A posting every day; an interesting idea every three months…
Suppose that you’re slightly fatter than the ordinarily chubby American (average BMI of 27, which is “overweight”). Maybe your BMI is 28.5, for example. Would it make sense to chow down at illegal holiday gatherings this year in hopes of hitting an “obese” BMI of 30? At that point, you could get priority for the COVID-19 vaccine.
Full post, including commentsTo the Swedish MD/PhDs, e.g., Johan Giesecke and Anders Tegnell, most of the world’s reaction to coronavirus is irrational panic. To the Karens with whom I am friends on Facebook, hiding in a bunker while waiting for the next batch of governors’ orders is an entirely rational, even “scientific”, response to a disease that has killed a significant number of people.
I wonder if we can look at how Americans respond to influenza as a way to determine how much of the COVID-19 shutdown is rationally motivated.
Influenza kills 80,000 Americans, mostly elderly, in a typical “bad” year and up to 225,000 (population-adjusted) in an exceptional year, such as 1957-58. Influenza infection can also leave victims with serious long-term health effects, such as impaired heart function. From the CDC:
Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.
So let’s says that COVID-19 is 5X as bad, for both lethality and long-term effects on survivors, as a bad flu.
What happens when the flu season arrives in the U.S.? Do we shut down schools in communities where flu is “spiking”? Do young healthy adults don masks, saying that though they aren’t at risk they want to protect the elderly? Do people work from home whenever they’re able to? Do we establish any limits on retail or restaurant capacity, ban indoor dining, or limit hours?
In my experience, the answer to all of the above is “No.” From what I have seen, Americans tape up “It’s flu season; wash your hands” signs in a few places and continue with life as usual.
A rational and consistent group of humans, therefore, would respond to COVID-19 with something like 5X the actions taken during flu season. We would see 5X as many “wash your hands” signs. Children who lost 3 minutes of schooling during flu season (time spent washing hands instead of studying) would lose 15 minutes of schooling during COVID-19. Or maybe two windows would be opened in every classroom and mixing of students in the cafeteria would be curtailed in favor of lunch at desks. Instead, the reaction is 120X. Children lose 360 minutes of schooling (school entirely shut down) per day rather than 3 minutes. Children lose their social life, playgrounds, etc.
The same analysis could be done for adults. If they’re hiding in their bunkers 5 days per week currently, that would be consistent with their flu season response if they had previously hid 1 day per week during flu season.
Our universities are always in the vanguard…
From the above article, the 20th century’s best ideas are alive and well:
Typical penalties include writing letters of apology, performing community service projects, meeting with advisers, and completing educational research papers about public health—not to mention the shame most feel after having been shown to have placed their fellow students at risk.
Readers: Does the above way of looking at coronapanic make sense?
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A variety of friends on Facebook (mostly identifying as “women” and in their 50s) have been posting their concern regarding the wicked Swedes running out of ICU capacity, implicitly due to their failure to don the Church of Shutdown’s hijab and continuing to run (unmasked!) schools for everyone under 16.
(For the first time in the year since Covid-19 reached the U.S./Europe, the Swedes have some real restrictions, e.g., movie theaters and similar large “public” gatherings are shut down; our Swedish helicopter instructors says that his mom’s hair salon has been open continuously, however, and remains open. His parents still don’t own a mask. They would be discouraged from hosting a party for 30 people at their house, but it would not be illegal for them to do so. Unlike in Maskachusetts, Swedes need not tell the government when they’ve traveled or to where nor do they need to submit medical records to government authorities “on request”.)
An example post: “ICUs in Stockholm reach 99 percent capacity: report” (The Hill).
In the best American fashion, this article presents all of the information out of context. How many ICU beds are there in Sweden? How does that compare to what we have here in the U.S.? How does the number of Covid-19 patients in the ICU compare to what Sweden had back in the spring of 2020?
First, it seems that the number of ICU beds occupied by Covid-19 patients is actually only about half what it was during the April 2020 peak:
How does 259 ICU patients with Covid-19 in wicked Sweden compare to the situation in place that is a model of shutdown (9 months) and masks (7-8 months)? Maskachusetts currently has 309 Covid-19 patients in the ICU (state dashboard) or 1.7X the rate when adjusted for population.
Second, it looks as though Swedes don’t have that many hospital beds that they designated as “ICU”. Reuters, under a headline that directly contradicts the above (“ICU bends not full”):
Sweden still has 148 unoccupied beds in intensive care wards nationwide, corresponding to 22% free capacity, said Irene Nilsson-Carlsson, senior public health adviser at the National Health Board.
In other words, the entire country of more than 10 million people has about 675 hospital beds designated as “ICU”.
How does this compare to the U.S.? Here in Maskachusetts, population 7 million, we have 1,500 “ICU” beds in ordinary times and that is boosted to 2,700 for a “surge” (boston.com). Sweden would need 4,000 ICU beds to have the same number per person as Massachusetts.
How about the rest of the U.S.? It looks as though 70,000 adult ICU beds is the baseline (aha.org). That’s 212 beds per million residents of the U.S. Sweden has 66 ICU beds per million residents.
So… even without coronavirus, if the Swedes organized medicine the way that we do, 100 percent full ICU in Sweden would correspond to 31 percent full in the U.S.
See also Infidels in Sweden are refusing to die (April 21):
Full post, including commentsFor True Believers in the Church of Shutdown, what Sweden is doing is merely a variant form of their own religion, just as Hinduism was for the Portuguese who spent an entire summer on the west coast of India in the late 15th century. So strong was their belief in Christianity that they believed Hindu temples to be churches (and Ganesha was Jesus with a big Jewish nose?). They attended Hindu religious rituals and believed that they were observing Christian practices.
A scientific analysis of the effects of California’s Santa Clara County’s mask order of April 17.
Source: Karl Dierenbach
Full post, including commentsMaskachusetts is the 3rd most restricted state in the U.S. (WalletHub ranking). Florida is ranked #11 for freedom. Yet the latest map from covidexitstrategy.org, which our state officials use to decide cleanliness/godliness for travel order purposes, shows that no-mask-order Florida has 427 new cases of COVID-19 per million residents while fully-masked-since-May Massachusetts has 704 new cases per million (slightly lower positivity rate, but that could simply be due to the fact that universities here are constantly testing the rich white locked-in students and thus pumping up the denominator).
If the God of Shutdown is a just god, and the people of Florida have been flouting the church dogma of shutdown+masks, aren’t we forced to conclude that the God of Shutdown has a special love for Floridians?
Related:
Today is National Pearl Harbor Remembrance Day, marking 79 years since we entered World War II in order to fight Totalitarianism.
Here in Massachusetts, as part of our governor’s more-than-50 orders, we are required to tell the government, via a web form, about any travels that we might have undertaken. And “Quarantine for 14 days or produce a negative COVID-19 test result that has been administered up to 72-hours prior to your arrival in Massachusetts.”
From mass.gov:
72-hour Testing Rule: The individual can produce, upon request, proof of a negative test result for COVID-19 from a test administered on a sample taken no longer than 72 hours before your arrival in Massachusetts.
So we’ve spent hundreds of $billions (software, time spent with forms) for our medical records to be protected by HIPAA (federal law), but the state can demand a portion of our record via a “request” (fine of $7,000 if one fails to comply with the “request”; see the governor’s 45th order).
Plainly the Shutdown Karens can say that this is quite reasonable. The governor has declared an emergency so the state government should have access to whatever is necessary to deal more effectively with that emergency (never mind that test and trace immediately fell apart, so this information is useless, or that the typical person is not contagious by the time a test has been scheduled and result received (NYT)). But, on the other hand, a governor can declare additional “emergencies” any time that he/she/ze/they wants to. Obesity kills far more Americans than COVID-19. Couldn’t a governor declare an obesity crisis and demand that people submit medical records related to obesity and diabetes? We’re already in an opioid crisis, right? Why shouldn’t the state have the right to “request” your prescription records to make sure that you haven’t been getting too many OxyContin pills? (and fine you $7,000 if you fail to comply with the request)
Very loosely related, a conversation with a 5-year-old after putting a e-collar on our golden retriever to prevent her from scratching at a scab:
“Health Care Workers Plead With Americans To Take Pandemic More Seriously” (NPR):
Health workers and hospitals already strained by the pandemic are increasingly making direct appeals to the public with open letters, asking people to mask up and stay at home this holiday season.
I was chatting this evening with our stealth author of Medical School 2020. He’s working 12-hour shifts at a hospital where roughly 8 percent of the beds are occupied by COVID-19 patients. “Remember that if someone comes in with appendicitis and happens to test positive, they become a ‘COVID-19 patient’ in our census,” he said.
How seriously do frontline health care workers take the pandemic? Our mole in the system described a doc and nurse couple electing to take a mid-November vacation in Aruba. They got on a flight that was 100-percent full, thus voluntarily spending hours sharing a narrow cylinder of air with 150+ other humans. When they got off the plane, they were subjected to screening questions by the Aruban authorities. Instead of admitting that they worked in a hospital every day, they said that they “worked in biochem.” On reaching the (packed) resort, they said “The majority of the other guests were health care workers” (i.e., there were additional hundreds of doctors, nurses, etc. who had chosen to take the risk of contracting COVID-19 at the jammed airports or on the full flights).
(Separately, should COVID-19 patients be in the hospital to begin with? It is not like having a heart attack or getting into a car accident where the doctors have effective treatments to offer. Why aren’t they at home with an oxygen bottle and a CPAP machine or high-flow nasal cannula? A med school professor friend:
Many things could be done from home cheaper and safer but we don’t have the infrastructure or culture. Home model kills the rationale for the hospital cash cow.
Our Medical School 2020 author:
I agree that outside of severe Covid, most of the interventions can be done at home — we send patients home with up to 5 L O2 for bad COPD. It somewhat reminds me of the slow transition from inpatient to outpatient management for other conditions, e.g., deep ventous thromobosis (“blood clots in the legs”) that now is managed with oral blood thinners at home instead of in the hospital. … There are really only a few interventions that we do for covid19 — low and high flow oxygen supplementation, noninvasive (think CPAP) or invasive mechanical ventilation, steroids (actually a good intervention for mechanically ventilated patients — 30 vs 40 percent 1-month mortality) and remdesivir (only benefit shown in low O2 patients with decrease in hospital stay of 10 vs 15 days in small study). … I agree that the only difference for non-severe covid infections between home versus inpatient is just getting telemetry monitoring and daily labs in the hope of catching worsening pulmonary function or prognostication of the weird complications of covid (e.g., heart attacks, blood clots). Unsure of our prognostic ability to guess who will worsen versus who will improve early on in the course (uptodate states the shortness of breath from covid19 occurs up to 8 days after symptom onset). Perhaps utilizing some Apple Watches and Fitbits over those 8 days might save some hospital beds.
See “A Covid-19 Lesson: Some Seriously Ill Patients Can Be Treated at Home” (NYT, July 18) for a story about a hospital that innovated.)
Is #StayHomeSaveLives the new #TakeTheBusSaveThePlanet? Classically, everyone agrees that it would be a good idea if other people took the bus or the subway, thus reducing traffic congestion and pollution.
From the official Aruba tourism site:
(I would love to go right now, but despite my reputation for skepticism regarding coronapanic, I would not voluntarily get on a commercial airline with all seats full.)
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In their righteous muscular efforts to “control” coronavirus, some state governors and city mayors have ordered restaurants shut down, except for outdoor dining. In response, restaurants have built four-sided tents filled with CO2-emitting propane heaters. It is unclear why this is different from being indoors, other than the lack of a real HVAC system. The tent sides are necessary, though, because otherwise the propane heat will blow away.
Why not heat the customers instead of the air?
Back in 2010, I wrote Heated Furniture to Save Energy?
A lot of cars have heated seats. When the seat heater is on, most drivers will set the interior temperature 3-7 degrees lower than with the seat heater off. Why not apply the same technology to houses?
Imagine being at home in a 65-degree house. Even in a T-shirt and jeans, it would probably be comfortable to walk around, stir a pot on the stove, carry laundry, scrub and clean, walk on a treadmill while typing on a computer (as I’m doing now!). However, if one were to sit down and read a book, it would begin to seem cold. Why not install heat in all of the seats and beds of the house? And sensors to turn the heat on and off automatically? In a lot of ways, this would be more comfortable than a current house because the air temperature would be set for actively moving around while the seat temperature would be set for sedentary activities.
There is a fine line between brilliant and stupid, of course, but could it be that coronaplague has pushed this idea over the line?
A Dutch company, sit & heat, seems to have thought of this: heated cushions that can fit into a standard frame. Serta makes a chair-shaped electric quilt (could not survive outdoors) for only $64. A plastic chair with a built-in 750-watt heater is $900 (Galanter & Jones; they have sofas too at roughly $6,000 and claim they are “cast stone”).
If heated chairs were mass-produced in Asia, presumably the cost per chair would be only about $100 more than a regular outdoor chair. That should be affordable for a restaurant.
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Text message exchange with a couple of 24-year-olds:
Surface contamination has been ruled out as a significant source of coronavirus infection, right? (see below, however, for how cleaning can cut flu risk by 2 percent) Everyone agrees that it is now mostly about aerosols and therefore a gym is a perfect environment for spreading, yes? (People breathing hard and relying on non-N95 masks and/or bandanas as PPE.)
Masks make people complacent and prone to ignoring instructions to keep a 6′ distance. I wonder if the sight of workers with spray bottles and paper towels has the same effect. These 24-year-olds feel that they are significantly less likely to get infected because they’ve seen every surface being wiped, despite the fact that wiped surfaces are irrelevant when faced with an aerosol enemy.
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… does this mean coronapanic is over? Some items that haven’t been seen for 8+ months were simultaneously in stock on December 2:
What happened?
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