31 March 2020

On how to deal with the Coronavirus Epidemic

I keep saying this, but I am going to keep on saying it, in hopes that it will influence a few people and that others saying similar things will create a critical mass to actually do something.


There is only one way ONE WAY before there is an effective antiviral treatment or vaccine, to prevent millions of cases, hundreds of thousands of deaths, and continued virtual cessation of the economy. And that is to drive the R0 ("R naught") for our country down to or below 1. (R0 < 1). If you don't understand what R0 is, it's pretty simple. It's the rate of infection of others by each infected person. If each person contracting the virus infects fewer than one other person, in relatively short order, the rate of new infections drops to zero. It's Epidemiology 101.

No amount of "social distancing" or other half measures that fail to achieve this will actually stop the epidemic. Any easing up will just cause it to return later.

Our Federal government botched the response early on. That's just a fact, and there's no point in arguing about it. But what is actually worse is that our governments, even our state governments, are STILL not doing what is necessary.

This is a war. We have seen what it is doing to our economy, our way of life, everything. We have to respond to it the way our country responded to Pearl Harbor. Full mobilization. Temporary extraordinary measures. Compulsion that we're not used to in this country, but it's necessary. If you read about what has been done in China, Singapore, Japan, Taiwan, and Hong Kong, you realize that suggestions and half measures are not enough. We must mobilize as if we were in a major war, because WE ARE.

There is no way to get R0 below one other than the following: TEST at least 65% of the adult population while maintaining "Stay at Home" nationwide. TEST everyone who is asymptomatic and tests negative again with an antibody test to determine if they are exposed asymptomatic immune. Such people are very much needed to help in the fight. It may even be necessary to draft some of them into service.

The reason for the 65% figure is that this is the threshold where, if that percentage of the population is immune, or isolated, or recovered, or known negative, then the virus will begin to disappear. This happens naturally, but only after a devastating catastrophe that we MUST prevent.

Those who test positive but are asymptomatic must be STRICTLY quarantined for at least 14 days. Everyone who tests positive and is ill needs to be given treatment in ISOLATION.

There needs to be a worldwide effort, but right now a major national effort, to produce a cheap, disposable, and eminently mass producible test with at least 99% reliability. This should be the challenge. The first company to succeed should get, not a patent, but a direct reward payment from the US treasury of $1 billion. The powers invoked (finally) by Trump to force manufacture of war materiel should be used to ramp up mass production of PPE, test materials, field hospitals, and major isolation installations to treat the sick without continuing to spread the virus in the population. Thousands of people with ancillary medical training and skills should be brought in from the serum immune population to help with this effort.  

In the meantime, EVERY conceivable effort must be promoted and funded to develop effective antivirals and vaccines, because that is what will finally end this and allow international exchange and travel to resume.

If our nation finally realizes that this REALLY is the equivalent of a World War event, this kind of response can work. There will have to be massive relief efforts in conjunction with it, and a total commitment of the citizenry to cooperate and make it work.

This is our challenge.


29 March 2020

We need truly MASSIVE SARS-CoV 2 testing NOW

I don't pretend to be a medical expert, but some things are pretty obvious and it's equally obvious that no one is actually doing them. Would love to see some more discussion of this issue. 

In order to really get a handle on this thing, it is painfully obvious that we need to massively ramp up testing, including antibody testing, of VIRTUALLY EVERYONE. If we are able to determine who is infected, and who has recovered, we would be able to isolate the infected, and make use of the willing recovered who presumably have at least temporary immunity. By reducing to very low numbers the people who are out and about spreading the virus in the community, which is mostly the asymptomatic infected that widespread testing can identify, we could start to really bring the numbers of new cases and deaths down, much faster. This has already been demonstrated to work in Hong Kong, Taiwan, Singapore, and, to a slightly lesser degree, S. Korea. PPE and ventilators are desperately needed. But so is truly massive testing. We need tens of millions a week, not hundreds of thousands, of diagnostic and antibody tests to determine who is and has been infected, with a goal to testing at least 60% of the adult population just as soon as possible. (That number is frequently cited as the threshold for "herd immunity.") 

And to those who would argue feasibility or cost, I would like to point out the enormous, even catastrophic cost of NOT doing this. This is a war. This is probably the ONLY path to victory, if victory means significantly reducing the number of people who become very sick and even die from this disease, and significantly accelerating an end to the devastating effects on both public health and the economy. We are spending a vast amount of non-existent money (debt and printing money) to mitigate the effects; this is something that would actually redress the causes. And just as it proved feasible to build liberty ships in a week during World War 2, if we really are determined to do this, we can do it. It takes the will, making the resources available, and sheer determination to get it done. The question is whether our nation still has that kind of ability, or not. Our future likely depends on the answer to that question. 



28 March 2020

Sent this to my state representative about unnecessary state park closures

 Dear Rep. Meek, 

You came to my door during the last election campaign (Robinette Court in North Clackamas), which I appreciated.

I have not written to you before, but now I have an issue that I consider quite important, which is the misguided and unnecessary closure of all the State Parks to day use. I of course understand the thinking, but I would urge you to consider proposing a reversal of this policy to the governor or by a resolution or something. People need fresh air, a place to enjoy a little sunshine and nature, take the dog for a walk, etc. EVEN MORE now than in normal times. And we're told by the CDC and others that "stay home" doesn't literally mean stay inside, it means avoid physical contacts. But it's completely possible, easy, even, to go to a most parks most of the time and stay more than six feet away from everyone. You drive there in your own car, no contact, walk around, no contact, go home, no contact. There is just NO GOOD REASON to restrict this activity, and it's very important and beneficial to peoples' mental health in these trying times. I am very angry about this and strongly urge you to do something about it. Why not just post regulations requiring physical distancing, and close only those parks (such as some beaches) that typically become too crowded?  Just because we are doing everything we can to slow the spread of this terrible disease doesn't mean that everything we do has to come to an end. Where, as here, there is just no good reason for the restrictions, there needs to be more flexibility. 

I am law abiding and am not planning on breaking rules. But I will point out that regulations that are unnecessary and overly restrictive like this INVITE people to disregard them. And once people start ignoring restrictions, it's harder to enforce the ones that are truly necessary. EVERY restriction imposed because of this disease should be CAREFULLY limited to only what is truly necessary for this very reason. 

Thank you. 

David Studhalter

26 March 2020

Fwd: The Big Picture on Coronavirus: Interview with Larry Brilliant

this is interesting, if you haven't had altogether too much coronavirus discussion already, in which case right above is the delete button. Please hit. 

---------- Forwarded message ---------
From: Tikkun & the Network of Spiritual Progressives <rabbilerner@tikkun.org>
Date: Thu, Mar 26, 2020 at 4:01 PM
Subject: The Big Picture on Coronavirus: Interview with Larry Brilliant
To: David Studhalter <studhalter@gyromantic.com>

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The Doctor who Helped Defeat Smallpox Explains What's Coming

by Steven Levy

Image courtesy of Joi Ito

Larry Brilliant says he doesn't have a crystal ball. But 14 years ago, Brilliant, the epidemiologist who helped eradicate smallpox, spoke to a TED audience and described what the next pandemic would look like. At the time, it sounded almost too horrible to take seriously. "A billion people would get sick," he said. "As many as 165 million people would die. There would be a global recession and depression, and the cost to our economy of $1 to $3 trillion would be far worse for everyone than merely 100 million people dying, because so many more people would lose their jobs and their health care benefits, that the consequences are almost unthinkable."


Now the unthinkable is here, and Brilliant, the Chairman of the board of Ending Pandemics, is sharing expertise with those on the front lines. We are a long way from 100 million deaths due to the novel coronavirus, but it has turned our world upside down. Brilliant is trying not to say "I told you so" too often. But he did tell us so, not only in talks and writings, but as the senior technical advisor for the pandemic horror film Contagion, now a top streaming selection for the homebound. Besides working with the World Health Organization in the effort to end smallpox, Brilliant, who is now 75, has fought flu, polio, and blindness; once led Google's nonprofit wing, Google.org; co-founded the conferencing system the Well; and has traveled with the Grateful Dead.

We talked by phone on Tuesday. At the time, President Donald Trump's response to the crisis had started to change from "no worries at all" to finally taking more significant steps to stem the pandemic. Brilliant lives in one of the six Bay Area counties where residents were ordered to shelter in place. When we began the conversation, he'd just gotten off the phone with someone he described as high government official, who asked Brilliant "How the fuck did we get here?" I wanted to hear how we'll get out of here. The conversation has been edited and condensed.

Steven Levy: I was in the room in 2006 when you gave that TED talk. Your wish was "Help Me Stop Pandemics." You didn't get your wish, did you?

Larry Brilliant: No, I didn't get that wish at all, although the systems that I asked for have certainly been created and are being used. It's very funny because we did a movie, Contagion—

We're all watching that movie now.

People say Contagion is prescient. We just saw the science. The whole epidemiological community has been warning everybody for the past 10 or 15 years that it wasn't a question of whether we were going to have a pandemic like this. It was simply when. It's really hard to get people to listen. I mean, Trump pushed out the admiral on the National Security Council, who was the only person at that level who's responsible for pandemic defense. With him went his entire downline of employees and staff and relationships. And then Trump removed the [early warning] funding for countries around the world.

I've heard you talk about the significance that this is a "novel" virus.

It doesn't mean a fictitious virus. It's not like a novel or a novella.

Too bad.

It means it's new. That there is no human being in the world that has immunity as a result of having had it before. That means it's capable of infecting 7.8 billion of our brothers and sisters.

Since it's novel, we're still learning about it. Do you believe that if someone gets it and recovers, that person thereafter has immunity?

So I don't see anything in this virus, even though it's novel, [that contradicts that]. There are cases where people think that they've gotten it again, [but] that's more likely to be a test failure than it is an actual reinfection. But there's going to be tens of millions of us or hundreds of millions of us or more who will get this virus before it's all over, and with large numbers like that, almost anything where you ask "Does this happen?" can happen. That doesn't mean that it is of public health or epidemiological importance.

Is this the worst outbreak you've ever seen?

It's the most dangerous pandemic in our lifetime.

We are being asked to do things, certainly, that never happened in my lifetime—stay in the house, stay six feet away from other people, don't go to group gatherings. Are we getting the right advice?

Well, as you reach me, I'm pretending that I'm in a meditation retreat, but I'm actually being semi-quarantined in Marin County. Yes, this is very good advice. But did we get good advice from the president of the United States for the first 12 weeks? No. All we got were lies. Saying it's fake, by saying this is a Democratic hoax. There are still people today who believe that, to their detriment. Speaking as a public health person, this is the most irresponsible act of an elected official that I've ever witnessed in my lifetime. But what you're hearing now [to self-isolate, close schools, cancel events] is right. Is it going to protect us completely? Is it going to make the world safe forever? No. It's a great thing because we want to spread out the disease over time.

Flatten the curve.

By slowing it down or flattening it, we're not going to decrease the total number of cases, we're going to postpone many cases, until we get a vaccine—which we will, because there's nothing in the virology that makes me frightened that we won't get a vaccine in 12 to 18 months. Eventually, we will get to the epidemiologist gold ring.

What's that?

That means, A, a large enough quantity of us have caught the disease and become immune. And B, we have a vaccine. The combination of A plus B is enough to create herd immunity, which is around 70 or 80 percent.

I hold out hope that we get an antiviral for Covid-19 that is curative, but in addition is prophylactic. It's certainly unproven and it's certainly controversial, and certainly a lot of people are not going to agree with me. But I offer as evidence two papers in 2005, one in Nature and one in Science. They both did mathematical modeling with influenza, to see whether saturation with just Tamiflu of an area around a case of influenza could stop the outbreak. And in both cases, it worked. I also offer as evidence the fact that at one point we thought HIV/AIDS was incurable and a death sentence. Then, some wonderful scientists discovered antiviral drugs, and we've learned that some of those drugs can be given prior to exposure and prevent the disease. Because of the intense interest in getting [Covid-19] conquered, we will put the scientific clout and money and resources behind finding antivirals that have prophylactic or preventive characteristics that can be used in addition to [vaccines].

When will we be able to leave the house and go back to work?

I have a very good retrospect-oscope, but what's needed right now as a prospecto-scope. If this were a tennis match, I would say advantage virus right now. But there's really good news from South Korea—they had less than 100 cases today. China had more cases imported than it had from continuous transmission from Wuhan today. The Chinese model will be very hard for us to follow. We're not going to be locking people up in their apartments, boarding them up. But the South Korea model is one that we could follow. Unfortunately, it requires doing the proportionate number of tests that they did—they did well over a quarter of a million tests. In fact, by the time South Korea had done 200,000 tests, we had probably done less than 1,000.

Now that we've missed the opportunity for early testing, is it too late for testing to make a difference?

Absolutely not. Tests would make a measurable difference. We should be doing a stochastic process random probability sample of the country to find out where the hell the virus really is. Because we don't know. Maybe Mississippi is reporting no cases because it's not looking. How would they know? Zimbabwe reports zero cases because they don't have testing capability, not because they don't have the virus. We need something that looks like a home pregnancy test, that you can do at home.

If you were the president for one day, what would you say in the daily briefing?

I would begin the press conference by saying "Ladies and gentlemen, let me introduce you to Ron Klain—he was the Ebola czar [under President Barack Obama], and now I've called him back and made him COVID czar. Everything will be centralized under one person who has the respect of both the public health community and the political community." We're a divided country right now. Right now, Tony Fauci [head of the National Institute of Allergy and Infectious Diseases] is the closest that we come to that.

Are you scared?

I'm in the age group that has a one in seven mortality rate if I get it. If you're not worried, you're not paying attention. But I'm not scared. I firmly believe that the steps that we're taking will extend the time that it takes for the virus to make the rounds. I think that, in turn, will increase the likelihood that we will have a vaccine or we will have a prophylactic antiviral in time to cut off, reduce, or truncate the spread. Everybody needs to remember: This is not a zombie apocalypse. It's not a mass extinction event.

Should we be wearing masks?

The N95 mask itself is extremely wonderful. The pores in the mask are three microns wide. The virus is one micron wide. So you get people who say, well, it's not going to work. But you try having three big, huge football players who are rushing for lunch through a door at lunchtime—they're not going to get through. In the latest data I saw, the mask provided 5x protection. That's really good. But we have to keep the hospitals going and we have to keep the health professionals able to come to work and be safe. So masks should go where they're needed the most: in taking care of patients.

How will we know when we're through this?

The world is not going to begin to look normal until three things have happened. One, we figure out whether the distribution of this virus looks like an iceberg, which is one-seventh above the water, or a pyramid, where we see everything. If we're only seeing right now one-seventh of the actual disease because we're not testing enough, and we're just blind to it, then we're in a world of hurt. Two, we have a treatment that works, a vaccine or antiviral. And three, maybe most important, we begin to see large numbers of people—in particular nurses, home health care providers, doctors, policemen, firemen, and teachers who have had the disease—are immune, and we have tested them to know that they are not infectious any longer. And we have a system that identifies them, either a concert wristband or a card with their photograph and some kind of a stamp on it. Then we can be comfortable sending our children back to school, because we know the teacher is not infectious.

And instead of saying "No, you can't visit anybody in nursing home," we have a group of people who are certified that they work with elderly and vulnerable people, and nurses who can go back into the hospitals and dentists who can open your mouth and look in your mouth and not be giving you the virus. When those three things happen, that's when normalcy will return.

This interview appeared first on Apple News.

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All we are is the result of what we have thought, it is founded on our thoughts, it is made up of our thoughts.   --Dhammapada


COVID is not FLU, life in the time of Coronavirus

Farflung correspondents, 

You STILL see people comparing COVID to the seasonal flu. This is not only not correct medically, it is potentially dangerous disinformation. This piece (Johns Hopkins) gives a very quick rundown of some of the differences, but one crucial difference that is frequently discussed among epidemiologists when interviewed by objective and probing journalists, but not penetrating the more general media, is this: the flu kills, relatively infrequently, not generally by directly damaging the tissues of the lungs, but sort of like a careless visitor who leaves the door open so the axe murderer gets in. Flu weakens the body and its immune system, allowing opportunistic, usually bacterial, pneumonia to get a foothold. What weakens the system is not so much the virus itself but the body's own inflammatory response. This happens more frequently, of course, to older and generally less healthy people. The 1918 flu, for reasons that have never been fully and satisfactorily explained, preferentially affected younger people, especially men, but that is not true of flu in general, or of coronavirus disease (including other coronaviruses). 

COVID, on the other hand, IS the axe murderer. It directly damages the lungs, and can, in fortunately relatively infrequent cases, cause very rapid progression from healthy to absolutely critical condition and even death, within days. It is, apparently, slightly MORE contagious than ordinary flu. But the reasons it is so threatening is not only that it has an overall death rate in the vicinity of 10x typical seasonal flu, it also has a much higher incidence of serious illness, requiring hospitalization, which has the potential to completely overwhelm medical systems worldwide. This is already happening in many areas.

The fact that COVID sharply skews upwards in people over 50 and with generally poor health, especially COPD and asthma, is well known by now. People over 70 are at significantly greater risk even in the absence of underlying conditions, and people over 80 even moreso. The virus also preferentially, to a certain extent, kills men more often than women. But, from most reports, the presence of underlying health deficits is even more of a risk factor than age alone. These observations are in part still anecdotal; a clear scientifically verified profile of this disease has not yet been developed. 

Two additional points that many people fail to appreciate. It is completely meaningless to compare the death rate from COVID to car accidents or seasonal flu. These things are already present, to their full extent, in our society, and we have adapted to their effects. COVID, even now, is just getting started on its massive worldwide tsunami of NOVEL infection, to which no one, except the limited number who have already recovered, has immunity. Eventually, it will mutate (because any pathogen that has strains that are fatal to a significant fraction of their hosts will tend through natural selection, running at hundreds of thousands of times faster in viruses than in macroscopic organisms, to mutate into less lethal forms). Also,  we will develop a vaccine or effective antivirals, or, through ordinary development of herd immunity that eventually happens even without intervention... but in any case, eventually, the epidemic will subside. In the meantime, it is not primarily the raw numbers of deaths, but the complete breakdown of our ability to deliver medical care, to COVID victims or anyone else, that is of greatest concern. 

The ancillary, but also very serious, effects on the global economy are also reasons not to follow our president's idiotic advice, but to follow protocols designed to turn the curve down and begin to reduce infections. (Because if we go into a cycle of repeated lockdowns and easing up, but never really get the virus under control, we will see little if any economic recovery (who will go to the movies when their family members are sick and can't get a hospital bed?), and in the end the overall effect of the epidemic will be far worse, not better. Virtually everyone with a clear understanding of the disease and fundamentals of economics, including most Republicans not entirely beholden to the president, agree with this. The British briefly tried the "let it ride, herd immunity" route, but quickly realized it was a disaster, and now Boris Johnson sounds almost exactly like Tony Fauci. 

A second point, less important perhaps but not too well known, is that it appears that this virus often causes PERMANENT damage to the respiratory systems of those who become critically ill but recover. The flu and even bacterial pneumonia do not typically do this to as great an extent. This effect is still being evaluated, and as far as I know remains anecdotal, but you can be pretty sure there will be scientific papers published on it soon. 

Stay well, stay home, if you do have to go out, keep your distance. We will get through this. Bad as it is, it is self-limiting, and if we pull together as a country and even as a world, we may be in a better position to put the pieces back together afterwards, and even have an opportunity to jettison some of the more self-destructive behavior we've been engaging in as a species for the last number of years. I remain guardedly optimistic on that score. 



23 March 2020

Brown to issue stay at home order

Of interest principally to Oregonians. 


All we are is the result of what we have thought, it is founded on our thoughts, it is made up of our thoughts.   --Dhammapada


Corona News

This is the most hopeful and encouraging thing I've seen in a while. From LATimes.



16 March 2020

Fwd: For Our Joint Sanity

This is what it means to face crisis with courage.

---------- Forwarded message ---------

From: Portland Piano <info@portlandpiano.org>
Date: Mon, Mar 16, 2020 at 3:29 PM
Subject: For Our Joint Sanity
To: <ds@gyromantic.com>

Portland Piano International

On this oddly quiet first day of the "work-week," we find ourselves still thinking lots and lots about you. So many of you have let us know that you have enjoyed our prior messages with those great Anderson & Roe music videos. Thus, for our joint sanity, we thought we'd keep going!
In 1939, in the midst of the bombardment of London, the phenomenal and brave pianist Myra Hess (later made a Dame by the monarch), proposed playing a recital for anxious Londoners at the National Gallery and found a queue of people waiting for the first one to be two miles long! She continued with her own recitals and organized another 1,697 concerts, lasting through April of 1946. A total of 824,152 people came and more than 16,000 pounds was contributed to the Musicians Benevolent Fund. She opened every one of her recitals with her own transcription of Bach's "Jesu, Joy of Man's Desiring."
Here is a video of Dame Myra (click image for video):

It was a different time and the recording is slightly funky, but the sincerity comes through.
Decades later, when our pal and favorite artist Angela Hewitt was scheduled to play a recital for a gala for the series on September 16, 2001, 9/11 happened and air travel in the United State was suspended. But, Angela was in Ottawa, flew to Vancouver, B.C., traveled by a friend's car to the American border at Blaine, Washington, was met there by a new Portland friend who got her to Portland three hours before curtain, and the show went on as planned.
Without a word to the audience, adding to the announced program, Angela strode on stage in cobalt blue sequins and began with Dame Myra's wonderful transcription. A thousand people burst into tears. It was one of PPI's best moments in history.
And, here is Angela. (click image for video). This video may even be of that September 11, 2001 moment.

You buoy our spirits in this challenging time, dear PPI family. Let's do stay in touch.
"Music, my rampart, and my only one."
– Edna St. Vincent Millay

Sincerely yours,
Maryellen McCulloch 
Board President            

Lauren Canfield
Robin Power            
Associate Director     

Bill Crane
Director of Audience Engagement
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All we are is the result of what we have thought, it is founded on our thoughts, it is made up of our thoughts.   --Dhammapada