This short April 27th post by Karl Denninger is a good summary of the facts as known so far. My summary (with comments):

• What was demonstrated by the Diamond Princess cases (that despite being very close proximity not everyone became infected and at least 50% of infections show no symptoms).
• What was demonstrated from early March by the Kirkland, Washington, nursing home debacle (Kirkland now facing at least one “wrongful death” lawsuit) was that nursing homes and hospitals were a major vector and therefore inaction by the owners of those institutions and by the governors of those States is tantamount to negligent homicide. (If elected President, Denninger promises to hold those folk criminally and civilly liable, and deny Medicaid funds to institutions that continue to refuse to obey the law. He does not seriously expect to be drafted, I might add.)
• Testing has proved that mitigation policies do not, cannot and have not stopped transmission.
• Lockdowns are a waste of time and probably indirectly harm and kill people, as shown by serologic surveys.
• The data out of Wuhan showed that vents were mostly ineffective, and therefore trying to “flatten the curve” which means making vents available, “driving people into hospitals and encouraging invasive procedures” was and is counter-productive and even dangerous. Adding financial incentives to do that is manslaughter and should be dealt with accordingly. I don’t agree with this entirely: while it is now clear that vents kill more people than they save and why, hospitals may still be the best places for seriously ill people to get the prophylactic treatment they need.
• Data now proves (what was fairly obvious from early on, especially when considering historical examples such as the 1918-19 “Spanish” flu (which started in the US and was spread to Europe by US soldiers, and the 1950s Canadian polio epidemic ) that the sanatorium model is the most rational way to deal with the seriously ill or compromised patients. (“Her day would end 12 hours later by carefully removing the awkward gown, gloves and mask she wore, ensuring as she did that none of her clothes became contaminated. She would return to the former army barracks where she and other nursing students lived in isolation, their food delivered from the hospital cafeteria.”)
• Since a huge percentage of those infected are not harmed at all or only have minimal symptoms you want to encourage that event since it is the only means to build immunity in the population.  (But there is some doubt as to whether immunity is acquired and how long it lasts for: see especially 1.10 of this report by Belgian specialist Marc Wathelet.)

A colleague of mine is Australian and just got back to Japan from there before they locked the gates, so Australian news about Covid-19 catches my eye. Here’s one by Steve Sailer:

Australia is a country of 25 million with a couple of big cities and it had a lot of travel back and forth with China. But its coronavirus stats are remarkably non-alarming:

What is Australia doing right?

The comments are also intelligent (mostly) and illuminating (not everyone agrees with Steve’s hopeful outlook), and sometimes humorous, like Sailer’s blog posts. Here’s one I liked, in response to Steve’s question of “what happens to old people in Australia?”

“I’m going outside, and I may be a while”.

https://www.unz.com/isteve/what-is-australia-doing-right/#comment-3842404

Here’s Steve speculating on whether BCG vaccinations might have an effect on susceptibility to Covid-19, quoting a medical article: How to Use Immigrants to Study Whether BCG Vaccine is Advantageous.

And speaking of ventilators, here’s a comment on ventilators (Sailer’s post is in response to article claiming old white men are hogging all the ventilators in NY): “Anyway, the good news is that ventilators aren’t in short supply most places. The bad news is that in part that is because they don’t work as well as expected at saving lives. But in turn, the good news is that doctors seems to have discovered some low cost work-arounds, like laying on your stomach, that seem to work at least as well.”

Anyone know what “low cost work-arounds” he’s referring to?

A friend passed on this article (slightly technical but layman-friendly) on the mechanics of what COVID-19 does in the lungs. Here’s the key part:

When the red blood cell gets to the alveoli, or the little sacs in your lungs where all the gas exchange happens, that special little iron ion can flip between FE2+ and FE3+ states with electron exchange and bond to some oxygen, then it goes off on its little merry way to deliver o2 elsewhere.

Here’s where COVID-19 comes in. Its glycoproteins bond to the heme, and in doing so that special and toxic oxidative iron ion is “disassociated” (released). It’s basically let out of the cage and now freely roaming around on its own. This is bad for two reasons:

1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once all the hemoglobin is impaired, the red blood cell is essentially turned into a Freightliner truck cab with no trailer and no ability to store its cargo.. it is useless and just running around with COVID-19 virus attached to its porphyrin. All these useless trucks running around not delivering oxygen is what starts to lead to desaturation, or watching the patient’s spo2 levels drop. It is INCORRECT to assume traditional ARDS and in doing so, you’re treating the WRONG DISEASE. Think of it a lot like carbon monoxide poisoning, in which CO is bound to the hemoglobin, making it unable to carry oxygen. In those cases, ventilators aren’t treating the root cause; the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. The red blood cells just can’t carry o2, end of story. Only in this case, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry o2 because it has lost its iron ion. The body compensates for this lack of o2 carrying capacity and deliveries by having your kidneys release hormones like erythropoietin, which tell your bone marrow factories to ramp up production on new red blood cells with freshly made and fully functioning hemoglobin. This is the reason you find elevated hemoglobin and decreased blood oxygen saturation as one of the 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.

2) That little iron ion, along with millions of its friends released from other hemes, are now floating through your blood freely. As I mentioned before, this type of iron ion is highly reactive and causes oxidative damage. …

The core point being, treating patients with the iron ions stripped from their hemoglobin (rendering it abnormally nonfunctional) with ventilator intubation is futile, unless you’re just hoping the patient’s immune system will work its magic in time. The root of the illness needs to be addressed.

Best case scenario? Treatment regimen early, before symptoms progress too far. Hydroxychloroquine with Azithromicin has shown fantastic … promise and I’ll explain why it does so well next.

Covid-19 had us all fooled, but now we might have finally found its secret.

To see why chloroquine, a malaria drug, works with a virus, read the rest of the article. It’s too technical to summarize here, but it has to do with the exchange of iron and hemaglobin in the lungs, and that’s why it’s relevant.

The number of infected cases keeps rising in Japan, and people are starting to freak out, but can we keep some perspective? The numbers of infected are only the ones they are testing, and that means only the ones sick enough to ask for it (tho perhaps they are testing medical staff for antibodies, at least I damn well hope so, like Germany is).

The graphic below is a couple of weeks old, but still should bring some perspective. The number of deaths in Spain, UK and NY city are highly regrettable of course, that goes without saying.

In 2018 in the United States, there were over 2.8 million deaths. That gives some perspective to President Trump terrifying claim of over 2 million deaths if nothing was done, but Dr. Fauci later (March 29) backtracked from that prediction.

USA unemployment figures went sky-high in March with 3.3 million (4.4%), over 4x the previous record of 695,000 in October 1982. That’s right, nearly 40 years ago! “US Treasury secretary Steve Mnuchin has predicted unemployment in the US – close to record lows only last month – could reach 20%.” Unemployment during the Great Depression in the US did not go over 25%.

If the economy collapses, who will pay for the medical equipment and personnel? The police, the firefighters? The Market-Ticker(not a man to make claims not based on data) claims 30% of US small businesses have gone under already, and is urging an end to the lockdowns and to let people go back to work.

“The biggest mistake we made was to admit patients infected with COVID-19 into hospitals throughout the region,” said Carlo Borghetti, the vice-premier of Lombardy, an economically crucial region with a population of 10 million… We should have immediately set up separate structures exclusively for people sick with coronavirus. I recommend the rest of the world do this, to not send COVID patients into health-care facilities that are still uninfected….

However, the virus was not only spread to “clean” — i.e. infection-free — hospitals by admitting positive patients. In early March, as the number of infected was doubling every few days, authorities allowed overwhelmed hospitals to transfer those who tested positive but weren’t gravely ill into assisted-living facilities for the elderly.”

The lessons Italy has learned about its COVID-19 outbreak could help the rest of the world

Read that last paragraph again. Why did Italy not learn the lessons from South Korea? Or even from earlier epidemics? Such as the polio outbreak in Canada in the 1950s. I quote (my emphasis):

Her day would end 12 hours later by carefully removing the awkward gown, gloves and mask she wore, ensuring as she did that none of her clothes became contaminated. She would return to the former army barracks where she and other nursing students lived in isolation, their food delivered from the hospital cafeteria.

In the 1950s, Canada faced a terrifying epidemic. Here’s how it was conquered.

Is Spain making the same mistakes (102136 cases as of writing)? How about NYC?

This is worth reading. The writer is not a medical expert but understands exponents and is watching the data.

This virus is not being spread the way we’re told. Social distancing is close to worthless. NY’s data makes this quite clear.  So does Florida’s. It’s being spread in the medical environment — specifically, in the hospitals — not, in the main, on the beach or in the bar. When Singapore and South Korea figured out that if as a medical provider you wash your damn hands before and after, without exception, every potential contact with an infected person or surface even if you didn’t have a mask on for 30 minutes during casual conversations with others … transmission to and between their medical providers stopped. … And guess what immediately happened after that?  Their national case rate stabilized and fell. The hypothesis that fits the facts is that a material part of transmission is actually happening in the hospital with the medical providers spreading it through the community both directly and indirectly.

Hypothesis: Hospitals ARE the Vector @RealDonaldTrump

The step functions in the data here in the United States cannot be explained by ordinary community transmission but they are completely explained if the transmission is happening not among ordinary casual contact — that is, not “social distancing”, but rather through the medical system itself.  That explains the step functions that are seen in places like Florida since it takes several days before you seek medical attention after infection and it also explains why NY, despite locking down the city and more than one viral generation time passing — in fact two — has seen no material decrease at all in their transmission rate.

In addition it further is supported by the fact that what we’ve seen here, in Italy, in Wuhan — indeed everywhere is not an exponential curve.  It’s a step-function flat acceleration graph.  Broad community transmission doesn’t happen this way (you instead get a straight and continual exponential expansion until you start to obtain suppression via herd immunity) but if the spread happens as each “generation” gets driven to hospitals for testing and medical attention and the spread is largely happening there what we see here and in other nations in the case rate data is exactly the function you produce in terms of exposure rates. In other words there should be no straight-line sections in the case rate graphs — but there are.

Hypothesis: Hospitals ARE the Vector @RealDonaldTrump

In other words, the “lockdowns” are not doing anything much in terms of suppression, but they are ruining small businesses, many of them irreversibly.

Let us be kind to one another, as someone wrote over 2000 years ago. What does it mean to be civilized? Does it not mean we reject the law of the jungle, of the survival only of the fittest, and the devil take the hindmost? That instead the strong take care of the weak?

“Mead said that the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed… A broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery. Helping someone else through difficulty is where civilization starts, Mead said.”

Monday Musings 23 March 2020, David Perell and apparently quoted in Ira Byock, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life (Avery, 2012)

We are at our best when we serve others. Be civilized.

From the WHO website:

• Total cases over 330,000
• Total deaths 14,600+
• China 81.603
• Italy 59,138 (+5560 since March 22)
• USA 31,573 (+ 4826 since March 22)
• France 15,821 (+ 1336 since March 22)
• S Korea 8,961
• Switzerland 6,971 (just overtook UK)
• UK 5,687 (+ 620 since March 22)
• Australia 1,709
• Malaysia 1,306 (just overtook Japan)
• Japan 1,089 cases (+ 34 since March 22)
• Singapore 455 cases (next door to Malaysia and they just closed the border)
• Taiwan got dropped off the WHO map! 215 according to Johns Hopkins map. (+ 62 since March 22)

And just for perspective, as a good friend recently reminded me, the mortality rate for humans has been very stable for a very, very long time – 100%!

Event 201 – a pandemic tabletop exercise – took place in October 2019. A Mr. Gao (George!) from China took part. Did he know that this game was playing out for real in a major city back home, even as they spoke?

Update: Dr. Gao is a big deal. Click for details.

What a weird coincidence. Just one of those darnedest things.

The purpose of the exercise was presumably to test various countries’ preparedness for such an eventuality, which has been touted for decades as inevitable. If so, it did not really work, did it, boys and girls?

Worldwide confirmed cases have now topped 300,000.

• China seems to have plateau’d at 81,000+ (but what happens when they remove the travel restrictions?)
• Italy in 2nd place now 53,578
• US in 3rd place: 26,747 (with 5x Italy’s population; hmmm, are they testing?)
• France: 14,485 (+6833 since March 18, av. 1708.25/day)
• UK 5,067 (+3113 since March 18, av. 778.25/day)
• Japan 1,055 (+182 since March 18, av. 45.5/day; hmmm, are THEY testing? Tokyo numbers: 130). See below. See also this colour-coded tracker map (added to sidebar) and the Ministry of Health, Labor and Welfare map).
• Taiwan: 153.

Japan

• Japan yet to reach its peak of COVID-19 infections, study shows (March 18)
• Japan’s COVID-19 infections much higher than reported, says NIID (March 7)
• Japan COVID-19 news updates
• Japan was expecting a coronavirus explosion. Where is it? (March 20)
• Why is Japan still a coronavirus outlier? (March 21)
• “despite discouraging checks on those who don’t have symptoms or contact with a carrier, the infection rate lies at 5.6 percent. That compares to around 3 percent in South Korea, but 18 percent in Italy” and ” “It is really difficult to identify every case, because so many infections are mild. Containment has been working in Hong Kong and Singapore by aggressive case-finding,” said Ben Cowling, an epidemiology professor at the University of Hong Kong. “I would expect a gradual increase in cases in Japan because of silent transmission in the community.” Japan was expecting a coronavirus explosion. Where is it? (March 20)
• Why is Japan posting such low numbers? Reasons to expect (much) higher numbers include:
  • Close contact with China
  • 38 million people in Tokyo alone, densely packed
  • Italy has the oldest average age in Europe and 2nd in the world, but Japan in no.1!
  • A common factor in the China deaths was smoking: In 2017, Japan had the highest rate of male smoking among the G7 nations.
• Possible reasons for the (so far) low numbers:
  • Japan isn’t testing and hoping the resulting low numbers will allow the Tokyo Olympics to continue as planned; but is this a likely explanation? “But if the government’s testing regime is a failure, surely we’d see evidence of the disease’s spread in other ways. Its presence would appear not as positive test results but in the guise of an overwhelmed health care system and overcrowded mortuaries. We have seen no such evidence.”
  • Good luck? People bow instead of shaking hands (well, in general); people wear masks when sick or to avoid contamination, air pollution; people already wash their hands a lot; and already high rates of isolation amongst the elderly
  • “that Japan’s “just enough” efforts, built upon those pre-existing conditions have simply worked”: limited testing, early closure of mass events and schools, and spontaneous efforts by individuals and businesses.
• But… the 2-3 week containment period announced end of February has come to an end, and “hanami” (cherry-blossom-viewing) season is set to begin. Stay tuned.

It’s natural that people want to avoid catching this disease, and therefore travel as little as possible, stock up on food, etc. On top of that, there are various emergency measures being taken by governments in the countries and areas most heavily affected, e.g. UK (Coronavirus: Boris Johnson tells UK pubs and restaurants to shut in virus fight 🔴 @BBC News – BBC 21 March 2020). China’s numbers seem to have plateau’d, but what happens when the restrictions are lifted? Limiting people’s movements and interactions obvious temporarily limits the spread of the virus, but does not kill it. The only thing that will do that is when immunity tops 70% or so thereby severely limiting the potential hosts.

I repeat what seem to me the key points from the Imperial College report of March 16th, 2020:

Suppression: The good news: will require social distancing of the entire population + home isolation of cases + household quarantines + maybe school and university closures.

The bad news: “this will need to be maintained until a vaccine becomes available (18 months +) because transmission will quickly rebound if interventions are relaxed. “China and S Korea show that suppression is possible in the short term. It remains to be seen whether it is possible long-term.” Imperial College UK Covid-19 Response Team Report

This is worth reading, though slightly technical. Issued today, March 16, 2020. My takeaways on it below. But first, a quick illustration of the potential benefit of social distancing:

• Japan: 873 (+34 from March 16)
• UK 1,954 (+559 from March 16)
• France 7,652 (+2,215 from March 16)
• Numbers from the WHO map.

My key takeaways from the Imperial College report:

There are two strategies suggested:

• mitigation
• suppression

“Each policy has major challenges”. That means pluses and minuses. There is no magic bullet.

• mitigation: ” slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection”
• suppression: “reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely.”

See that “indefinitely”? That’s one of the problems.