg

What if the License Raj in a U.S. state makes it illegal to operate K-12 schools once again, as was done in most states back in March? Could American rebels reboot the Irish hedge school tradition? From Wikipedia:

Hedge schools (Irish names include scoil chois claí, scoil ghairid and scoil scairte) were small informal illegal schools, particularly in 18th- and 19th-century Ireland, designed to secretly provide the rudiments of primary education to children of ‘non-conforming’ faiths (Catholic and Presbyterian). Under the penal laws only schools for those of the Anglican faith were allowed. Instead Catholics and Presbyterians set up highly informal secret operations that met in private homes.

Historians generally agree that they provided a kind of schooling, occasionally at a high level, for up to 400,000 students by the mid-1820s. J. R. R. Adams says the hedge schools testified “to the strong desire of ordinary Irish people to see their children receive some sort of education.” Antonia McManus argues that there “can be little doubt that Irish parents set a high value on a hedge school education and made enormous sacrifices to secure it for their children….[the hedge schoolteacher was] one of their own”.

While the “hedge school” label suggests the classes took place outdoors (next to a hedgerow), classes were normally held in a house or barn.

From my rain-soaked May/June 2019 trip to Ireland:

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Anniversary celebration on Facebook

by philg

A recent Facebook post:

(Text: “15 years ago today my then-wife demanded a divorce. I think it shocked her when I walked out of that house a few minutes later, never looking back. Much was lost in that moment. Much was gained.”)

Representative comment:

We’re all here to learn! I know you’ve learned a lot and have had another chance to be a wonderful husband and father!

I have had a chance to talk to this guy in real life a bit. He is unaware of whether the wife-turned-plaintiff is dead or alive. He also hadn’t spoken with a child from that marriage for many years and was unaware as to whether the child, who would have been an adult at that point, was dead or alive. (The former life was in a different state.)

When we interviewed people for Real World Divorce, the defendants who moved to different states or countries and rebooted as though the marriage had never occurred did seem to have recovered the best from being attacked in family court. But I think this is an extreme example of being “present” as the Buddhists would say.

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Republicans could win in November if they gave Americans universal health insurance?

by philg

In September 2009, I wrote “Health Care Reform”. Essentially the government would take the $trillions being spent on Medicare and Medicaid and put it into buying every American a reasonably good HMO policy.

  • each resident will be given a voucher good for signing up at the clinic or HMO of his or her choice; the amount of the voucher will depend on the resident’s age and sex (the weighted average of all vouchers will equal $2,000 or whatever we’ve decided we want to spend)
  • a clinic or HMO that wishes to get any revenue from the federal government will be required to take any person who submits a voucher, regardless of preexisting conditions
  • a resident of the U.S. can switch clinics annually, let’s say on May 1.
  • the clinic is responsible to pay for the resident’s emergency medical care at another facility

A note:

One likely side effect of this reform is the return to centrality of the primary care physician. Joe Medicare Patient often does not have any doctor who understands much less coordinates his care. If Joe has seen six specialists, he may be on drugs that are working at cross purposes. If Joe is in the ICU at a typical hospital, the multiple doctors treating him may never talk to each other. Each one knows what tests and procedures he or she has ordered, but, except by looking at the patient’s chart, has no idea what the other doctors are investigating. One primary care doctor who reviewed this proposal said “The first item I address with new patients in my office is to try to get them off as many drugs as possible; when a 70-year-old is on 11 meds you better believe there are many unintended interactions.”

How has this aged and what would be different during coronaplague?

Americans want, most of all, for the Great Father in Washington to love them. “Trump, like Herbert Hoover, is ‘the man who doesn’t care.’ Biden can make that stick.” (USA Today, June 28):

Most of all, Trump is the man who doesn’t care. He doesn’t feel your pain. He doesn’t mourn the dead, comfort the grieving, or support the struggling. He doesn’t consider his words or worry that they could have consequences. He doesn’t listen to experts or ponder his options.

Congress is almost finished with its “work” for this session. If the Republicans want to win in November, why not make Americans feel that the they are loved and cared for? We don’t care about money anymore, right? We are happy to spend 100 percent of our accumulated wealth hiding from coronaplague if that is what it takes to cut the death toll slightly. We are happy to print and borrow trillions. A universal HMO policy for every resident of the U.S. wouldn’t have to cost any more than the current bleeding for Medicaid and Medicare plus whatever employers pay for mid-range coverage.

Will anyone, other than folks in the industry, miss the current system? A couple of recent news items:

At least to judge by my Facebook feed, Americans are convinced that, despite the lack of any effective therapy for Covid-19 and despite the fact that the Feds pick up the tab when the uninsured are treated for Covid-19, universal health insurance would hugely cut the number of Covid-19 deaths.

Readers: What do you think? Could Trump and the Republicans take most of the wind out of the Democrats’ sails with one big health care hand-out? (of course, all of the money for this would just come from taxpayers themselves, but somehow Americans never seem to consider that they will ultimately have to work for whatever the government “gives’ them)

Bonus pictures of the house that Medicaid and Medicare built, in Nome, Alaska, from September 2019. This single building is likely worth more than all of the rest of the houses and commercial real estate in the city.

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Department of Extrapolation: Masks worked in a hospital…

by philg

… so they will definitely work in the general population.

“Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now” (JAMA) says masks worked in the hospital:

In the largest health care system in Massachusetts with more than 75 000 employees, in tandem with routine symptom screening and diagnostic testing of symptomatic HCWs for SARS-CoV-2 infection, leadership mandated a policy of universal masking for all HCWs as well as for all patients. The authors present data that prior to implementation of universal masking in late March 2020, new infections among HCWs with direct or indirect patient contact were increasing exponentially, from 0% to 21.3% (a mean increase of 1.16% per day). However, after the universal masking policy was in place, the proportion of symptomatic HCWs with positive test results steadily declined, from 14.7% to 11.5% (a mean decrease of 0.49% per day). Although not a randomized clinical trial, this study provides critically important data to emphasize that masking helps prevent transmission of SARS-CoV-2.

Therefore, masks will send coronaplague packing:

First, public health officials and leaders need to ensure that the public understands clearly when and how to wear cloth face coverings properly and continue building the evidence base for their effectiveness. Second, although cloth face coverings are generally well tolerated for short periods, with prolonged use they can be irritating or difficult for some people to breathe through, especially in hot or humid environments. Innovation is needed to extend their physical comfort and ease of use. Third, the public needs consistent, clear, and appealing messaging that normalizes community masking. At this critical juncture when COVID-19 is resurging, broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19.

The apparent contradiction between the bold-faced portions is not addressed.

[Potential bad news for American Karens: “It is probably safe for individuals and safe for others to drive alone…without a face covering,” (see this instructional video)]

So… the Swedes and the World Health Organization (advice through early June) are wrong about masks for the general population being effective in reducing plague? How might we be disappointed a few months down the road if we rely on this article?

  1. In a hospital people don’t have any real choice about how far apart to stand (similar to public transport). So the donning of masks won’t lead people to change their “social distance” (risk compensation and see also “Why is Sweden still not asking people to wear face masks?”).
  2. Each hospital worker has been fitted for an N95 mask (choice of at least 6 different styles) by a professional fitter.
  3. Hospital workers dispose of the masks between patients or at the end of each day. Hospital workers have access to handwashing and hand sanitizer within a step or two.

When you look at two members of the general public in a grocery store, none of the foregoing applies. Hospitals and doctors’ offices here in Maskachusetts seem to recognize this. If you need to enter one of these buildings you will be required to put your saliva-soaked face rag back into your pocket. Then you will be required to use hand sanitizer or soap and water. Then you will be given a brand-new clean paper face mask to wear. The bandana that protects society from the plague going exponential is not considered worthwhile protection inside the hospital.

Department of Sweden is still right (Karen Philip’s favorite department!): the Swedes give out free clean masks when people are getting on public transport.

Separately, if it as easy as the Mask Karens say to eliminate a virus by putting masks on the general population, why didn’t we use this technique to eliminate influenza, which has killed literally millions of Americans during my lifetime?

(What’s the downside of relying on masks? If we put our faith in masks and then, a few months down the road discover that they aren’t effective for the general population, that delays the measures that we actually need to take, e.g., moving more activities outdoors under shade structures, decluttering retail environments, having crowded high schools rent empty big box stores so that students can be spread out more.)

Bonus: allegorical photo showing the fate of those who don’t wear a mask, from the old fishing hamlet of Helgumannen. Faro, Gotland.

and another one… (Langhammars. Faro, Gotland)

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Test and trace in Virginia (8 days of patience required)

by philg

I recently spoke with two attorneys from Charlottesville, Virginia. They wanted to get tested for active coronaplague in preparation for a family reunion that included some older relatives. One is employed by the state and therefore both have absolutely top-of-the-line health insurance.

“Most of the places we called said that we couldn’t get a test unless we had symptoms,” said the wife. “We did finally find a place, but they said that the results wouldn’t be available for 8 days.”

Maybe things are better in Maskachusetts? Cambridge was offering free testing for residents and, by July 8, the entire month of July had been booked (i.e., the wait to get tested and then receive a result would be at least 25 days or so).

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Why aren’t there good fish tank cameras? (underwater in the aquarium)

by philg

Public aquariums have webcams, e.g., from the Georgia Aquarium (funded by Home Depot founder Bernie Marcus and reopened, unlike our aquarium here in Boston).

What about for hobbyists? We should be able to buy a product that goes into the tank, gets power from a USB-C cable, and transmits video back up the cable to a wall wart that then pushes the video up to a server or at least a local computer. This is basically the same hardware as in an $85 Ring Stick Up camera, right, but cracked into a couple of pieces and a little more waterproofed?

Why doesn’t this product exist? Why can’t our fish “go live” on Facebook without a lot of custom engineering?

(And, no, it wouldn’t be acceptable to have a camera on the outside of the tank due to algae growth. Nor is it easy to find that kind of product already packaged up!)

(above: Atlanta’s Georgia Aquarium)

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Are Florida and Texas good natural experiments in the effectiveness of masks?

by philg

Given what I have seen of mask usage in practice, I do not think they will be helpful in the U.S. except maybe to delay infections by a few weeks. I agree with the Swedes and the WHO that this is likely to be a multi-year experience with the coronavirus. And there will likely be another similar virus right behind this one. So I think we would slow down viral spread more effectively by restructuring our physical environment so that it isn’t relevant whether people are using a bandana improperly (or wearing a mask with an exhaust valve, which I see regularly among the righteous of Cambridge), etc. More stuff could happen outdoors under shade structures, for example.

rickduncanlive.com: Hey! Linus dropped his security blanket. Maybe ...

I wonder if the mask is like Linus’s security blanket in Peanuts. People like to believe that they can control their fate. We hear that someone died of cancer and ask “Did he smoke?” The person is dead so it shouldn’t matter, but we want to know because we want to be assured that we won’t be killed by a random cancer and that we can extend our lives by clean living. The “science” as of March (and through early June at the WHO!) was that masks wouldn’t protect 8 billion humans from spreading coronavirus. But we didn’t like that answer so “science” gave us a new answer. It is highly comforting because we are controlling our fate, not living or dying depending on the whims of the virus and the accidents of geography (Maine versus Massachusetts, for example, a 14:1 difference in death rate).

Like most people, I hope that the universal mask laws can have some beneficial effect. But I fear that we are setting ourselves up for yet another disappointment and we will whip ourselves for not doing a good enough job. Yes, we wore masks, but too many of us did so without covering our noses. Yes, we wore masks, but that led too many of us to abandon the 6′ social distance. We wouldn’t have had a death rate comparable to Sweden’s if only we had…

This is kind of like the difference between Greek/Roman religion and Christianity. If the barbarians attack and burn your Greek/Roman city, you say “That was a terrible experience, but the gods are capricious sociopaths so we will just have to rebuild as best we can.” If the same thing happens to a Christian, he/she/ze/they must say “God is benevolent and omnipotent, so it must have been our wickedness that led to this bad outcome.”

I wonder if there is a mask experiment happening for us right now. Massachusetts and New York had a big surge in infections and then deaths back before any mask laws went into effect (May 6 here in what is now “Maskachusetts”). Florida and Texas have come out of shutdown. They are pretty well masked. We would expect the arc of the epidemics there to be less dramatic than in NY and MA due to (a) a bunch of restrictions still in place, e.g., no mass gatherings, (b) nursing homes much better protected than in MA or NY. But is the arc yet more attenuated in a way that we can perhaps attribute to Floridians and Texans being under mask orders?

Related:

  • “Flu Masks Failed In 1918, But We Need Them Now” (HealthAffairs): In 1919, Wilfred Kellogg’s study for the California State Board of Health concluded that mask ordinances “applied forcibly to entire communities” did not decrease cases and deaths, as confirmed by comparisons of cities with widely divergent policies on masking. … Second, the review of practices in 1918 demonstrates masks must be worn correctly and consistently, fully covering the nose and mouth, with sufficient layers to prevent the spread of droplets. Advocates for masks in 2020 can use this historical lesson to argue that masks must be worn properly, or they will not achieve their objectives. [Summary: this time it is different and Americans will be as good at using masks as surgical nurses]
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