A radiologist on coronavirus

From a forthcoming chapter in Medical School 2020:

“I don’t think people realize what is coming. The virus is reported to have almost a 20 percent infection rate. On the cruise ship, one asymptomatic person infected 600 people. Our health system covers about 1 million people. We have 54 ICU beds. The numbers just don’t work.” He continues: “On top of this, this will be a supply crisis. Our health system reverts back to the medieval when we don’t have common medications. Penicillin is not made in the US anymore. There is going to be a huge shortage of needles. China supplies everything, and they are shut down.” Is he stockpiling? “Oh yeah.”

This conversation occurred last week. Our anonymous hero was shadowing the radiologists.

Separately, I was at a dinner party on Friday evening in a West LA house that Zillow estimates is worth $3.6 million. The guests on previous occasions spent about 90 percent of their time displaying their virtuous concern for others: Trump-hatred, wanting to help the vulnerable, social justice, etc. During this dinner, however, 90 percent of the conversation was about the rich white guests’ personal fears of contracting the coronavirus, whether to modify travel plans to minimize the risk, etc. (They mixed in a bit of Trump hatred by talking about how the $5 trillion/year Federal government would be powerless to do anything regarding coronavirus due to incompetent leadership by Trump and Pence. They have almost total faith in the power of the Federal government to solve problems, but only if the correct President and VP are installed at the top.)

[At least one Bernie supporter from 2016 had moved into the Elizabeth Warren camp. To judge by the dinner crowd, Warren’s appeal is strongest to women who don’t work and feel aggrieved that some people earn and/or have a lot of money. Bernie’s message is fundamentally about optimism that a slightly tweaked government (just one little tax on billionaires!) can deliver on every American’s dream while Warren is skimming off the most resentful subset of Bernie 2016 supporters?]

Given the large number of destitute people wandering around Los Angeles and/or camping on the sidewalk, I’m not too surprised that rich white people in LA have their personal welfare as Priority #1. But until coronavirus hit, there was some kind of social taboo about giving voice to this priority. Fear of death, apparently, has caused people to abandon any feeling of shame regarding selfish concern.

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Academic lectures on a modern subject: the Black Death

I’m listening right now to “The Black Death: The World’s Most Devastating Plague” by Dorsey Armstrong, a professor at Purdue. Unfortunately, due to coronavirus, this is a timely subject. Fascinating topic even without the connection to our latest events.

Oh yes, guess where the author says the first wave of plague that hit Europe in the 14th century started? The Hubei province of China, in 1331.

Related:

  • “Immigration is the Reverse Black Death?” (Professor Armstrong concurs with other scholars that the reduction of population by 50 percent led to an enormous boost in income and standard of living for the survivors and their descendants; the U.S. is trying this in the other direction and expecting the same result!)
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Cruise ships in the time of plague

Even if coronavirus isn’t a serious statistical risk from being on a cruise ship, I wonder if the public health response will trim the sails (so to speak) of the hitherto unstoppable industry.

Consider the passengers on the Diamond Princess in Japan. Best case for the healthy ones is to be stuck at the dock for 14 days, mostly in their tiny cabins. From NPR:

On the ship, passengers — including some who had already spent two weeks aboard the vessel before the quarantine doubled their stay — are told not to leave their rooms. They visit the deck in shifts, for a rare breath of fresh air.

But there could be days of quarantine after a scare, right? So if you book a cruise from Date X to Date Y you won’t have any guarantee of getting back to work, family, and other commitments.

Does this prove the old adage that being on a boat is like being in prison, except that you can’t drown in prison?

Related:

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Boots on the ground in Shanghai

… actually it might be more accurate to say “boots in the apartment”. I have been WeChatting with a friend who is a professor in Shanghai.

Her university is planning to start classes two weeks late, on February 17, and restrict them to online-only through March 15. Staff were given a holiday through February 10 “but all of our admins seem to be working very hard from home.”

What about food?

Malls are generally open, but only a few of the stores and even fewer restaurants in them are open. They have only one entrance open, with someone checking forehead temperature. Supermarkets, both in and out of malls, are open. About 25 percent of the food stall markets are open, a higher fraction for those that specialize in fancy fruit (popular New Year gifts). Several grocery and restaurant delivery services are working. Almost no other retail open.

Our know-everything-about-China media suggests that the Chinese response to coronavirus has been weak and that an American-style government could have done better, but this sounds to me stronger than anything the U.S. has ever done to try to contain a flu epidemic. The U.S. seems to have responded to the last big one (swine flu) by stockpiling antiviral meds for people who got sick (source). I don’t remember much being done to prevent the virus from spreading.

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Price-fixing in the U.S. healthcare system, by the numbers

A bill arrived for a (routine and negative) medical test today. Due to the artificially restricted supply, the provider attempted to fix the price at $150 (ask a physician who #resists Trump and welcomes migrants if European doctors should be able to come to the U.S. and start offering medical services!). Via the miracle of monopsony, however, Blue Cross dictated to them a price of $47.08 (why the .08?) and thus a paper-in-the-mail process was initiated to collect the cost of a local restaurant meal (annual deductible not yet met so this $47.08 has to be paid on top of the $10,000-ish cost of the policy).

My favorite thing about Bernie Sanders is that he is the only politician with the courage to say “this is dumb; we should try something else.”

Sanders seems to have done well in Iowa (though not as well as the politician that I thought, six months ago, should be #1 among the Democrats). Maybe the enthusiasm for Sanders is partly driven by consumer rage on receiving explicit disclosures like this of how the U.S. health care system is not representative of an ordinary market (you can’t buy food insurance and get 2/3rds off your next McDonald’s bill; McDonald’s doesn’t make that much profit at its headline prices).

I wonder if Sanders’s opponents from all parties (Socialist, Green, Libertarian, Democrat, and Republican) would be wise to start their fight against Sanders by proposing a law that forbids providers to charge a higher price to individuals than to insurers.

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Colds will become less prevalent due to cashless economy?

From a Mexican’s point of view, American counter-service restaurants and ice cream stands do something completely unsanitary: the person handling the cash is also the person handling food.

At least in the Shanghai region, I noticed that the Chinese usually separate food-handling from customer-handling (not really “cash handling” since WeChat is the typical method of payment.)

I’m wondering if Americans will get fewer colds as we transition to a cashless economy. If everyone who goes to a counter pays by inserting a credit card into a machine or waving a phone, shouldn’t there be less chance of an infection being passed from customer-to-clerk-to-customer?

I couldn’t find good research on this subject. China would be an interesting case study since they have gone mostly cashless in a short period of time. Anecdotally, it was rare to see someone (Shanghai in November) suffering from a cold and I never got any hint of food poisoning.

But maybe this isn’t interesting because the effect will be small and swamped by increased transmission of disease due to increasing population density (from (a) population growth, (b) migration and urbanization).

Related:

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Air pollution has an insignificant effect on life expectancy?

It seems obvious that people who breathe filthy air would die young. Yet people in Shanghai live 13 years longer than those in poor provinces (source), which are presumably less densely populated and therefore might have cleaner air (but maybe they are breathing indoor smoke from coal used to heat?).

Another possibility is that people in Shanghai are being slowly killed by air pollution, but they’re so smart that their high IQ gives them a longer life expectancy to begin with. (Scientific American) Without the massive welfare state that the U.S. operates, it is tough for a person without a high IQ to move to Shanghai and thrive there (apartments are comparable in price to the most expensive U.S. cities; see Forbes).

There is supposedly a five-year difference in life expectancy in north versus south China due to worse air pollution from heating with coal in the north (source). But, again, how to square that with the 13-year boost in life expectancy in Shanghai, a city that is spectacularly polluted.

Mist or filth?

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Hospital price lists are a good idea, but let’s wait until 2021?

“Hospitals Sue Trump to Keep Negotiated Prices Secret” (nytimes):

The nation’s hospital groups sued the Trump administration on Wednesday over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.

The administration wanted the disclosure rule, which would go into effect in 2021, to allow patients to better shop for deals on a range of services, from M.R.I.s to hip replacements.

It is the 2021 part that fascinates me. There is enough time between now and 2021 for China to build an entire Manhattan worth of office and residential space within each of a few of their larger cities, to open another 2,000 miles of high-speed rail, to add some metro lines in their secondary cities, etc.

If hospitals have all of these prices in their computer systems (funded by tax dollars) and this is a good idea, why wouldn’t the regulation be for them to push them out onto their web sites within a few months?

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Is ingesting plastic actually fine for our health?

“Those fancy tea bags? Microplastics in them are macro offenders” (Guardian) says that excessively rich and/or pretentious people who drink tree from nylon bags are ingesting a lot of plastic (bonus: they’re also trashing the environment by consuming way more in energy and materials than folks who drink tea made from paper tea bags).

One local source for ingestible plastic is Tea Forté. Customers of this high-cost brand have been getting massive doses of plastic, far above what the turbine-powered helicopter moms fear kids might get from eating food cooked in a Teflon pan (example paranoia: “I do like to back up my points with scientific studies, but often it takes many years for a complete and acceptable study to make useful conclusions. With something like Teflon cookware, there are lots of vested interests so it could be a few more decades before valuable health information is known.” (i.e., we can predict Earth’s temperature 100 years from now, but 63 years of history with Teflon pans is not enough to say anything definitive; it is complicated by the fact that companies are getting insanely rich selling $10 pans at Target and using the profits to corrupt academic science)).

Have the drinkers of these fancy plastic-packaged teas done the required experiment for us? Their bodies might be half plastic by now and yet they aren’t dying off at an extraordinary rate.

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