Category: Health

Yesterday I asked “What is the point of closing universities and companies if K-12 schools remain open?”

Today it seems that a bunch more nearby K-12 schools are closed. The decisions are being made on a town-by-town basis, though. It is unclear to me how this can prevent an epidemic in the Boston area.

What’s more confusing, though, is that preschools/daycares remain open. Won’t that spread the coronavirus among households almost as efficiently as the K-12 schools? Maybe a one-week lag?

Related:

• “70 of 92 coronavirus cases in Massachusetts linked to Biogen employees after biotech firm’s Boston meeting” (CNN) explains where the plague came from. Mission Accomplished: “We work to have an impact beyond our medicines…”, from the Biogen Corporate Social Responsibility page. Like Justices Kavanaugh and RBG, the company brags about practicing gender discrimination in employment: “We are especially proud of our efforts to promote a diverse and inclusive workplace and to advance women in leadership roles.”
• Who funded the Biogen meeting? You did! “The cost of Biogen’s new drug: $750,000 per patient” (CBS). Thanks for paying taxes (Medicaid/Medicare) and health insurance premiums.

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A lot of U.S. universities seem to be sending the students home to catch glimpses of the truth via Internet (it will be like Plato’s cave, but with LED backlighting instead of a climate-destroying wood fire?).

The stated reason for this mass exodus is that this will slow the spread of coronavirus. But U.S. K-12 schools are generally staying open. Doesn’t that ensure the rapid spread of any epidemic, even if children themselves are not usually symptomatic? Almost everyone has at least some contact with a family with children. As long as the K-12 schools are open, children have contact with each other.

Here’s part of an email from the superintendent of our local public school (Lincoln, Massachusetts)…

The Governor’s Press Conference held yesterday afternoon shared the current status of COVID-19 cases in our state and emphasized how quickly the levels of cases can escalate. In light of the data and the recommendations provided by Governor Baker and Commissioner of Education Jeff Riley, we are putting additional plans in place to ensure that we do everything we can to mitigate the spread of COVID-19 within our school communities. Right now, the level of risk in our school communities is low.

The Massachusetts Department of Elementary and Secondary education is not approving remote learning for pre-K through grade 12 schools.

Finally, I want to remind everyone that events such as this can bring out the best in a community and can also bring out the worst. Please remember that the strength of our community and how we get through this event is dependent upon how we care for each other and reach out to those in need. We may have a tendency to look out for ourselves, intentionally or unintentionally profile others, or carry out actions that are felt as microaggressions. Let us all rise to the occasion and do all that we can to support each other to ensure that every student, staff member, and family feels supported, safe, and cared for. I recommend we all read this document regarding civil rights related to COVID-19. https://content.govdelivery.com/accounts/USED/bulletins/27f5130.

From the linked-to U.S. Department of Education letter:

There has been an increasing number of news reports regarding stereotyping, harassment, and bullying directed at persons perceived to be of Chinese American or, more generally, Asian descent, including students.

Nobody had the heart to tell our school superintendent that nearly all of the Asian families decamped some years ago to Newton, Lexington, and Brookline, whose school systems put up higher test scores. We would have to fight our way through quite a bit of traffic (in our Warren-stickered Teslas, naturally) if we wanted to microaggress an Asian.

Readers: If you’re not too busy unintentionally profiling Chinese Americans, can you please educate me on how “social distancing” in the U.S. is useful when K-12 schools remain open?

Related:

• assigned reading idea for the college kids sent home: The Decameron
• “Mann besprüht chinesische Nachbarin mit Desinfektionsspray” (Abendzeitung München): apparently, the Germans aren’t running out of disinfectant

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A friend is a physician at a Boston-area hospital with nearly $1 billion in annual revenue and more than 250 beds.

This evening I asked what he would do if a patient came in with the full slate of obvious coronavirus symptoms. “If his condition is critical, I can admit him,” Doctor Friend said, “but I can’t order a coronavirus test. In fact, the hospital has been trying to get the word out to people not to come to the hospital if they want a test.”

How is that possible? “We can’t do a coronavirus test in-house,” he responded. “I’ve heard that Quest is gearing up and will have millions of tests available soon. Once they’re ready, we can order tests through Quest.”

If a doctor in a big hospital in a big city cannot order a test, how can we have any confidence in what we’re told are the latest infection numbers for the U.S.? How can anyone know how many of our neighbors are infected with coronavirus and how many simply have a bad cold or a mild flu?

Separately, I ran into a friend who runs a small pharmacy with his brother. “Our sales are up 30 percent,” he said. “Mostly cleaning products, hand sanitizer,and so forth. We were able to buy some alcohol at twice the usual price and then we marked it up to $8, but now we’re sold out of almost everything.” Is any of this stuff useful to an average consumer? If the family doesn’t have coronavirus, what is the value in sanitizing everything? If a family member does have coronavirus, what is the value in cleaning up after the fact? “Unless you have new people coming into your household every day,” he replied, “I don’t see what difference it would make versus just washing your hands on returning home. But it makes people feel good to do something.”

He did not think that this round of coronavirus would turn out to be significant. He thought that it would, like the flu, kill some older people and then disappear for the summer.

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Apologies for the macabre subject, but with everyone freaking out about the coronavirus, I’m wondering if it makes sense to step back and ask why the Diamond Princess wasn’t a worst-case scenario. The ship held 3,700 people. The virus spread all around the ship before anyone knew what was going on. Then everyone on board was kept on board, all breathing from the same ventilation system, eating food from the same kitchen (almost surely prepared by at least some workers who had the virus, but didn’t know it). Out of 3,700 passengers and crew, 6 have died (Business Insider).

That’s a death rate of 1/6th of 1 percent (0.16 percent), and concentrated among people whose immune systems were weakened due to other factors (i.e., people who might have died a year later from the flu).

The U.S. overall is not more crowded than a cruise ship. Why should we expect more than 0.16 percent of Americans to die when this is all over? That’s unfortunate, of course, and a huge number when multiplied by 330 million: 535,000. But it is not an economy-ending or country-ending number. And, since our country is not in fact as densely populated as a cruise ship, the real number might be far less than this upper bound. It might be closer to the 80,000 who died from the flu in 2017-2018 (source). And there might not be that many additional deaths because the same people who get killed by the flu are also susceptible to COVID-19.

One factor that could explain how the death rate could be higher: as the disease spreads, hospitals and other health care resources will be spread thin. But, on the other hand, knowledge about how to treat the infection will improve. If these two factors cancel out, we’re back to the Diamond Princess being the worst-case scenario. Finally, consider that the cruise ship demographic is older and more fragile than the general population.

Related:

• “The Strongest Evidence Yet That America Is Botching Coronavirus Testing” (Atlantic): “I don’t know what went wrong,” a former CDC chief told The Atlantic.
• “Why the CDC botched its coronavirus testing” (Technology Review): The first testing kits from the Centers for Disease Control had a simple fault, and red tape prevented other labs from creating their own.

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The Black Death: The World’s Most Devastating Plague” by Dorsey Armstrong, a professor at Purdue, talks about places that were spared from most of the waves of plague that swept through Europe starting in 1348.

If we don’t want to die from coronavirus, what can we do?

Iceland was an example of a place that escaped plague for more than 50 years. It took a long time to reach Iceland by ship so asymptomatic carriers of the plague couldn’t walk off into port in Iceland. More likely they, and all of their crewmates, would die before reaching Iceland.

People today travel by plane, however, which is nearly instantaneous. So the “far away by ship” advantage does not seem likely to be realized by any country today.

Finland remained substantially plague-free, says the author, despite having land borders with Sweden, Norway, and Russia, as well as being integrated into the sea trading network of the time that had spread the disease so quickly throughout the Mediterranean and to the British Isles. The secret in Finland was low population density.

Wikipedia says, regarding the influenza pandemic of 1918: “In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population).” Our population is more than 3X the 1918 level and therefore our population density is more than 3X the 1918 level. So the Finland trick cannot work for Americans in general. But maybe for an individual American it could. Move to a non-urban area of a spread-out state, e.g., Alaska or Wyoming. Follow Barbra Streisand and the rest of the Hollywood #Resist crowd to Canada (or pick a different low-density country, such as Argentina).

The professor says that governments that shut down or severely restricted links to the outside world ended up saving most of their citizens and/or subjects. So maybe North Korea or a similarly restricted nation will be comparatively safe?

The professor says that cities with good sanitation did not escape the plague, but death rates were lower. So Japan and Switzerland might have fewer cases of coronavirus? “Mortality burden of the 1918–1919 influenza pandemic in Europe” says that Switzerland was not significantly different from France (but sparsely populated Finland suffered only half the death rate).

Integrating what we know from the Black Death and present-day statistics and conditions, Iceland and New Zealand seem like the most obvious places to run for a re-enactment of the Decameron. They’re islands. They have lower population densities than the U.S. They have comfortably high living standards. However, we need to cross Iceland off the list due to the fact that it operates an international airline hub. People from more than 50 different countries might show up on a typical evening. That leaves… New Zealand.

Fun fact: We get the word “quarantine” from the Venetian government’s requirement that ships coming into Dubrovnik wait at a nearby island for 40 days before coming into contact with the townspeople.

At least we’ll never have to worry about plague per se, again, right? Actually… the bacterium has evolved antibiotic resistance in Madagascar (CDC) and the fleas that carry it have evolved insecticide resistance.

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