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Infection Fatality Rates Under Different Scenarios
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There has been much discussion recently about what might be the Infection Fatality Rate of the coronavirus. But of course the IFR is highly dependent upon whether the medical care system is functioning or is turning away patients in the parking lot. Furthermore, if it is functioning, it is, hopefully, improving over time.

The more the medical system can do for Chinese virus victims, the less you want to see the the medical care system overwhelmed. But here are questions I don’t know the answer for: How much good has the medical care system done so far for infected people? Is medical care getting better? Is it likely to improve a lot before there is a vaccine?

There are basically 5 levels of medical care for infected people:

1. None: Stay home, don’t see a doctor
2. See a doctor, go back home
3. Hospitalization
4. ICU
5. Ventilator

How have the treatments changed in effectiveness over time versus expectations? My guess is that ventilators have proven less effective than was hoped. However, Hospitalization and ICU (Boris Johnson got both, but not a ventilator) may have improved: the discovery of “proning” with non-intrusive oxygen treatment may have improved recovery rates.

Has hydroxychloroquine helped levels 2 and 3? My impression is that it doesn’t do much good for Level 5, but might work pretty well for less severe levels. Has hydroxychloroquine gotten into wide enough use to impact overall IFR rates?

 
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  1. Has hydroxychloroquine gotten into wide enough use to impact overall IFR rates?

    It has gotten into wide enough use to impact news coverage of its effectiveness in hammering Trump for praising its use.

  2. My guess is that the Diamond Princess data give us a passable idea of how lethal this is for people over 60 with a symptomatic infection (about 5% die). The Italian data available at Statista suggest that mortality is intensely concentrated among people over 60; the New York data suggest a less intense but still quite marked concentration among the old. Our problem has been that we did not have enough protective equipment for people under 50 and for people under 60 w/o certain problems (e.g. obesity). Had we had the equipment, we could have had a social distancing regime which isolated the old and the obese but permitted all but an odd minority of the remainder to continue working. We need those masks, we need that sanitizer, and we need to keep away from each other, but we don’t need to be idled.

    • Agree: Inquiring Mind
    • Replies: @Hypnotoad666

    We need those masks, we need that sanitizer, and we need to keep away from each other, but we don’t need to be idled.
     
    That's the Swedish model, which is working fine (https://www.google.com/search?q=swedish+covid-19+figures&rlz=1C1CHBF_enUS777US777&oq=Swedish+covid-19&aqs=chrome.2.69i57j0l2.17309j1j7&sourceid=chrome&ie=UTF-8), compared with the U.S. lockdown approach (https://www.google.com/search?q=new+york+covid+numbers&rlz=1C1CHBF_enUS777US777&oq=New+York+covid+numbers&aqs=chrome.0.0l8.10237j1j7&sourceid=chrome&ie=UTF-8)

    Indeed, by the time we come crawling out of our holes to inevitably get infected anyway, Sweden will be at or near herd immunity. Whereas, we probably just made everything worse by destroying our economy in a pointless effort to flatten (and thereby lengthen) the curve of infection.

    Third World countries that are doing nothing by default are likely having a similar experience to Sweden, but since they don't do any testing or record keeping it's not obvious yet.

    When historians are finally able to look back with some perspective on the Great Wu-Flu Panic of 2020, the blame will fall on: (a) The Chinese for lying to the world while the virus spread; (b) The media and public health officials for whip-lashing in two weeks from "it's no problem" to "we're all going to die;" and (c) The CDC, FDA and public health officials for failing to plan ahead and being totally incompetent in testing, data collection, and production and distribution of medical supplies.

    In short, a complete and total clusterf**k in response to an epidemic that everyone knew was going to happen at some point.
    , @Redman
    I don't disagree with any of this. But I've been ignoring the lockdown consistently here in NYC. I've been going to my office everyday since Cuomo declared the State's quarantine.

    Walking around the city, I've noticed that quite a large percentage of the people also ignoring the lockdown are quite old (as in older the boomer age). I don't have an answer for why this is. But it may be that a lot of old people (maybe it's a NYC thing) know their time is probably limited and aren't going to be forced into hiding for who knows how long. They have less fear than the boomers although their risk is much greater.
  3. here in New Jersey they predicted a shortage of ICU beds 2 weeks ago…this never occurred.
    they also predicted ~16,000 hospitalized and only 7,000 have been hospitalized. So the predicted were way off for hospitalizations.

    Maybe the Trump Tonic prevents many patients from being hospitalized. In addition to patients getting hydroxychloroquine many people began taking zinc and other vitamins to protect themselves and treat their minor symptoms which may have prevented thousands of hospitalizations.

    In the weeks before the lockdown our local stores were sold out of vitamin C and zinc lozenges and Airborne. This was back in the first week of March.

    Since all the vitamins were sold out weeks ago , I assume people have been taking more vitamins than usual over the last 4 weeks in an attempt to build up their immune systems to fight the virus. Maybe this has also had an effect on hospitalizations. Everyone in my family has been taking Vitamin D, C and zinc for the last 4 weeks. I also began drinking green tea and Tonic Water each day. Maybe it is working, we have not gotten sick despite living in an area where 30% have been infected and we have 3 children who were in School until March 18.

    • Thanks: Mark G.
    • Replies: @Redman
    You have confirmation that 30% in your area have been infected? Do you mind me asking where you have read that? That seems quite high and I live in Westchester.
  4. Until we have much more testing, it’s meaningless to discuss IFRs, since we have little idea of the denominator. For example, I don’t think we can extrapolate Stanford’s Santa Clara County results to the entire nation and say that the number infected is 55-80 times more than we thought, any more than we can extrapolate the Telluride, CO results. I think it’s better to discuss the Case Fatality Rate, especially in the context of what treatments might be effective.

    • Replies: @JeffH
    But now there's better data from LA County Health Dept and USC, showing essentially the same thing. The LA data really is a random sample, and the number of people they found (6 percent of males, 2 percent of females) with antibodies exceeds the potential false-positive rate of the test by a comfortable margin. Now that we are finally getting some actual data on how many people have been infected, it turns out that the corona virus is more contagious than the flu, but no more than twice as deadly. The shutdowns are both ineffective and unnecessary.
  5. There’s also squaring the difference between the IFR from Santa Clara (.09-.15%) and NYC (clearly well north of .15%), given >13000 excess deaths in the city, and a population of 8.9mm.

    Maybe the SC virus is a different, less deadly variant than the NYC virus, with the latter being
    European and the former Asian?

    • Replies: @Hernan Pizzaro del Blanco
    The demographics and density are very different in NYC compared to Santa Clara.

    NYC is 25% Black compared to 2% Black in SC.
    40% Asian in Santa Clara verse 14% in NYC
    Average age in Santa Clara is 33 verse 41 in NYC

    So we would expect the IFR to be significantly higher in NYC due to the different demographics.
  6. I’m hoping that our medical care does more for CV patients than the police and fireman were able to do for those who died on 9/11. But I’m not optimistic. Many of them paid the ultimate sacrifice in doing their jobs on 9/11 (some rushed to the scene although off duty or retired). They all showed the best instincts of mankind.

    Yet in the end, nobody was willing to admit it didn’t make much difference. The bravery of these men was mostly for naught.

    Some inspirational stories of heroic medical care have been reported. Like the former Rose Bowl doctor who was saved after ventilation didn’t work. But these seem to be few and far between so far. I think we’re probably just rolling the dice with our genetics and hoping we haven’t ignored (or damaged) our own immune systems too much in the past.

  7. It use to be a ventilator was just primarily used to keep the dying comfortable til the end. Not surprised it isn’t effective. From what I read hydroxychloroquine is used with zinc. Don’t most medications deplete users of zinc? If so, that would explain why it is impacting the old. It seems like once you get to fifty, your whole purpose is to keep pharmaceutical companies in the black. Perhaps the most interesting tidbit coming out recently is that 40% of Boston’s homeless testing positive despite having no systems. Can that really be true? Would that make hardship and outdoors the solution?

    • Replies: @peterike

    Perhaps the most interesting tidbit coming out recently is that 40% of Boston’s homeless testing positive despite having no systems. Can that really be true? Would that make hardship and outdoors the solution?
     
    Maybe it's the because the homeless aren't on all those wonderful drugs they ply the middle-aged and elderly with? Among the many other things possibly not being measured, is anyone tracking prescription drug use and correlating against Corona deaths?

    Anyway, being outdoors is actually a great way to not get the virus.
  8. My impression has been that there has been no treatment for the vast majority of symptomatic people so you either pull through or get to level 5 before you get to ICU and then ICU is just your death bed.

    The one case I know of the doctors laughed at the guy for 2 weeks before his wife found a lung specialist willing to take it seriously. Then he was still sent home awaiting a positive test. No word on Hydroxychloroquine. No word on if he got anything. He’s fine now though. 2 weeks of up and down flu but fine.

    I think this is the vast majority of symptomatic people. They get ignored and ignored, they get denied chloroquine etc etc…Then they get really ill and die.

    So if your symptomatic you need to get the right treatment early on so you don’t get too far down the path of no return.

    You need to take your health in your own hands…if you start to get the flu, you need to get to the hospital or a doctor who can prescribe stuff ASAP and not waste time

    • Replies: @Travis
    well stated.

    Unfortunately in New York access to Hydroxychloroquine is banned outside of a hospital. In New Jersey Hydroxychloroquine is not for sale at any pharmacy. You need to be admitted to a hospital to obtain access to Hydroxychloroquine or any of the anti-virile medications. The Health commissioner is telling all residents with symptoms stay home...if your symptoms get worse and you are having trouble breathing then you can go to the hospital and get treated.

    We have stocked up on Tonic water and vitamins, hopefully this will keep us out of the hospital. 40% of those in my county already have CV. So half the people we encounter are probably infected. Still unable to obtain masks, but have enough tonic water to last 10 more days.
  9. Anonymous[904] • Disclaimer says:

    There hasn’t been enough testing. There should be more drive through testing locations, and those should be the main place people are getting tested. Hospitals should separate into COVID and non-Covid hospitals.

    Patients who can show a recent negative status can go to the non-covid hospitals. Everyone else to the Covid hospitals.

    Why do most hospitals have a COVID ward? And even if they don’t have one, they are not actively keeping COVID patients out; why? This seems obvious.

    You should be able to get the hydroxychloroquine/ azithromiacin prescription over the phone after testing positive at a drive through location. If everyone did that early enough, this thing would be like a regular flu.

    There should also be trials ongoing regarding recovered patients. Does long-term remdesivir give recovered patients better outcomes over a control group of recovered individuals?

    What we still need:

    More swab tests
    More swab testing facilities
    More drugs (hydroxychloroquine, remdesivir)
    Fewer COVID hospital locations (isolate spreading)

    Has every chemical lab and compounding pharmacy in the country been tapped as a resource for these things? If not, why not? Why are we still relying on China and India?

  10. One doctor in Seattle survived by being moved to another hospital that had ECMO (extracorporeal membrane oxygenation).

    https://www.npr.org/sections/coronavirus-live-updates/2020/04/13/833734452/-i-felt-like-rip-van-winkle-one-of-first-u-s-doctors-with-covid-19-is-back-home

    “ECMO allowed us to sustain his life while we tried other therapies,” says Dr. Krish Patel, an oncologist at Swedish who helped treat Padgett.

    Patel thinks the drug that may have made the difference was something called tocilizumab, an immunosuppressive therapy for conditions such as rheumatoid arthritis. The hope is that it can also tame the immune system overreactions known as cytokine storms, which can ravage a COVID-19 patient’s organs.

    • Replies: @Anon
    The point would be to have a viable home treatment.

    Home treatment is funny. Some show few symptoms and get well. Some bad symptoms and hospital. Some are doing good and suddenly make a turn for the worse. Some get home from hospital and die suddenly next day.

    Tocizu-whatever-the-name is 1,000 usd per shot. Remdesivir only for seriously ill and in hospital setting.

    For home care, it seems Hidroxicloroquine + azithromycin works well. If you throw in Heparin one could get even better numbers. Oximeter & thermometer are musts.

    Personally, for the masses, my money is on Ivermectin at first suspicion of covid. Seems to lower viral load and no adverse effects.

    May I inquire whether you think virus is man-made? Was release deliberate?
  11. I’ve been wondering the same things. The lockdown was predicated on the assumption that large numbers of infected would require hospitals and ventilators; if that’s not the case, then there should be very few people who die solely because they couldn’t get a hospital admission/ventilator.

  12. Here are some recent links of possible interest to our host and the commentariat.

    “I Spent Seven Weeks in a Wuhan ICU. Here’s What I Learned”. By Wu Feng, MD at “Sixth Tone,” a South China based website. April 13, 2020.
    A first-person account by a Guangdong ICU doctor who volunteered in a Wuhan hospital in January and February.

    A Tweet by “Naval” earlier today, with links to 7 recent serology surveys (about half of which have been discussed by Steve).

    Andrew Gelman posted “Concerns with that Stanford study of coronavirus prevalence” at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn’t think the Santa Clara study met that hurdle.

    A current post by economist Lars Christensen, “ONE factor explains most of the differences in Covid19 deaths across countries”.
    Christensen discusses a scatterplot of nations, “Covid-19 fatality rate” vs. “share of males >=80”. Along the lines of Kratoklastes’ critique of my effort to spitball NYC infection rates, Christensen focuses of the outsize impact of Covid-19 on the aged.
    A Nature preprint (accepted but not yet revised after review), dated April 1st. “Virological assessment of hospitalized patients with COVID-2019”. Roman Wölfel et al closely followed nine patients who were identified by contact tracing in late January or early February after becoming infected at a business meeting in Munich. There’s a “Journal Club” style blog post here discussing it. Table 3 (see the free-access PDF) shows that all 9 people seroconverted. Extended Data Table 1 shows that most developed cross-reactivity to one or more of the four endemic strains of coronavirus (can reactivity to an endemic coronavirus confer partial protection?). Figure 2 is a day-by-day record of how much virus each patient produced in nasal secretions, sputum, and stool over the course of their illness and recovery. Some produced over 100 million viruses per millilter of nasal secretions, at the worst points in the first week. That sounds like a lot.

    • Replies: @utu
    Critique of Santa Clara Stanford study by Balaji S. Srinivasan
    https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25
    , @Reg Cæsar

    my effort to spitball NYC infection
     
    Could you please take care to choose less contagious metaphors?


    https://i5.walmartimages.com/asr/00d3130b-585b-40b7-8608-67f2b4f79ef6_1.cdd98036f0bd68f42fbab7dea3cbf06b.jpeg?odnHeight=450&odnWidth=450&odnBg=FFFFFF
    , @AnotherDad

    Andrew Gelman posted “Concerns with that Stanford study of coronavirus prevalence” at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn’t think the Santa Clara study met that hurdle.
     
    My take on the Stanford study as well. Basically useless other than suggesting the infection rate is still very low, which i think most reasonable, non-data-averse people understood.

    We need testing. Some complete samples of a community or a particular population or truly random samples with big N> But regardless the only way to really get good knowledge out of data is when the data is solidly above the level of noise. If tests can have a false positive rate around 1-2%, then we can't say very much other than--"still not very infected"--unless we're up north of 5%.

    That's why i keep going back to the Diamond Princess. A reasonably complete data set that lets us say intelligent things. Not everything you'd like to know, but a pretty solid grasp.

    A current post by economist Lars Christensen, “ONE factor explains most of the differences in Covid19 deaths across countries”.
     
    This deaths-per-million vs. age graph doesn't impress me at all. Yes, in the fullness of time they'll be a pretty strong correlation between age structure and IFR. Zero doubt on that.

    But right now we are very early in the infection and mostly the death counts involve just how early the infection started to spread, what measures were taken, how good are the medical interventions there and how accurately does the nation count.
    , @Telemachos

    In fact the average of people dying with Covid19 have been around 80 years in most countries and men are more likely to die than women.
     
    The disparity is more extreme than I'd thought. In Italy men have been 66% of the dead, but 73% of those age 70-79, 78% of those 60-69, and 79% of those 50-59. It's the large number of women older than 90 that reduces the disparity in the whole group.

    Also, the women who died were slightly more sick to begin with. The median number of comorbidities among women was 3.4, among men 3.2.

    That decision tree paper of Ioannidis says:

    "While men made up a grossly disproportionate number of both hospitalizations and critical illness, this difference was attenuated by multivariable adjustment for comorbidities such that gender was no longer one of the most prominent risk variables."
     
    Which means what? That men in general have more pre-existing conditions than women? Enough to explain such a huge disparity? But 'no longer one of the most prominent' is vague. By how much was the disparity reduced?
  13. I’ve found interesting the discovery of “proning” as a method of treatment. Here we have these news channels putting forth supposed experts, and front line doctors who see this every single day have figured out something so utterly basic (“Hey, let’s roll them over”) but that might actually help significantly in fighting this disease. I applaud doctors that are willing to try and solve the problem, even if it involves something so mundane, which is what I believe good doctors should do. It goes to show good doctors don’t know everything, but are willing to solve problems however they need to be solved. It also brings down to size these experts who think they know it all, and believe more funding is the answer to everything.

    OT, a five year old girl died in Detroit who tested positive for the virus. Of course, it isn’t until paragraph 4 when the article mentions she actually had a “rare form of meningitis”.

    https://www.freep.com/story/news/local/michigan/detroit/2020/04/20/detroit-girl-5-becomes-michigans-first-child-die-covid-19/5163403002/

  14. A hospital in Chicago (iirc) tested Remdisivir with promising results. 123 out of 125 patients went home. Emory University Hospital is currently conducting a double blind trial. Significant b/c Emory is adjacent to the CDC in Atlanta.

    • Replies: @kpkinsunnyphiladelphia
    And, on top of that, I'll be a monkey's uncle!!

    https://www.fiercebiotech.com/research/covid-19-new-animal-data-backs-up-gilead-s-remdesivir-as-other-treatment-candidates-emerge


    COVID-19: New animal data back up Gilead's remdesivir as other treatment candidates emerge

    In a trial involving 12 rhesus macaques, early treatment of COVID-19 with remdesivir reduced symptoms of the disease and lung damage, they reported in a study posted on bioRxiv. Six macaques were treated with the drug, while the others were untreated. Seven days after the start of the study, the macaques treated with remdesivir were significantly healthier than those in the control group...

    ...At the end of the week, all six untreated animals were showing breathing difficulties. Only one of the treated macaques had breathing problems, which were mild...
     
    Folks here may not be aware, but in Pharma, monkeys are used all the time to test efficacy and understand adverse events. PETA folks would be horrified at some of the things these primates are subjected to.
  15. @ic1000
    Here are some recent links of possible interest to our host and the commentariat.

    "I Spent Seven Weeks in a Wuhan ICU. Here’s What I Learned". By Wu Feng, MD at "Sixth Tone," a South China based website. April 13, 2020.
    A first-person account by a Guangdong ICU doctor who volunteered in a Wuhan hospital in January and February.

    A Tweet by "Naval" earlier today, with links to 7 recent serology surveys (about half of which have been discussed by Steve).

    Andrew Gelman posted "Concerns with that Stanford study of coronavirus prevalence" at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn't think the Santa Clara study met that hurdle.

    A current post by economist Lars Christensen, "ONE factor explains most of the differences in Covid19 deaths across countries".
    Christensen discusses a scatterplot of nations, "Covid-19 fatality rate" vs. "share of males >=80". Along the lines of Kratoklastes' critique of my effort to spitball NYC infection rates, Christensen focuses of the outsize impact of Covid-19 on the aged.
    https://marketmonetarist.files.wordpress.com/2020/04/covid19-deaths-pop-1.jpg

    A Nature preprint (accepted but not yet revised after review), dated April 1st. "Virological assessment of hospitalized patients with COVID-2019". Roman Wölfel et al closely followed nine patients who were identified by contact tracing in late January or early February after becoming infected at a business meeting in Munich. There's a "Journal Club" style blog post here discussing it. Table 3 (see the free-access PDF) shows that all 9 people seroconverted. Extended Data Table 1 shows that most developed cross-reactivity to one or more of the four endemic strains of coronavirus (can reactivity to an endemic coronavirus confer partial protection?). Figure 2 is a day-by-day record of how much virus each patient produced in nasal secretions, sputum, and stool over the course of their illness and recovery. Some produced over 100 million viruses per millilter of nasal secretions, at the worst points in the first week. That sounds like a lot.

    • Replies: @res
    That's a good article. I posted a link to it yesterday (one minute short of exactly 24 hours before your comment) in the thread discussing that study.
    https://www.unz.com/isteve/infection-rate-in-silicon-valley-was-under-5-in-early-april/#comment-3847174

    That was 17 comments before you accusing me of wasting energy and space in that thread.

  16. Anon[322] • Disclaimer says:

    NYTimes reported that many countries incl. Spain, UK, France, US are trying to conduct antibodies tests to get a clearer picture, and to see who could go back to work. The problem is no one knows what level of antibodies is enough immunity, and how long that immunity lasts. There is also a major problem with the tests. Most of the tests are currently made in China and they are extremely faulty, with only 30% accuracy, only detecting antibodies in those who have recovered from being severely ill. The exception is Germany.

    German tests are very accurate as they are all made in Germany.

    If there’s one good thing to come out of this fiasco, it is that we finally gain the resolve to bring back our manufacturing capacity. Moving it out of China does not solve the problem, as companies will only move it to other parts of Asia. We need a federal mandate, perhaps an EO, to bring back all our “essential manufacturing” incl. all medicine, medical equipment, high tech and defense manufacturing. Give these companies a 1 year tax holiday to bring back their manufacturing, after that, impose a 30% tax on all imports.

    It’s also high time for our corporations to show their loyalty to the country and their fellow countrymen by sending back all their foreign workers and replacing them with unemployed Americans. Trump needs to seize this opportunity and cancel all work visas incl. H1b, L1, B1, J1, OPT, CPT, H2b, H4b. I am in favor of cancelling all visas for Chinese nationals until the Wuhan lab is thoroughly investigated.

  17. @ic1000
    Here are some recent links of possible interest to our host and the commentariat.

    "I Spent Seven Weeks in a Wuhan ICU. Here’s What I Learned". By Wu Feng, MD at "Sixth Tone," a South China based website. April 13, 2020.
    A first-person account by a Guangdong ICU doctor who volunteered in a Wuhan hospital in January and February.

    A Tweet by "Naval" earlier today, with links to 7 recent serology surveys (about half of which have been discussed by Steve).

    Andrew Gelman posted "Concerns with that Stanford study of coronavirus prevalence" at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn't think the Santa Clara study met that hurdle.

    A current post by economist Lars Christensen, "ONE factor explains most of the differences in Covid19 deaths across countries".
    Christensen discusses a scatterplot of nations, "Covid-19 fatality rate" vs. "share of males >=80". Along the lines of Kratoklastes' critique of my effort to spitball NYC infection rates, Christensen focuses of the outsize impact of Covid-19 on the aged.
    https://marketmonetarist.files.wordpress.com/2020/04/covid19-deaths-pop-1.jpg

    A Nature preprint (accepted but not yet revised after review), dated April 1st. "Virological assessment of hospitalized patients with COVID-2019". Roman Wölfel et al closely followed nine patients who were identified by contact tracing in late January or early February after becoming infected at a business meeting in Munich. There's a "Journal Club" style blog post here discussing it. Table 3 (see the free-access PDF) shows that all 9 people seroconverted. Extended Data Table 1 shows that most developed cross-reactivity to one or more of the four endemic strains of coronavirus (can reactivity to an endemic coronavirus confer partial protection?). Figure 2 is a day-by-day record of how much virus each patient produced in nasal secretions, sputum, and stool over the course of their illness and recovery. Some produced over 100 million viruses per millilter of nasal secretions, at the worst points in the first week. That sounds like a lot.

    my effort to spitball NYC infection

    Could you please take care to choose less contagious metaphors?

    • LOL: ic1000
  18. Steve —

    I just minutes ago communicated with a friend of mine who practices at the University of Maryland Medical School.

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!

    As Yale researchers showed last year, (Kudo et al., National Academy of Sciences, 2019) low ambient humidity hurts the ability of the immune system to fight respiratory viral infection in animal hosts. “Low ambient humidity impairs barrier function and innate resistance against influenza infection.”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561219/

    The Yale group found that at 50% humidity, about half their animal hosts survived a viral respiratory challenge of the flu. At 20% humidity, 100% of the animal hosts died.

    The mechanism is that in very dry air (the 20% humidity of hospitals), the mucosal layer in the respiratory system dries out and organelles called cilia which should clear out viruses are immobilized. The above paper and figure 4 of this one explain the mechanism.

    https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

    I honestly believe hospitals are actually killing patients through incredibly dry air. A couple of generations ago, humidification was a go-to treatment for pneumonia. Now sophisticated climate control systems keep the humidity in hospitals very low.

    The extremely low humidity that hospitals are kept at explains why hospitalized patients are having such bad outcomes.

    My God.

    • Replies: @danand

    "He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!"

     

    Mr. Hessin, hospitals are almost forced to maintain low humidity, if nothing else but to suppress mold growth. The only quick solution that comes to mind is to put the SARS-CoV-2 victims outside in the overflow "tents". Tents have been erected outside all the major health facilities. Retrofit them with fine H2O spray misters; turn them into quasi green houses.

    Where those tents aren't available, they could use"grow tents'' (it is 4/20 after-all, and no, I don't personally imbibe). These can be set up in hours, and are relatively cheap:

    https://flic.kr/p/2iSvYD6

    As you say it's almost unimaginable that the entire medical community is not aware of this already? Is war really that foggy.
    , @res

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!
     
    That is awfully low. I see recommendations for 40-60%.
    https://www.carel.com/documents/10191/0/%2B4000021EN/8ad03ec9-6f9f-4216-8395-b2f95325671f
    Notice the informative chart on page six showing various factors influencing the recommendation. If viruses were the only issue the recommended range would be even higher.

    Any idea why they are keeping his hospital so dry? Can you ask him? Is it possible he is talking only about the OR?
    https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/ASTGuidelinesHumidityintheOR.pdf

    The maintenance of the required level of relative humidity (RH) in the operating room (OR) has been essential to control the growth of microorganisms, prevent electrostatic discharge (ESD), and comfort of the OR team. Additionally, RH level is important to the shelf life of sterile supplies that are stored in the surgery department and the levels established by manufacturers of electromedical devices. The subject of RH level involves a team of healthcare providers working together to identify the issues and develop solutions that includes CSTs, healthcare technology management (HTM; previously referred to as “Biomedical technicians”), and RNs. In 2008 the American Society of Heating, Refrigeration, and Air Conditioning (ASHRAE) revised its standard for the lower level of RH in the OR from 30% to 20% while still keeping the upper level of 60% in place (range now being 20% to 60%).1
     
    I think you will appreciate this Forbes article if you haven't seen it already.
    https://www.forbes.com/sites/leahbinder/2019/10/17/harvard-researcher-says-this-inexpensive-action-will-lower-hospital-infection-rates-and-protect-us-for-the-flu-season
    , @Steve Sailer
    I've had multiple humidifiers going in my house since Dan got on this kick a couple of months ago.

    Thanks!
  19. anonymous[186] • Disclaimer says:

    Tom Hanks and Rita got some. She indicated it was a pretty obnoxious experience. Vomiting, vertigo, etc., but it seemed to stop the virus in it’s tracks for them. Although she covered her ass regarding being perceived as supporting Trump’s contention on the stuff by saying her recovery afterwards could have been a lucky coincidence. Will be fun to see if it wasn’t a coincidence so we can see how many people she might have helped kill by refusing the stuff now. So many entertainment careers being damaged by this virus. I love it.

    Question would be what stage of the Tom Hanks Virus they were at before thay asked to bring out the hard stuff. It’s funny how you don’t give a shit about politics when your rich celebrity ass is on the line:

    “Gimme the Trump Stuff!! For Godssake gimme the Trump Stuff!! NOW, you sonofabitch, NOW!!! I love the man! I do!!! Gimme it! God bless Trump! Gimme the Trump Stufff!!!”

    –Rita and Tom Hanks

    • LOL: Inquiring Mind
  20. I would like to give a shout out to Alachua County, Florida, home of the University of Florida Gators, which has so far had 215 cases of COVID-19, 27 hospitalizations, and zero deaths.

    That is a CFR of 0.

    I don’t know what they are doing, but they must be doing something right. The world might want to beat a path to University of Florida Health Shands Hospital in Gainesville to see what they are up to.

    https://ufhealth.org/uf-health-shands-hospital

    Of course, being a university town, there is a young local population, but on the other hand Gainesville is the regional medical center for the surrounding counties and takes all the cases in north west Florida that are too difficult for the local hospitals and closer to Gainesville than to Tallahassee, which is 150 miles away.

    • Replies: @obwandiyag
    Book-cooking.
    , @Spud Boy
    I visited UF Gainesville once on business when I was in my late 30s. Hottest college women I've ever seen. Wow.
    , @Jonathan Mason
    I should also add to this that the county where I live in Florida has less than 20 cases, and has not had a new case in the last 10 days. Woo-hoo. We are jumping up and down on the curve and squashing it into the dirt. Bad curve!

    I think a lot of credit goes to Walmart where they are making people line up 6-feet apart to wait for a shopping cart with a sanitized push bar.

    At the schools today they were handing out bags of free food. At first I didn't want it, and the teacher said to me "but where are you getting your food?". I replied: "Well we buy it at the supermarket and carry it home", but she seemed to think I needed some, so I accepted it.

    Since physical school is now canceled until August 20th or thereabouts, I guess they need to get rid of frozen stuff. It is mostly disgusting stuff, but we managed to make a couple meals out of it and got 2 dozen small cartons of chocolate milk.
    , @Anon

    That is a CFR of 0.

    I don’t know what they are doing, but they must be doing something right.
     

    They don't accept anyone over 60 or have underlying conditions.:)
  21. Has hydroxychloroquine helped levels 2 and 3? My impression is that it doesn’t do much good for Level 5, but might work pretty well for less severe levels. Has hydroxychloroquine gotten into wide enough use to impact overall IFR rates?

    As one would expect from our esteemed blog proprietor, these are great questions. But, alas, we are not going to get answers to them.

    Common sense tells you that the combination of hydroxychloroquine and zinc (gotta have the zinc!) is prophylactic, but not curative, given its “mechanism of action” in vitro. By the time you are on a ventilator the virus has got its mitts onto you and your are in deep trouble — the damage is done.

    To assess the regimen’s value at all phases would require an enormous stratified subject pool by age, co-morbidity and serological testing that has them infection free at the start, then evaluated over an extended period of time, with the virus active enough so you could actually see infections and prophylaxis. But how would you REALLY know?

    Imagine you have two persons, both 40, one who gets the treatment and one who doesn’t. Both get infected. Both are asymptomatic and move through the disease phase smoothly. Maybe person A did so because of the treatment; maybe not. Maybe person B moved through because, well, there are confounding variables we CAN’T see that make him less likely to have a bad disease course no matter what.

    This is the inherent problem with double blind studies in the pharma space. It’s why the FDA got huge pushback on Avastin, when they said it didn’t make a difference but some breast cancer patients were adamant that it saved them, and it probably did.

    Ideal scientific experiments hold everything constant but one variable and measure outcomes. If you can’t keep it to one variable, your experiment is much much weaker.

  22. Sweden Is Right. The Economy Should be Left Open – Mike Whitney, UNZ

    The piece debunks itself when it quotes a Swedish epidemiologist who says:

    “The truth is that we have a policy similar to that of other countries,” says Anders Tegnell, Sweden’s state epidemiologist, “Like everyone, we are trying to slow down the rate of infection … The differences derive from a different tradition and from a different culture that prevail in Sweden. We prefer voluntary measures, and there is a high level of trust here between the population and the authorities, so we are able to avoid coercive restrictions”
    Sweden can do without orders of social distancing because its people will socially distance voluntarily when asked. That works because “there is a high level of trust here between the population and the authorities”. That does not hold for the community of Somali people and other immigrants in Sweden more of whom are dying than in any other group.

    Now project such a voluntary attempt onto the U.S. public where there is little, if any, trust between the population and the authorities. It simply would not work and one would soon have a runaway epidemic with all its bad consequences. Whitney’s conclusion that we should all do like Sweden is thus not justified.

    https://www.moonofalabama.org/2020/04/the-moa-week-in-review-open-thread-2020-31.html#more

  23. @Jonathan Mason
    I would like to give a shout out to Alachua County, Florida, home of the University of Florida Gators, which has so far had 215 cases of COVID-19, 27 hospitalizations, and zero deaths.

    That is a CFR of 0.

    I don't know what they are doing, but they must be doing something right. The world might want to beat a path to University of Florida Health Shands Hospital in Gainesville to see what they are up to.

    https://ufhealth.org/uf-health-shands-hospital

    Of course, being a university town, there is a young local population, but on the other hand Gainesville is the regional medical center for the surrounding counties and takes all the cases in north west Florida that are too difficult for the local hospitals and closer to Gainesville than to Tallahassee, which is 150 miles away.

    Book-cooking.

  24. Looking at California, an average of about 1600 people die from flu, pneumonia, or upper respiratory disease each month. We’re at about 1200 deaths attributed to CV so far. I would be extremely surprised if we still have the 1600 for flu, pneumonia, and upper respiratory plus the additional CV deaths. I think there’s more than enough evidence to support protecting the old and sick, and letting everyone else who desires go back to pre CV activity.

  25. Has hydroxychloroquine helped levels 2 and 3?

    How about its nasty effect on hearts? Is it so concentrated on people already prone to fibrillation that you can simply deny them the treatment and risk it on everyone else?

  26. Has hydroxychloroquine helped levels 2 and 3? My impression is that it doesn’t do much good for Level 5, but might work pretty well for less severe levels. Has hydroxychloroquine gotten into wide enough use to impact overall IFR rates?

    Good questions. I hope we start getting some answers. If hydroxychloroquine does help reduce fatalities that might help explain the low IFR seen in the Kaiser Permanente study.

    I also wonder whether hydroxychloroquine might increase the average infection-death lag. That could make IFR inference from death rates more difficult.

    • Agree: danand
  27. Hail says: • Website

    Infection Fatality Rates Under Different Scenarios

    How about a modified IFR calculation, “expected years of aggregate, all-population life-years and life-years-equivalent lost?” under different scenarios?

    My calculation is that the Coronavirus Response is causing literally hundreds of times more net lost life-years than it is purported to be saving (if it is saving any at all). (Except for Sweden and some others.)

    There are a lot of variables, but it’s plausible the response is even causing (will cause) thousands of times more net lost life-years than it saves. At least hundreds.

  28. @Jonathan Mason
    I would like to give a shout out to Alachua County, Florida, home of the University of Florida Gators, which has so far had 215 cases of COVID-19, 27 hospitalizations, and zero deaths.

    That is a CFR of 0.

    I don't know what they are doing, but they must be doing something right. The world might want to beat a path to University of Florida Health Shands Hospital in Gainesville to see what they are up to.

    https://ufhealth.org/uf-health-shands-hospital

    Of course, being a university town, there is a young local population, but on the other hand Gainesville is the regional medical center for the surrounding counties and takes all the cases in north west Florida that are too difficult for the local hospitals and closer to Gainesville than to Tallahassee, which is 150 miles away.

    I visited UF Gainesville once on business when I was in my late 30s. Hottest college women I’ve ever seen. Wow.

  29. OK, what can I do to decrease my chances of permanent injury or dying from COVAD-19?

    Answer: Exercise.

    It increases your extracellular superoxide dismutase (EcSOD).

    From PubMed, Extracellular superoxide dismutase, a molecular transducer of health benefits of exercise.

    “In this review we will discuss the findings in humans and animal studies supporting the benefits of EcSOD induced by exercise training in reducing oxidative stress in various tissues. In particularly, we will highlight the importance of skeletal muscle EcSOD, which is induced by endurance exercise and redistributed through the circulation to the peripheral tissues, as a molecular transducer of exercise training to confer protection against oxidative stress and damage in various disease conditions.”

  30. @Jonathan Mason
    I would like to give a shout out to Alachua County, Florida, home of the University of Florida Gators, which has so far had 215 cases of COVID-19, 27 hospitalizations, and zero deaths.

    That is a CFR of 0.

    I don't know what they are doing, but they must be doing something right. The world might want to beat a path to University of Florida Health Shands Hospital in Gainesville to see what they are up to.

    https://ufhealth.org/uf-health-shands-hospital

    Of course, being a university town, there is a young local population, but on the other hand Gainesville is the regional medical center for the surrounding counties and takes all the cases in north west Florida that are too difficult for the local hospitals and closer to Gainesville than to Tallahassee, which is 150 miles away.

    I should also add to this that the county where I live in Florida has less than 20 cases, and has not had a new case in the last 10 days. Woo-hoo. We are jumping up and down on the curve and squashing it into the dirt. Bad curve!

    I think a lot of credit goes to Walmart where they are making people line up 6-feet apart to wait for a shopping cart with a sanitized push bar.

    At the schools today they were handing out bags of free food. At first I didn’t want it, and the teacher said to me “but where are you getting your food?”. I replied: “Well we buy it at the supermarket and carry it home”, but she seemed to think I needed some, so I accepted it.

    Since physical school is now canceled until August 20th or thereabouts, I guess they need to get rid of frozen stuff. It is mostly disgusting stuff, but we managed to make a couple meals out of it and got 2 dozen small cartons of chocolate milk.

  31. Has hydroxychloroquine helped levels 2 and 3? My impression is that it doesn’t do much good for Level 5, but might work pretty well for less severe levels.

    That is why you need controlled studies. Considering that the fatal dose of hydrochloroquine is only about double the therapeutic dose, it is hardly a safe drug. Supposing you forgot you already took it and took another dose just to be sure and then killed yourself? (Old people get easily confused.)

    https://www.nytimes.com/2020/04/12/health/chloroquine-coronavirus-trump.html

    The Brazilian study involved 81 hospitalized patients in the city of Manaus and was sponsored by the Brazilian state of Amazonas.

    Roughly half the study participants were given a dose of 450 milligrams of chloroquine twice daily for five days, while the rest were prescribed a higher dose of 600 milligrams for 10 days. Within three days, researchers started noticing heart arrhythmias in patients taking the higher dose. By the sixth day of treatment, 11 patients had died, leading to an immediate end to the high-dose segment of the trial.

  32. @Art Deco
    My guess is that the Diamond Princess data give us a passable idea of how lethal this is for people over 60 with a symptomatic infection (about 5% die). The Italian data available at Statista suggest that mortality is intensely concentrated among people over 60; the New York data suggest a less intense but still quite marked concentration among the old. Our problem has been that we did not have enough protective equipment for people under 50 and for people under 60 w/o certain problems (e.g. obesity). Had we had the equipment, we could have had a social distancing regime which isolated the old and the obese but permitted all but an odd minority of the remainder to continue working. We need those masks, we need that sanitizer, and we need to keep away from each other, but we don't need to be idled.

    We need those masks, we need that sanitizer, and we need to keep away from each other, but we don’t need to be idled.

    That’s the Swedish model, which is working fine (https://www.google.com/search?q=swedish+covid-19+figures&rlz=1C1CHBF_enUS777US777&oq=Swedish+covid-19&aqs=chrome.2.69i57j0l2.17309j1j7&sourceid=chrome&ie=UTF-8), compared with the U.S. lockdown approach (https://www.google.com/search?q=new+york+covid+numbers&rlz=1C1CHBF_enUS777US777&oq=New+York+covid+numbers&aqs=chrome.0.0l8.10237j1j7&sourceid=chrome&ie=UTF-8)

    Indeed, by the time we come crawling out of our holes to inevitably get infected anyway, Sweden will be at or near herd immunity. Whereas, we probably just made everything worse by destroying our economy in a pointless effort to flatten (and thereby lengthen) the curve of infection.

    Third World countries that are doing nothing by default are likely having a similar experience to Sweden, but since they don’t do any testing or record keeping it’s not obvious yet.

    When historians are finally able to look back with some perspective on the Great Wu-Flu Panic of 2020, the blame will fall on: (a) The Chinese for lying to the world while the virus spread; (b) The media and public health officials for whip-lashing in two weeks from “it’s no problem” to “we’re all going to die;” and (c) The CDC, FDA and public health officials for failing to plan ahead and being totally incompetent in testing, data collection, and production and distribution of medical supplies.

    In short, a complete and total clusterf**k in response to an epidemic that everyone knew was going to happen at some point.

  33. @James Speaks
    A hospital in Chicago (iirc) tested Remdisivir with promising results. 123 out of 125 patients went home. Emory University Hospital is currently conducting a double blind trial. Significant b/c Emory is adjacent to the CDC in Atlanta.

    And, on top of that, I’ll be a monkey’s uncle!!

    https://www.fiercebiotech.com/research/covid-19-new-animal-data-backs-up-gilead-s-remdesivir-as-other-treatment-candidates-emerge

    COVID-19: New animal data back up Gilead’s remdesivir as other treatment candidates emerge

    In a trial involving 12 rhesus macaques, early treatment of COVID-19 with remdesivir reduced symptoms of the disease and lung damage, they reported in a study posted on bioRxiv. Six macaques were treated with the drug, while the others were untreated. Seven days after the start of the study, the macaques treated with remdesivir were significantly healthier than those in the control group…

    …At the end of the week, all six untreated animals were showing breathing difficulties. Only one of the treated macaques had breathing problems, which were mild…

    Folks here may not be aware, but in Pharma, monkeys are used all the time to test efficacy and understand adverse events. PETA folks would be horrified at some of the things these primates are subjected to.

  34. @utu
    Critique of Santa Clara Stanford study by Balaji S. Srinivasan
    https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25

    That’s a good article. I posted a link to it yesterday (one minute short of exactly 24 hours before your comment) in the thread discussing that study.
    https://www.unz.com/isteve/infection-rate-in-silicon-valley-was-under-5-in-early-april/#comment-3847174

    That was 17 comments before you accusing me of wasting energy and space in that thread.

    • LOL: utu
  35. @DanHessinMD
    Steve --

    I just minutes ago communicated with a friend of mine who practices at the University of Maryland Medical School.

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!

    As Yale researchers showed last year, (Kudo et al., National Academy of Sciences, 2019) low ambient humidity hurts the ability of the immune system to fight respiratory viral infection in animal hosts. "Low ambient humidity impairs barrier function and innate resistance against influenza infection."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561219/

    The Yale group found that at 50% humidity, about half their animal hosts survived a viral respiratory challenge of the flu. At 20% humidity, 100% of the animal hosts died.

    The mechanism is that in very dry air (the 20% humidity of hospitals), the mucosal layer in the respiratory system dries out and organelles called cilia which should clear out viruses are immobilized. The above paper and figure 4 of this one explain the mechanism.

    https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

    I honestly believe hospitals are actually killing patients through incredibly dry air. A couple of generations ago, humidification was a go-to treatment for pneumonia. Now sophisticated climate control systems keep the humidity in hospitals very low.

    The extremely low humidity that hospitals are kept at explains why hospitalized patients are having such bad outcomes.

    My God.

    “He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!”

    Mr. Hessin, hospitals are almost forced to maintain low humidity, if nothing else but to suppress mold growth. The only quick solution that comes to mind is to put the SARS-CoV-2 victims outside in the overflow “tents”. Tents have been erected outside all the major health facilities. Retrofit them with fine H2O spray misters; turn them into quasi green houses.

    Where those tents aren’t available, they could use”grow tents” (it is 4/20 after-all, and no, I don’t personally imbibe). These can be set up in hours, and are relatively cheap:

    covid tent

    As you say it’s almost unimaginable that the entire medical community is not aware of this already? Is war really that foggy.

    • Replies: @res

    hospitals are almost forced to maintain low humidity, if nothing else but to suppress mold growth.
     
    Not 20% low. See my other comment with numbers and references. In particular, the page 6 chart I mention does a good job of capturing the tradeoffs involved.
  36. The infection fatality rate of COVID-19 is about the same as that of the flu. Prof. Ioannidis updates us on what the latest evidence shows (4/20/2020):
    https://www.youtube.com/embed/cwPqmLoZA4s

    • Replies: @BB753
    I can't wait for Greg Cochran's reaction to Ioannidis assertions and his mustachioed Greek smirk! Lol!
  37. @DanHessinMD
    Steve --

    I just minutes ago communicated with a friend of mine who practices at the University of Maryland Medical School.

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!

    As Yale researchers showed last year, (Kudo et al., National Academy of Sciences, 2019) low ambient humidity hurts the ability of the immune system to fight respiratory viral infection in animal hosts. "Low ambient humidity impairs barrier function and innate resistance against influenza infection."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561219/

    The Yale group found that at 50% humidity, about half their animal hosts survived a viral respiratory challenge of the flu. At 20% humidity, 100% of the animal hosts died.

    The mechanism is that in very dry air (the 20% humidity of hospitals), the mucosal layer in the respiratory system dries out and organelles called cilia which should clear out viruses are immobilized. The above paper and figure 4 of this one explain the mechanism.

    https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

    I honestly believe hospitals are actually killing patients through incredibly dry air. A couple of generations ago, humidification was a go-to treatment for pneumonia. Now sophisticated climate control systems keep the humidity in hospitals very low.

    The extremely low humidity that hospitals are kept at explains why hospitalized patients are having such bad outcomes.

    My God.

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!

    That is awfully low. I see recommendations for 40-60%.
    https://www.carel.com/documents/10191/0/%2B4000021EN/8ad03ec9-6f9f-4216-8395-b2f95325671f
    Notice the informative chart on page six showing various factors influencing the recommendation. If viruses were the only issue the recommended range would be even higher.

    Any idea why they are keeping his hospital so dry? Can you ask him? Is it possible he is talking only about the OR?
    https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/ASTGuidelinesHumidityintheOR.pdf

    The maintenance of the required level of relative humidity (RH) in the operating room (OR) has been essential to control the growth of microorganisms, prevent electrostatic discharge (ESD), and comfort of the OR team. Additionally, RH level is important to the shelf life of sterile supplies that are stored in the surgery department and the levels established by manufacturers of electromedical devices. The subject of RH level involves a team of healthcare providers working together to identify the issues and develop solutions that includes CSTs, healthcare technology management (HTM; previously referred to as “Biomedical technicians”), and RNs. In 2008 the American Society of Heating, Refrigeration, and Air Conditioning (ASHRAE) revised its standard for the lower level of RH in the OR from 30% to 20% while still keeping the upper level of 60% in place (range now being 20% to 60%).1

    I think you will appreciate this Forbes article if you haven’t seen it already.
    https://www.forbes.com/sites/leahbinder/2019/10/17/harvard-researcher-says-this-inexpensive-action-will-lower-hospital-infection-rates-and-protect-us-for-the-flu-season

  38. @danand

    "He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!"

     

    Mr. Hessin, hospitals are almost forced to maintain low humidity, if nothing else but to suppress mold growth. The only quick solution that comes to mind is to put the SARS-CoV-2 victims outside in the overflow "tents". Tents have been erected outside all the major health facilities. Retrofit them with fine H2O spray misters; turn them into quasi green houses.

    Where those tents aren't available, they could use"grow tents'' (it is 4/20 after-all, and no, I don't personally imbibe). These can be set up in hours, and are relatively cheap:

    https://flic.kr/p/2iSvYD6

    As you say it's almost unimaginable that the entire medical community is not aware of this already? Is war really that foggy.

    hospitals are almost forced to maintain low humidity, if nothing else but to suppress mold growth.

    Not 20% low. See my other comment with numbers and references. In particular, the page 6 chart I mention does a good job of capturing the tradeoffs involved.

  39. @TomSchmidt
    There's also squaring the difference between the IFR from Santa Clara (.09-.15%) and NYC (clearly well north of .15%), given >13000 excess deaths in the city, and a population of 8.9mm.

    Maybe the SC virus is a different, less deadly variant than the NYC virus, with the latter being
    European and the former Asian?

    The demographics and density are very different in NYC compared to Santa Clara.

    NYC is 25% Black compared to 2% Black in SC.
    40% Asian in Santa Clara verse 14% in NYC
    Average age in Santa Clara is 33 verse 41 in NYC

    So we would expect the IFR to be significantly higher in NYC due to the different demographics.

    • Replies: @TomSchmidt
    Yes,it could just be that simple. I'd think the more important point is %over 65. Black correlates better with obesity, too, while Asians in NYC are less affected.
  40. Does COVID-19, its treatment, and potential fatality rates really matter anymore? We have bigger fish to fry.

  41. If anyone on this thread wants to help save lives, getting the message out that hospitals need to put humidity at 50% instead of 20% would be a great start. Hospitals are chilling and dessicating their patients’ lungs, and killing tons of people. You’d think one of the networks could spare one minute from their Trump Derangement programming to provide one particle of useful knowledge. And you would be wrong.

    Hospitals seem inexplicably incapable of treating this. Well that is because they are actually harming their charges.

    I think this is why third world countries are actually doing so much better at treating this. They aren’t dessicating their patients’ lungs.

    “As you say it’s almost unimaginable that the entire medical community is not aware of this already? Is war really that foggy.”

    Apparently.

  42. @Art Deco
    My guess is that the Diamond Princess data give us a passable idea of how lethal this is for people over 60 with a symptomatic infection (about 5% die). The Italian data available at Statista suggest that mortality is intensely concentrated among people over 60; the New York data suggest a less intense but still quite marked concentration among the old. Our problem has been that we did not have enough protective equipment for people under 50 and for people under 60 w/o certain problems (e.g. obesity). Had we had the equipment, we could have had a social distancing regime which isolated the old and the obese but permitted all but an odd minority of the remainder to continue working. We need those masks, we need that sanitizer, and we need to keep away from each other, but we don't need to be idled.

    I don’t disagree with any of this. But I’ve been ignoring the lockdown consistently here in NYC. I’ve been going to my office everyday since Cuomo declared the State’s quarantine.

    Walking around the city, I’ve noticed that quite a large percentage of the people also ignoring the lockdown are quite old (as in older the boomer age). I don’t have an answer for why this is. But it may be that a lot of old people (maybe it’s a NYC thing) know their time is probably limited and aren’t going to be forced into hiding for who knows how long. They have less fear than the boomers although their risk is much greater.

  43. @Travis
    here in New Jersey they predicted a shortage of ICU beds 2 weeks ago...this never occurred.
    they also predicted ~16,000 hospitalized and only 7,000 have been hospitalized. So the predicted were way off for hospitalizations.

    Maybe the Trump Tonic prevents many patients from being hospitalized. In addition to patients getting hydroxychloroquine many people began taking zinc and other vitamins to protect themselves and treat their minor symptoms which may have prevented thousands of hospitalizations.

    In the weeks before the lockdown our local stores were sold out of vitamin C and zinc lozenges and Airborne. This was back in the first week of March.

    Since all the vitamins were sold out weeks ago , I assume people have been taking more vitamins than usual over the last 4 weeks in an attempt to build up their immune systems to fight the virus. Maybe this has also had an effect on hospitalizations. Everyone in my family has been taking Vitamin D, C and zinc for the last 4 weeks. I also began drinking green tea and Tonic Water each day. Maybe it is working, we have not gotten sick despite living in an area where 30% have been infected and we have 3 children who were in School until March 18.

    You have confirmation that 30% in your area have been infected? Do you mind me asking where you have read that? That seems quite high and I live in Westchester.

  44. @GalenMD
    The infection fatality rate of COVID-19 is about the same as that of the flu. Prof. Ioannidis updates us on what the latest evidence shows (4/20/2020):
    https://www.youtube.com/embed/cwPqmLoZA4s

    I can’t wait for Greg Cochran’s reaction to Ioannidis assertions and his mustachioed Greek smirk! Lol!

  45. @Old and Grumpy
    It use to be a ventilator was just primarily used to keep the dying comfortable til the end. Not surprised it isn't effective. From what I read hydroxychloroquine is used with zinc. Don't most medications deplete users of zinc? If so, that would explain why it is impacting the old. It seems like once you get to fifty, your whole purpose is to keep pharmaceutical companies in the black. Perhaps the most interesting tidbit coming out recently is that 40% of Boston's homeless testing positive despite having no systems. Can that really be true? Would that make hardship and outdoors the solution?

    Perhaps the most interesting tidbit coming out recently is that 40% of Boston’s homeless testing positive despite having no systems. Can that really be true? Would that make hardship and outdoors the solution?

    Maybe it’s the because the homeless aren’t on all those wonderful drugs they ply the middle-aged and elderly with? Among the many other things possibly not being measured, is anyone tracking prescription drug use and correlating against Corona deaths?

    Anyway, being outdoors is actually a great way to not get the virus.

    • Replies: @TomSchmidt
    But the comment is 40% of our "urban outdoorsmen" have it.
  46. @Jonathan Mason
    I would like to give a shout out to Alachua County, Florida, home of the University of Florida Gators, which has so far had 215 cases of COVID-19, 27 hospitalizations, and zero deaths.

    That is a CFR of 0.

    I don't know what they are doing, but they must be doing something right. The world might want to beat a path to University of Florida Health Shands Hospital in Gainesville to see what they are up to.

    https://ufhealth.org/uf-health-shands-hospital

    Of course, being a university town, there is a young local population, but on the other hand Gainesville is the regional medical center for the surrounding counties and takes all the cases in north west Florida that are too difficult for the local hospitals and closer to Gainesville than to Tallahassee, which is 150 miles away.

    That is a CFR of 0.

    I don’t know what they are doing, but they must be doing something right.

    They don’t accept anyone over 60 or have underlying conditions.:)

  47. @FPD72
    Until we have much more testing, it’s meaningless to discuss IFRs, since we have little idea of the denominator. For example, I don’t think we can extrapolate Stanford’s Santa Clara County results to the entire nation and say that the number infected is 55-80 times more than we thought, any more than we can extrapolate the Telluride, CO results. I think it’s better to discuss the Case Fatality Rate, especially in the context of what treatments might be effective.

    But now there’s better data from LA County Health Dept and USC, showing essentially the same thing. The LA data really is a random sample, and the number of people they found (6 percent of males, 2 percent of females) with antibodies exceeds the potential false-positive rate of the test by a comfortable margin. Now that we are finally getting some actual data on how many people have been infected, it turns out that the corona virus is more contagious than the flu, but no more than twice as deadly. The shutdowns are both ineffective and unnecessary.

    • Agree: GalenMD
  48. @ic1000
    Here are some recent links of possible interest to our host and the commentariat.

    "I Spent Seven Weeks in a Wuhan ICU. Here’s What I Learned". By Wu Feng, MD at "Sixth Tone," a South China based website. April 13, 2020.
    A first-person account by a Guangdong ICU doctor who volunteered in a Wuhan hospital in January and February.

    A Tweet by "Naval" earlier today, with links to 7 recent serology surveys (about half of which have been discussed by Steve).

    Andrew Gelman posted "Concerns with that Stanford study of coronavirus prevalence" at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn't think the Santa Clara study met that hurdle.

    A current post by economist Lars Christensen, "ONE factor explains most of the differences in Covid19 deaths across countries".
    Christensen discusses a scatterplot of nations, "Covid-19 fatality rate" vs. "share of males >=80". Along the lines of Kratoklastes' critique of my effort to spitball NYC infection rates, Christensen focuses of the outsize impact of Covid-19 on the aged.
    https://marketmonetarist.files.wordpress.com/2020/04/covid19-deaths-pop-1.jpg

    A Nature preprint (accepted but not yet revised after review), dated April 1st. "Virological assessment of hospitalized patients with COVID-2019". Roman Wölfel et al closely followed nine patients who were identified by contact tracing in late January or early February after becoming infected at a business meeting in Munich. There's a "Journal Club" style blog post here discussing it. Table 3 (see the free-access PDF) shows that all 9 people seroconverted. Extended Data Table 1 shows that most developed cross-reactivity to one or more of the four endemic strains of coronavirus (can reactivity to an endemic coronavirus confer partial protection?). Figure 2 is a day-by-day record of how much virus each patient produced in nasal secretions, sputum, and stool over the course of their illness and recovery. Some produced over 100 million viruses per millilter of nasal secretions, at the worst points in the first week. That sounds like a lot.

    Andrew Gelman posted “Concerns with that Stanford study of coronavirus prevalence” at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn’t think the Santa Clara study met that hurdle.

    My take on the Stanford study as well. Basically useless other than suggesting the infection rate is still very low, which i think most reasonable, non-data-averse people understood.

    We need testing. Some complete samples of a community or a particular population or truly random samples with big N> But regardless the only way to really get good knowledge out of data is when the data is solidly above the level of noise. If tests can have a false positive rate around 1-2%, then we can’t say very much other than–“still not very infected”–unless we’re up north of 5%.

    That’s why i keep going back to the Diamond Princess. A reasonably complete data set that lets us say intelligent things. Not everything you’d like to know, but a pretty solid grasp.

    A current post by economist Lars Christensen, “ONE factor explains most of the differences in Covid19 deaths across countries”.

    This deaths-per-million vs. age graph doesn’t impress me at all. Yes, in the fullness of time they’ll be a pretty strong correlation between age structure and IFR. Zero doubt on that.

    But right now we are very early in the infection and mostly the death counts involve just how early the infection started to spread, what measures were taken, how good are the medical interventions there and how accurately does the nation count.

  49. @peterike

    Perhaps the most interesting tidbit coming out recently is that 40% of Boston’s homeless testing positive despite having no systems. Can that really be true? Would that make hardship and outdoors the solution?
     
    Maybe it's the because the homeless aren't on all those wonderful drugs they ply the middle-aged and elderly with? Among the many other things possibly not being measured, is anyone tracking prescription drug use and correlating against Corona deaths?

    Anyway, being outdoors is actually a great way to not get the virus.

    But the comment is 40% of our “urban outdoorsmen” have it.

  50. @DanHessinMD
    Steve --

    I just minutes ago communicated with a friend of mine who practices at the University of Maryland Medical School.

    He informed me that the humidity at the hospital is kept at 20%! That is incredibly, artificially, dry!

    As Yale researchers showed last year, (Kudo et al., National Academy of Sciences, 2019) low ambient humidity hurts the ability of the immune system to fight respiratory viral infection in animal hosts. "Low ambient humidity impairs barrier function and innate resistance against influenza infection."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561219/

    The Yale group found that at 50% humidity, about half their animal hosts survived a viral respiratory challenge of the flu. At 20% humidity, 100% of the animal hosts died.

    The mechanism is that in very dry air (the 20% humidity of hospitals), the mucosal layer in the respiratory system dries out and organelles called cilia which should clear out viruses are immobilized. The above paper and figure 4 of this one explain the mechanism.

    https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

    I honestly believe hospitals are actually killing patients through incredibly dry air. A couple of generations ago, humidification was a go-to treatment for pneumonia. Now sophisticated climate control systems keep the humidity in hospitals very low.

    The extremely low humidity that hospitals are kept at explains why hospitalized patients are having such bad outcomes.

    My God.

    I’ve had multiple humidifiers going in my house since Dan got on this kick a couple of months ago.

    Thanks!

    • Replies: @Jenner Ickham Errican

    I’ve had multiple humidifiers going in my house
     
    Uh Steve, be careful…

    Don’t end up getting sick due to potential toxic mold exposure.

    https://en.wikipedia.org/wiki/Mold_health_issues#Exposure_sources_and_prevention

    Prevention of mold exposure and its ensuing health issues begins with prevention of mold growth in the first place by avoiding a mold-supporting environment such as humid air.
     
    , @TomSchmidt
    There's some logic to the idea, based in keeping the cilia healthy and sweeping things out of the lungs.

    We spent much of the 60s looking for the chemicals disrupting life, after Rachel Carson's Silent Spring. The 1965 surgeon general's report found, not surprisingly, a correlation between smoking and cancer. We've also been on the case against asbestos since the 70s, and there's no question that mesothelioma results from inhalation of asbestos fibers. Interestingly, there's American white asbestos and cheaper Chinese blue asbestos; the latter has fibers that are like sharp needles that catch in the lung passageways, and is the probable culprit in asbestosis and cancer.

    Since the 1960s, we have also found that some cancers result from infection. The clearest case is cervical cancer.

    One proposed theory on lung cancers is that smoking, and asbestos, paralyze or destroy the cilia moving infectious agents out of the lungs. Aside from pneumonia, this would also allow other pathogens access to lung tissue. If any were viruses similar to HPV, they might kick off the chain of events leading to lung cancer.

  51. @Thoughts
    My impression has been that there has been no treatment for the vast majority of symptomatic people so you either pull through or get to level 5 before you get to ICU and then ICU is just your death bed.

    The one case I know of the doctors laughed at the guy for 2 weeks before his wife found a lung specialist willing to take it seriously. Then he was still sent home awaiting a positive test. No word on Hydroxychloroquine. No word on if he got anything. He's fine now though. 2 weeks of up and down flu but fine.

    I think this is the vast majority of symptomatic people. They get ignored and ignored, they get denied chloroquine etc etc...Then they get really ill and die.

    So if your symptomatic you need to get the right treatment early on so you don't get too far down the path of no return.

    You need to take your health in your own hands...if you start to get the flu, you need to get to the hospital or a doctor who can prescribe stuff ASAP and not waste time

    well stated.

    Unfortunately in New York access to Hydroxychloroquine is banned outside of a hospital. In New Jersey Hydroxychloroquine is not for sale at any pharmacy. You need to be admitted to a hospital to obtain access to Hydroxychloroquine or any of the anti-virile medications. The Health commissioner is telling all residents with symptoms stay home…if your symptoms get worse and you are having trouble breathing then you can go to the hospital and get treated.

    We have stocked up on Tonic water and vitamins, hopefully this will keep us out of the hospital. 40% of those in my county already have CV. So half the people we encounter are probably infected. Still unable to obtain masks, but have enough tonic water to last 10 more days.

    • Replies: @res

    40% of those in my county already have CV.
     
    What do you base that on?
  52. @Travis
    well stated.

    Unfortunately in New York access to Hydroxychloroquine is banned outside of a hospital. In New Jersey Hydroxychloroquine is not for sale at any pharmacy. You need to be admitted to a hospital to obtain access to Hydroxychloroquine or any of the anti-virile medications. The Health commissioner is telling all residents with symptoms stay home...if your symptoms get worse and you are having trouble breathing then you can go to the hospital and get treated.

    We have stocked up on Tonic water and vitamins, hopefully this will keep us out of the hospital. 40% of those in my county already have CV. So half the people we encounter are probably infected. Still unable to obtain masks, but have enough tonic water to last 10 more days.

    40% of those in my county already have CV.

    What do you base that on?

    • Replies: @Travis
    775 known deaths in Essex County , NJ. If the fatality rate is .5% then we had about 156,000 cases 3 weeks ago and the number of cases would have doubled over the last 21 days to 312,000 cases which is about 40% of the population of my county.
  53. Anon[540] • Disclaimer says:
    @utu
    One doctor in Seattle survived by being moved to another hospital that had ECMO (extracorporeal membrane oxygenation).

    https://www.npr.org/sections/coronavirus-live-updates/2020/04/13/833734452/-i-felt-like-rip-van-winkle-one-of-first-u-s-doctors-with-covid-19-is-back-home

    "ECMO allowed us to sustain his life while we tried other therapies," says Dr. Krish Patel, an oncologist at Swedish who helped treat Padgett.

    Patel thinks the drug that may have made the difference was something called tocilizumab, an immunosuppressive therapy for conditions such as rheumatoid arthritis. The hope is that it can also tame the immune system overreactions known as cytokine storms, which can ravage a COVID-19 patient's organs.
     

    The point would be to have a viable home treatment.

    Home treatment is funny. Some show few symptoms and get well. Some bad symptoms and hospital. Some are doing good and suddenly make a turn for the worse. Some get home from hospital and die suddenly next day.

    Tocizu-whatever-the-name is 1,000 usd per shot. Remdesivir only for seriously ill and in hospital setting.

    For home care, it seems Hidroxicloroquine + azithromycin works well. If you throw in Heparin one could get even better numbers. Oximeter & thermometer are musts.

    Personally, for the masses, my money is on Ivermectin at first suspicion of covid. Seems to lower viral load and no adverse effects.

    May I inquire whether you think virus is man-made? Was release deliberate?

    • Replies: @utu
    "May I inquire whether you think virus is man-made? Was release deliberate?" - We will never know.
  54. @res

    40% of those in my county already have CV.
     
    What do you base that on?

    775 known deaths in Essex County , NJ. If the fatality rate is .5% then we had about 156,000 cases 3 weeks ago and the number of cases would have doubled over the last 21 days to 312,000 cases which is about 40% of the population of my county.

    • Replies: @res
    Thanks for elaborating! Those seem like reasonable assumptions. With what I find to be a shocking result (40% have been infected). That should be getting close to herd immunity. Have you tried that analysis on other counties?

    It would be interesting to do a bulk version of that analysis for US counties and create a map showing estimated proportion infected. It would probably be necessary to tweak the doubling times though.
  55. I have a related question that perhaps someone can answer. I haven’t taken the time to read Steve lately, so I’ve missed it if it’s already been asked.

    There’s a lot of commentary about critical cases, e.g., lots die even with treatment, and about asymptomatic and mild cases, but not so much about ‘serious’ cases, which is generally said to be the 10-15% of officially diagnosed cases that are not critical but supposedly require hospitalization. What happens to serious cases that don’t get hospitalized? What does hospitalization entail, just mainly oxygen support?

  56. @Steve Sailer
    I've had multiple humidifiers going in my house since Dan got on this kick a couple of months ago.

    Thanks!

    I’ve had multiple humidifiers going in my house

    Uh Steve, be careful…

    Don’t end up getting sick due to potential toxic mold exposure.

    https://en.wikipedia.org/wiki/Mold_health_issues#Exposure_sources_and_prevention

    Prevention of mold exposure and its ensuing health issues begins with prevention of mold growth in the first place by avoiding a mold-supporting environment such as humid air.

    • Replies: @Steve Sailer
    Hopefully we'll be able to turn the heater off until the fall pretty soon.
    , @Telemachos

    Don’t end up getting sick due to potential toxic mold exposure.
     
    Yes, my doctor warned me of that years ago, and I replaced the humidifier with an old-fashioned boiling kettle. Easy to clean the interior of a kettle. Of course I can't keep a kettle boiling while I sleep but periodic use is enough.

    BTW, it's astounding to me how dry and over-heated so many NY interiors are. (and then over-air-conditioned in summer.)
  57. @Jenner Ickham Errican

    I’ve had multiple humidifiers going in my house
     
    Uh Steve, be careful…

    Don’t end up getting sick due to potential toxic mold exposure.

    https://en.wikipedia.org/wiki/Mold_health_issues#Exposure_sources_and_prevention

    Prevention of mold exposure and its ensuing health issues begins with prevention of mold growth in the first place by avoiding a mold-supporting environment such as humid air.
     

    Hopefully we’ll be able to turn the heater off until the fall pretty soon.

    • Replies: @MEH 0910
    https://twitter.com/StudioCityPatch/status/1252837261986521091
  58. @Anon
    The point would be to have a viable home treatment.

    Home treatment is funny. Some show few symptoms and get well. Some bad symptoms and hospital. Some are doing good and suddenly make a turn for the worse. Some get home from hospital and die suddenly next day.

    Tocizu-whatever-the-name is 1,000 usd per shot. Remdesivir only for seriously ill and in hospital setting.

    For home care, it seems Hidroxicloroquine + azithromycin works well. If you throw in Heparin one could get even better numbers. Oximeter & thermometer are musts.

    Personally, for the masses, my money is on Ivermectin at first suspicion of covid. Seems to lower viral load and no adverse effects.

    May I inquire whether you think virus is man-made? Was release deliberate?

    “May I inquire whether you think virus is man-made? Was release deliberate?” – We will never know.

  59. @Jenner Ickham Errican

    I’ve had multiple humidifiers going in my house
     
    Uh Steve, be careful…

    Don’t end up getting sick due to potential toxic mold exposure.

    https://en.wikipedia.org/wiki/Mold_health_issues#Exposure_sources_and_prevention

    Prevention of mold exposure and its ensuing health issues begins with prevention of mold growth in the first place by avoiding a mold-supporting environment such as humid air.
     

    Don’t end up getting sick due to potential toxic mold exposure.

    Yes, my doctor warned me of that years ago, and I replaced the humidifier with an old-fashioned boiling kettle. Easy to clean the interior of a kettle. Of course I can’t keep a kettle boiling while I sleep but periodic use is enough.

    BTW, it’s astounding to me how dry and over-heated so many NY interiors are. (and then over-air-conditioned in summer.)

  60. @ic1000
    Here are some recent links of possible interest to our host and the commentariat.

    "I Spent Seven Weeks in a Wuhan ICU. Here’s What I Learned". By Wu Feng, MD at "Sixth Tone," a South China based website. April 13, 2020.
    A first-person account by a Guangdong ICU doctor who volunteered in a Wuhan hospital in January and February.

    A Tweet by "Naval" earlier today, with links to 7 recent serology surveys (about half of which have been discussed by Steve).

    Andrew Gelman posted "Concerns with that Stanford study of coronavirus prevalence" at his blog on April 19th. He makes a powerful criticism: when prevalence is low (e.g. single-digits), the specificity of the test must be extremely high for meaningful conclusions to be drawn. Gelman doesn't think the Santa Clara study met that hurdle.

    A current post by economist Lars Christensen, "ONE factor explains most of the differences in Covid19 deaths across countries".
    Christensen discusses a scatterplot of nations, "Covid-19 fatality rate" vs. "share of males >=80". Along the lines of Kratoklastes' critique of my effort to spitball NYC infection rates, Christensen focuses of the outsize impact of Covid-19 on the aged.
    https://marketmonetarist.files.wordpress.com/2020/04/covid19-deaths-pop-1.jpg

    A Nature preprint (accepted but not yet revised after review), dated April 1st. "Virological assessment of hospitalized patients with COVID-2019". Roman Wölfel et al closely followed nine patients who were identified by contact tracing in late January or early February after becoming infected at a business meeting in Munich. There's a "Journal Club" style blog post here discussing it. Table 3 (see the free-access PDF) shows that all 9 people seroconverted. Extended Data Table 1 shows that most developed cross-reactivity to one or more of the four endemic strains of coronavirus (can reactivity to an endemic coronavirus confer partial protection?). Figure 2 is a day-by-day record of how much virus each patient produced in nasal secretions, sputum, and stool over the course of their illness and recovery. Some produced over 100 million viruses per millilter of nasal secretions, at the worst points in the first week. That sounds like a lot.

    In fact the average of people dying with Covid19 have been around 80 years in most countries and men are more likely to die than women.

    The disparity is more extreme than I’d thought. In Italy men have been 66% of the dead, but 73% of those age 70-79, 78% of those 60-69, and 79% of those 50-59. It’s the large number of women older than 90 that reduces the disparity in the whole group.

    Also, the women who died were slightly more sick to begin with. The median number of comorbidities among women was 3.4, among men 3.2.

    That decision tree paper of Ioannidis says:

    “While men made up a grossly disproportionate number of both hospitalizations and critical illness, this difference was attenuated by multivariable adjustment for comorbidities such that gender was no longer one of the most prominent risk variables.”

    Which means what? That men in general have more pre-existing conditions than women? Enough to explain such a huge disparity? But ‘no longer one of the most prominent’ is vague. By how much was the disparity reduced?

    • Replies: @Steve Sailer
    Women live longer on average.
  61. @Telemachos

    In fact the average of people dying with Covid19 have been around 80 years in most countries and men are more likely to die than women.
     
    The disparity is more extreme than I'd thought. In Italy men have been 66% of the dead, but 73% of those age 70-79, 78% of those 60-69, and 79% of those 50-59. It's the large number of women older than 90 that reduces the disparity in the whole group.

    Also, the women who died were slightly more sick to begin with. The median number of comorbidities among women was 3.4, among men 3.2.

    That decision tree paper of Ioannidis says:

    "While men made up a grossly disproportionate number of both hospitalizations and critical illness, this difference was attenuated by multivariable adjustment for comorbidities such that gender was no longer one of the most prominent risk variables."
     
    Which means what? That men in general have more pre-existing conditions than women? Enough to explain such a huge disparity? But 'no longer one of the most prominent' is vague. By how much was the disparity reduced?

    Women live longer on average.

    • Replies: @Telemachos
    Yes, and the number of victims among the oldest patients are what I might have expected given that fact:

    90+:
    Women: 1,731
    Men: 1,082

    80-89:
    Men: 5,329
    Women: 3,421

    So far what one might have expected given life expectancy in men vs. women. But look at the younger patients:

    70-79:
    Men: 4,746
    Women: 1,786

    60-69:
    Men: 1,881
    Women: 537

    50-59:

    Men: 634
    Women: 165

    40-49:

    Men: 138
    Women 46

    The disparity is huge, and the cigarette-smoking theory, which at least seemed plausible, seems to have been disproved.

    Okay, there's this:

    Several studies have shown that men younger than 65 consistently have higher levels of hypertension compared to women of the same age group. This difference is particularly pronounced in early adulthood—for instance, one study found that among 18- to 29-year-old white adults, just 1.5 percent of women but over 5 percent of men reported hypertension (for black women and men, the proportions were 4% and 10%, respectively) (Cutler et al. 2008).
     
    Also:

    More men (36.6 percent) than women (29.3 percent) have pre-diabetes.
     
    And those are the leading underlying conditions.
  62. @Hernan Pizzaro del Blanco
    The demographics and density are very different in NYC compared to Santa Clara.

    NYC is 25% Black compared to 2% Black in SC.
    40% Asian in Santa Clara verse 14% in NYC
    Average age in Santa Clara is 33 verse 41 in NYC

    So we would expect the IFR to be significantly higher in NYC due to the different demographics.

    Yes,it could just be that simple. I’d think the more important point is %over 65. Black correlates better with obesity, too, while Asians in NYC are less affected.

  63. @Steve Sailer
    I've had multiple humidifiers going in my house since Dan got on this kick a couple of months ago.

    Thanks!

    There’s some logic to the idea, based in keeping the cilia healthy and sweeping things out of the lungs.

    We spent much of the 60s looking for the chemicals disrupting life, after Rachel Carson’s Silent Spring. The 1965 surgeon general’s report found, not surprisingly, a correlation between smoking and cancer. We’ve also been on the case against asbestos since the 70s, and there’s no question that mesothelioma results from inhalation of asbestos fibers. Interestingly, there’s American white asbestos and cheaper Chinese blue asbestos; the latter has fibers that are like sharp needles that catch in the lung passageways, and is the probable culprit in asbestosis and cancer.

    Since the 1960s, we have also found that some cancers result from infection. The clearest case is cervical cancer.

    One proposed theory on lung cancers is that smoking, and asbestos, paralyze or destroy the cilia moving infectious agents out of the lungs. Aside from pneumonia, this would also allow other pathogens access to lung tissue. If any were viruses similar to HPV, they might kick off the chain of events leading to lung cancer.

    • Replies: @Dissident
    Interesting info and thoughts.

    We’ve also been on the case against asbestos since the 70s, and there’s no question that mesothelioma results from inhalation of asbestos fibers. Interestingly, there’s American white asbestos and cheaper Chinese blue asbestos; the latter has fibers that are like sharp needles that catch in the lung passageways, and is the probable culprit in asbestosis and cancer.
     
    When did we start importing asbestos from China? Wasn't it well after a link to asbestosis and cancer had evidenced?

    Incidentally, I've heard the claim made that the insulating materials that we have replaced asbestos with are not necessarily any less harmful. I wonder what you think of that.

  64. @Travis
    775 known deaths in Essex County , NJ. If the fatality rate is .5% then we had about 156,000 cases 3 weeks ago and the number of cases would have doubled over the last 21 days to 312,000 cases which is about 40% of the population of my county.

    Thanks for elaborating! Those seem like reasonable assumptions. With what I find to be a shocking result (40% have been infected). That should be getting close to herd immunity. Have you tried that analysis on other counties?

    It would be interesting to do a bulk version of that analysis for US counties and create a map showing estimated proportion infected. It would probably be necessary to tweak the doubling times though.

  65. @Steve Sailer
    Women live longer on average.

    Yes, and the number of victims among the oldest patients are what I might have expected given that fact:

    90+:
    Women: 1,731
    Men: 1,082

    80-89:
    Men: 5,329
    Women: 3,421

    So far what one might have expected given life expectancy in men vs. women. But look at the younger patients:

    70-79:
    Men: 4,746
    Women: 1,786

    60-69:
    Men: 1,881
    Women: 537

    50-59:

    Men: 634
    Women: 165

    40-49:

    Men: 138
    Women 46

    The disparity is huge, and the cigarette-smoking theory, which at least seemed plausible, seems to have been disproved.

    Okay, there’s this:

    Several studies have shown that men younger than 65 consistently have higher levels of hypertension compared to women of the same age group. This difference is particularly pronounced in early adulthood—for instance, one study found that among 18- to 29-year-old white adults, just 1.5 percent of women but over 5 percent of men reported hypertension (for black women and men, the proportions were 4% and 10%, respectively) (Cutler et al. 2008).

    Also:

    More men (36.6 percent) than women (29.3 percent) have pre-diabetes.

    And those are the leading underlying conditions.

  66. @Steve Sailer
    Hopefully we'll be able to turn the heater off until the fall pretty soon.

    • Replies: @Joe Stalin
    Chicago actually had a 218-foot thermometer during the 1933-1934 Century of Progress exhibition.

    Pretty darn cool!

    https://i.pinimg.com/originals/c5/f8/b5/c5f8b59e4d10622da5676e03cfa04c61.jpg

    https://i.ebayimg.com/00/s/MTYwMFgxMDcw/z/tkkAAOSwa9FbBGGB/$_3.JPG
  67. @MEH 0910
    https://twitter.com/StudioCityPatch/status/1252837261986521091

    Chicago actually had a 218-foot thermometer during the 1933-1934 Century of Progress exhibition.

    Pretty darn cool!

  68. @TomSchmidt
    There's some logic to the idea, based in keeping the cilia healthy and sweeping things out of the lungs.

    We spent much of the 60s looking for the chemicals disrupting life, after Rachel Carson's Silent Spring. The 1965 surgeon general's report found, not surprisingly, a correlation between smoking and cancer. We've also been on the case against asbestos since the 70s, and there's no question that mesothelioma results from inhalation of asbestos fibers. Interestingly, there's American white asbestos and cheaper Chinese blue asbestos; the latter has fibers that are like sharp needles that catch in the lung passageways, and is the probable culprit in asbestosis and cancer.

    Since the 1960s, we have also found that some cancers result from infection. The clearest case is cervical cancer.

    One proposed theory on lung cancers is that smoking, and asbestos, paralyze or destroy the cilia moving infectious agents out of the lungs. Aside from pneumonia, this would also allow other pathogens access to lung tissue. If any were viruses similar to HPV, they might kick off the chain of events leading to lung cancer.

    Interesting info and thoughts.

    We’ve also been on the case against asbestos since the 70s, and there’s no question that mesothelioma results from inhalation of asbestos fibers. Interestingly, there’s American white asbestos and cheaper Chinese blue asbestos; the latter has fibers that are like sharp needles that catch in the lung passageways, and is the probable culprit in asbestosis and cancer.

    When did we start importing asbestos from China? Wasn’t it well after a link to asbestosis and cancer had evidenced?

    Incidentally, I’ve heard the claim made that the insulating materials that we have replaced asbestos with are not necessarily any less harmful. I wonder what you think of that.

  69. On types of Asbestos, a good overview is here:
    https://www.pennmedicine.org/cancer/types-of-cancer/mesothelioma/asbestos-cancer/types-of-asbestos

    I might have been misleading. The Chinese were the first to discover asbestos, and their predominant variety of asbestos is the blue variety, which as you can see from the source is REALLY bad for you. Chinese Blue Asbestos might be thought of as “Portland Cement” more a description of a substance than an origin.

    US Asbestos is generally white asbestos; as the link states “Chrysotile asbestos is the only known type of asbestos that belongs to the serpentine family. Also known as white asbestos, this variety is made up of curly fibers and has a layered structure.”

    Now, earlier the link states: “Crocidolite asbestos, also known as blue asbestos, is considered the most hazardous type of asbestos in the amphibole family. Crocidolite is made up of extremely fine sharp fibers that are particularly easy to inhale. Studies show that crocidolite is so hazardous, it may be responsible for more illnesses and deaths than any other type of asbestos.”

    On American white asbestos we get:
    “Because it is the most widely used, chrysotile accounts for the majority of cases of mesothelioma and asbestos diseases including pleural mesothelioma.”

    Clearly, blue or white is responsible for more deaths, but not both; you don’t want to get either in your lungs. But those sharp needles jabbing your lungs are probably similar to the damage that the spikes on a coronavirus (so-called because of the spikes on it resembling a crown) does to your lungs, especially damaging the cilia.

    And yes, fiberglass fibers are also not a great thing to inhale. But then, fiberglass is as derided amongst insulation installers as wonder bread is amongst nutritionists. Spray foam, and block air movement!

    • Replies: @Dissident
    Thank you very much for that detailed response. Much appreciated. Stay safe!
  70. @TomSchmidt
    On types of Asbestos, a good overview is here:
    https://www.pennmedicine.org/cancer/types-of-cancer/mesothelioma/asbestos-cancer/types-of-asbestos

    I might have been misleading. The Chinese were the first to discover asbestos, and their predominant variety of asbestos is the blue variety, which as you can see from the source is REALLY bad for you. Chinese Blue Asbestos might be thought of as "Portland Cement" more a description of a substance than an origin.

    US Asbestos is generally white asbestos; as the link states "Chrysotile asbestos is the only known type of asbestos that belongs to the serpentine family. Also known as white asbestos, this variety is made up of curly fibers and has a layered structure."

    Now, earlier the link states: "Crocidolite asbestos, also known as blue asbestos, is considered the most hazardous type of asbestos in the amphibole family. Crocidolite is made up of extremely fine sharp fibers that are particularly easy to inhale. Studies show that crocidolite is so hazardous, it may be responsible for more illnesses and deaths than any other type of asbestos."

    On American white asbestos we get:
    "Because it is the most widely used, chrysotile accounts for the majority of cases of mesothelioma and asbestos diseases including pleural mesothelioma."

    Clearly, blue or white is responsible for more deaths, but not both; you don't want to get either in your lungs. But those sharp needles jabbing your lungs are probably similar to the damage that the spikes on a coronavirus (so-called because of the spikes on it resembling a crown) does to your lungs, especially damaging the cilia.

    And yes, fiberglass fibers are also not a great thing to inhale. But then, fiberglass is as derided amongst insulation installers as wonder bread is amongst nutritionists. Spray foam, and block air movement!

    Thank you very much for that detailed response. Much appreciated. Stay safe!

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