Coronavirus, End of Year 2020

 Coronavirus, End of Year 2020

The year ends with hope.  Vaccines are rolling out.  The first people vaccinated in the USA should be immune 37 days later on Jan 20. 

Other treatments to mitigate the severe symptoms are testing well.  At one hospital, a study of 83 patients, who tested positive for C-19, and all of who would have probably been admitted due to being in the high risk groups were treated with Bamlanivimab first.  Of the group, only 1 needed admission.

As of Christmas Eve, the number of new cases continued to grow, including my nephew and his fiancé.  (they have since hit the “recovered” status, but physically exhaust easy)  By doing an estimate based on number 21 times new cases, we peaked at 5,170,000 active cases on Christmas Eve, but have since retreated below the 5 million mark.

This is the horror story we were trying to avoid with the shutdown in March.  Then the number of known active cases was in the 10’s of thousands and had the potential to spread to 8 million by the end of April.  We avoided that calamity then, but are in it now.  But we have hope now.  I am repeating myself here, but assuming the current production schedule, about 190 million Americans will be vaccinated by June. 

That assumes no other vaccine becomes available.  Others are in the works by many companies partially funded with seed money by Project Warp Speed.  Like Moderna for 100 million doses and an option for 400 million more.  Pfizer developed their vaccine without seed money from the project, but agreed to provide 100 million doses as well, with an option for another 500 million doses.  World wide, there are a known 230+ vaccine projects in the works.

To be clear, the current vaccine’s takes two doses, a month apart, to be effective. 

One warning, the RNA vaccine has been shown to cause anaphylactic shock (an allergic reaction) in some people, even those who have never demonstrated this problem before.  A reaction of some kind in .63% of recipients of the trial group, and so far, about 1 in a million for full fledged Anaphylaxis.  These numbers may be adjusted as we get more data.  I am not an expert here, but I believe an injection of epinephrine can treat Anaphylaxis, and vaccine sites will probably have an “Epi” pen handy.

Regarding Long Term Impact.  Vascular damage has shown to affect the heart, kidneys, and lungs.  Back in July, this has shown damage between 35% and 70% of patients examined.  This even applies to mild cases when tested 2 months later, showing heart function degradation.  A recent German study is showing vascular damage in 10 times the mortality rate in patients.  Which is around 10% the number of cases.  Other studies range the numbers between 10 and 88%.  So the answer here is there is long term effects, but how prevalent, we don’t know. 

Men are shown to be more likely to contract the virus, but this may be just risk taking.  Women are more likely to die from it.  Type A blood types are more vulnerable, which may explain why Europe suffered as much as it did. 

One study has shown that 50% of hospitalized, but non-ICU patients are suffering from cognitive dysfunction. 

Children which exhibited minimal effects of the illness also are showing vascular damage, but this is masked by lower operating pressures.  It is unknown if these will heal over time.

This was shared on a Covid survivor group: 

I have not validated any of this, but everything here makes sense.

HOW TO FIGHT COVID AT HOME

The doctor sent me home to fight Covid with two prescriptions - Azithromycin 250mg & Dexamethason 6mg. When the nurse came in to discharge me, I asked her, "What can I do to help fight this at home?" She said, “Sleep on your stomach at all times with Covid. If you can’t sleep on your stomach because of heath issues sleep on your side. Do not lay on your back no matter what because it smashes your lungs and that will allow fluid to set in.

Set your clock every two hours while sleeping on your stomach, then get out of bed and walk for 15-30 min, no matter how tired or weak that you are. Also move your arms around frequently, it helps to open your lungs. Breathe in thru your nose, and out thru your mouth. This will help build up your lungs, plus help get rid of the Pneumonia or other fluid you may have.

When sitting in a recliner, sit up straight - do not lay back in the recliner, again this will smash your lungs. While watching TV - get up and walk during every commercial.

Eat at least 1 - 2 eggs a day, plus bananas, avocado and asparagus.These are good for Potassium.

Drink Pedialyte, Gatorade Zero, Powerade Zero & Water with Electrolytes to prevent you from becoming dehydrated. Do not drink anything cold - have it at room temperature or warm it up. Water with lemon, and little honey, peppermint tea, apple cider are good suggestions for getting in fluids. No milk products, or pork. Vitamin’s D3, C, B, Zinc, Probiotic One-Day are good ideas. Tylenol for fever. Mucinex, or Mucinex DM for drainage, plus helps the cough. Pepcid helps for cramps in your legs. One baby aspirin everyday can help prevent getting a blood clot, which can occur from low activity. "

Drink a smoothie of blueberries, strawberries, bananas, honey, tea and a spoon or two of peanut butter.

Coronavirus, by the Numbers, As I See It. Mid December

Coronavirus, by the Numbers, As I See It.  12/15/2020

The number of new cases had been increasing at an accelerated rate.  At the end of September, the new cases per day was 40,000 increasing by around 2% per day.  By the end of October it peaked at 101,000 while growing an average of 4% per day.  In November, the number of daily new cases hit a growth rate of 6% per day for 3 days, on the 7, 8 and 10th, before declining.  On November 20, the number of new cases was first hit 200,000.  December has had 10 out of 14 days over 200,000. The last week averaging 215,000 per day.  The good news the rate of increase for all of December is 2% per day.

This brings the estimated number of active cases to over 4.5 million.

And C-19 is now the #1 killer in the US.  Cancer kills 1,650 a day, but is not communicable.  On Dec 9^th, my birthday, Covid killed 3,260. Which was the peak number for the month.  The estimate of 400,000 deaths by inauguration day is no longer hypothetical, but a certainty.  We vectoring to have a higher death count in the USA than the Spanish Flu of 1918 at 675,000.  This assumes the 2,500 number per day till the day the first vaccinated person becomes immune (37 days) then drops to 2,000 per day for 5 months after that for no rational reason other than hope and prayers.   Then a 1,000 new cases per day for the rest of the year. 

The US Population in 1918 is 103 million, less than 1/3 what it is now.  So the overall affect on the psyche of the country will be less.

There is a meme running around about the deadliest days in history.  Galveston Hurricane, 8,000, Antietam 3,600, San Francisco Earthquake 3,000.  Already this list is obsolete.  Insert Dec 9, COVID-19 3,260 between #2 and #3.

On the vaccine front.  Pfizer’s was authorized by the UK at the beginning of the month.  Pfizer’s and Moderna’s was authorized on Dec 12, and first injections started on Dec 14.  They expect to have 40 million doses for the US by year’s end, almost enough for those living in long term health care facilities and health care workers. 

The vaccine requires 2 doses, taken a month apart, to be effective, so when you read the number of doses available, you may have to divide by 2 for calculating how many can be vaccinated.  I’ll use the higher number because that is what the Press uses to avoid confusion.

Between Pfizer and Moderna, they expect to ship 70 million doses a month through the winter.  Priority for those will be the over 65 crowd.  By April it is expected to start vaccination of the general population.  By June that would be enough to fully vaccinate about 190 million Americans. 

“Herd Immunity” requires an estimated 80% of the population.  For the USA, that is 265 Million. 

Dr Fauci, who should have a better idea on the production schedules than I, thinks we will achieve herd immunity by Fall of 2021, and normalized behavior by year’s end.

This is probably not a once and done thing.  Earlier reports said that the vaccine will require yearly boosters.

A note on vaccine effectiveness.  A small amount of immunity will develop about 2 weeks from the first dose, emphasis on the word small.  Full immunity about a week after the second dose.  So from day one, with the exception of test patients, the first immune person will be 37 days from Dec 14, or Jan 20.  The irony that that is inauguration day is not lost to me.  45's supporters will make hay of that coincidence.

It is unknown if the vaccine would keep you from spreading the virus.  That would take more long term testing.  It is only been shown to be 95% effective in keeping the patient from getting it.

There are currently at least 15 other vaccines being tested in the USA.  Status unknown.

There was much in the news about not congregating together during Thanksgiving.  And it seems to have worked.  In 2019, 17 million flew over the holiday, only 7 million in 2020.  While good news, there is no way that many people grouping together cannot have an effect to raise the numbers.  A week after Thanksgiving, the percentage increase per day of new cases started rising again. It had been lowering from 6% at the beginning of November to almost 2% per day.  That turned around the first week of December hitting over 200,000 new cases again on Dec 2.  I cannot explain why the percentage increase went down during the middle of November, and the rise the first of Dec is not explainable with the Thanksgiving holiday either.   To be clear, when I refer to percentage increase per day going down, it still means the number of new cases is going up, just not as fast. In the second week of December the rate of increase was down to 1.5%.  Since there should have been a spike caused by Thanksgiving get togethers, I am interpreting this to mean there is an overall decline in the increases.  And the expected spike is masking what could be a downward trend.  The next week will tell the tale. 

A note on how I am doing the percentage increase per day calculation.  The actual day to day numbers jump all over the place, like -16% then +17%.  Some agencies do not report on weekends, some not on Sunday.  Then there are people that are not sure if they have symptoms, and wait till Monday to be tested, causing a surge in reporting Wed/Thur.   I am averaging the daily increase against the previous 7 days in an attempt to produce a more coherent vector.  I also tried 14 days, but only got slightly better results.

A friend of mine suggested using “inverse harmonic mean”, which I have tried a couple of times, both against the percentage and the raw numbers, but both generated numbers that had no discernible correlation to reality, so I suspect I am not doing it right.  If there is any expertise out there interested in giving it a go, please call me.

At the beginning of the month, it was announced that Montgomery County, Pennsylvania, my home town, had reached 85% of its ICU capacity for C-19 patients (48 beds left).  Montgomery County has been one of the wealthiest counties in the nation for over a hundred years and has a lot of hospitals.  A number of new ones have been built in recent years.  So I shudder for less opulent communities of this nation.  Like Lehigh Valley (not an impoverished county by any means), is at 97% with 5 beds remaining.

The hospitalization rate for C-19 hit 100,000 in early December.  109,000 on Dec 13.  About 20% of them in the ICU, and 7% on ventilators.

https://covidtracking.com/data/national/hospitalization

Coronavirus, by the Numbers, As I See It. Late November

Nov 30.

Until mid November, the number of new cases had been increasing at an accelerated rate.  At the end of September, the new cases per day was 40,000 increasing by around 2% per day.  By the end of October it peaked at 101,000 while growing an average of 4% per day.  By November 10th, the number of daily new cases hit a growth rate of 6% per day.  Since then the rate of increase has been declining.   November 20 had a peak of just over 200,000 new cases for the day.  However, since then there  seems to be a steady decline in new cases. The last week averaging 157,000 per day.

This brings the estimated number of active cases to 3.7 million.

I was asked if this increase in cases just because we are testing more, and as such finding more.  Which is a valid point. 

8 weeks ago, the number of tests was about 1,100,000 per day which resulted in 51,400 new cases.

On Nov 15, there were 1,475,000 tests, which resulted in 140,000 new cases.

8 weeks ago, the number of positive tests was around 6%.  On Nov 15th it was 9.5%.

So the answer is yes, more tests, and a higher percentage of positive results.  The two factors have a multiplicative effect, not a linear effect.  35% more tests, 274% more cases.

However, there is another point to be considered.  How long after someone catches C-19 will they be detectable?  How many of the new cases were asymptomatic or ill months ago, but tested for other reasons.  I don’t have an answer for that.  The numbers range from days to weeks.  We do know a lot more people have had it with no ill effects.  How many of the new cases simply “hang fires”, just waiting for a test to declare?  The answer is we don’t know, but it is something to consider.  As a mind experiment, let’s say 100 million were asymptomatic and still testing positive.  Then any random sampling will generate 30% positive results. We can try to adjust this to fit the current increase to 9.5% rate, but if we stretch out the out the positive time span to a month, this test positive group but past illness group would be only 15 million in size.  I cannot say how likely this would be at this time. 

But the normal test for C-19 is for the virus, not the antibodies.  As the antibodies don't develop until 3 weeks past infection, and would not be very useful to dealing with the symptoms now.  So I don't think a reasonable percentage of the new cases are asymptomatic "hang fires".

So let’s look at another measure, hospital admissions.  Laboratory-Confirmed COVID-19-Associated Hospitalizations peaked first in mid April at 10 per 100k.  Then it dropped to 4 per 100k in mid June.  A second peak occurred in July to 8 per 100k.  Then dropped slowly until the end of September to under 4 before starting the current rise of 9.8 the second week of November.  For our age group the numbers are higher.  For ages 50-64, just add 5 to the above, and for 65+ we hit 30 per 100k mid November.

If these numbers do not seem accurate, it is because of the 56 states and territories, only 36 reports the hospitalized data, so any national accumulation can only show trends and vectors, not true numbers.

On Nov 28, the number of hospitalizations we know about due to C-19 was at 91,000, up 203% from October 28, at 44,200, which was up 50% from Sept 28 at 29,400.  The previous peak was at 59,000 on July 24, and that number was dropped by 1-2.5% per day over the summer.

Today’s count of ICU patients is 18,000+, and of them, 6,100 are on a ventilator.  The peak last April was 15,000 ICU and 6,000 on a ventilator.

Source: https://covidtracking.com/data/national/hospitalization

So we are currently surging upward.  But the news is not all bad.

In the spring, the infection was concentrated in the NE, now it is distributed nationwide. Less overall density of the virus, even though higher numbers. 

The overall mortality rate, if you catch C-19 today, is under 1%.  Long term effects about triple that.  This is down from 25% in the early stages.  The flu in 2019 claimed 34,200 lives over 35,500,000 cases for .09%, and so is 100 times less lethal than C-19.  This is down from 500 times earlier this year.

Temporary hospital bedding has been created, for example in a New York convention center, for non C-19 patients, allowing for some conversions to ICU Bedding in the hospitals themselves.

Equipment has been produced.

The only shortage is man hours available.  That is not easily produced.  A basic nurse takes at least 2 years of training.

3 companies have tested excellent efficacy with a vaccine over a large trial population.  2 tested over 90%, while one, Astrazenaca, had two trial groups, one over 90%, and one at 62%.   However 2 of the 3 vaccines require storage at extreme cold.  Pfizers needs to be kept at -94(F) degrees, while Astrazenaca’s is kept around 30(F) degrees.  Modera’s vaccine was announced to be stable at around -13(F). 

I have heard the Federal Government has created a number of mobile freezer units, both trucks and jets, in anticipation of the extreme cold to distribute the vaccine when available.  Well done.

An interesting study by Bocconi University in Milan has calculated that the economic closures in the spring have cost 169 billion, and saved 29,000 lives.  Or 6 million per life.  I don’t know how things are calculated so I cannot speak to the accuracy of the study.  The 29,000 lives seems very low.  We were vectoring on 8 million cases and 2 million dead at one point by mid spring.  Of course vectors are straight lines, when something like this needs to curve for a variety of reasons, like the must susceptible dying, and rapid behavior changes, or mask wearing and deliberate avoidance's of congested areas.

And how was the $169 billion calculated?  Are they counting the short term cost of economic activity?  Or the long term cost of a business dying, which removes its economic activity from the economy for 20+ years?  Then you have to factor in the dead and crippled victims.  The economic cost of their removal from economy.  So I would take this study with a healthy grain of salt. 

The reason for my opinion was based on the 911 atrocity.  I did a calculation on the economic hit that the strike on the two towers cost the economy.  The building replacement cost was fairly straight forward, a couple of billion, but for the people cost, I took the average income generated per year, for 20 years, and multiplied that by 2, because I figured if you were working in the world trade center, you were making more than the national average.  Then factored the multiplicative effect, as each dollar generated cycles many times in the economy, I came up with 200 billion.  Several years later the government, which spent millions on the calculation, came in on 170 billion.  I was off by 15%, but then I only spent 30 minutes doing the research. 

And that was for just 3,000 people.  So I find the economic cost of only 169 billion inaccurate with regard to the lives lost so far to C-19.  True, most of the victims are in retirement age (209,000), and contribute less to the economy in general, but many are not, about 55,000 as of this morning.  Certainly, much more value to the economy than 3,000 killed in 911.   

In the end, we live or die on the economy.  With most of us living in urban areas, we do not have the capacity to farm sufficient food.  We get that from the economy.  Shutting down parts of the economy reduces the ability of people to pay for the things they need, and without that, the people making those things have less ability to provide.  It is a degenerative cycle.  We have to learn to live with this until the vaccine is rolled out.  And try to keep the casualties, both people and businesses, to a minimum.

https://news.yahoo.com/169-bn-29-000-lives-013740202.html

 

 

Coronavirus, by the Numbers, As I See It. Mid November

Coronavirus, by the Numbers, As I See It.  Mid November

The number of new cases has been increasing at an accelerated rate.  At the end of September, the new cases per day was 40,000 increasing by around 2% per day.  By the end of October it peaked at 101,000 while growing an average of 4% per day.  Now in mid November we have hat 9 days of over 100,000 and it is growing at 6% per day, hitting 161,000 yesterday, Nov 11.

Even if the percentage increase does not increase any more, we are projecting out to 400,000 new cases per day by month’s end.  If only 1% die, that will be 4,000 dead per day.  This puts the one estimate of 400,000 dead by Feb 1 as optimistically low.  https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend

For a comparison, on April 8^th, 2020, there weren’t 400,000 cases in the whole country.

Only one state is officially in decline in active cases, Georgia.  I believe this is due to Georgia was not tracking recovered cases very well and her real number of active cases is close to 55,000, not 150,000.  But they seem to be working that problem.

ALL states have had increases in new case numbers.  Comparing Oct 27 to Nov 9 against Oct 12 to Oct 26, we have the following increases.

The least growth:

Louisiana             13.15%

Hawaii                   13.97%

Mississippi          14.73%

South Carolina   16.49%

North Carolina   18.01%

Tennessee          21.48%

Alabama              22.13%

Arkansas              25.51%

Montana             28.06%

Nebraska             29.94%

The most growth:

Ohio                      91.13%

Illinois                   104.41%

New Hampshire               105.90%

Kansas                  108.44%

Connecticut        108.75%

Colorado              116.31%

Michigan              128.94%

Minnesota          137.60%

Iowa                     159.92%

Maine                   239.03%

There are many studies on why the virus is increasing so quickly now.  One is that people have been having outdoor events and have now moved indoors.  While still maintaining the 6 feet and mask guidelines.  However time and ventilation is also a factor.  Spending 3 hours indoors with an infected person has a higher percentage chance of transmission than 3 hours out doors with the same person. 

This has been corroborated by case tracking in my county, Montgomery in Pennsylvania

Another study shows that 80% of the infections come from “super spreader” events.  Which is defined as 1 person infecting 6 or more in a single event.  The White House Rose Garden event is an example.  One person infected 12, then cased a bloom of cases that infected others.

Minimizing contact is the only true answer, wherever possible.  The guide lines are just that, guidelines.  They reduce the percentages, but not to zero.

In other news:  Pfizer has announced 90% efficacy in their early vaccine trials.  The trial involved some 40,000 participants, 94 in the control group contracted the virus, while the inoculated group on had 9.

VP Pence announced that Pfizer was part of “Operation Warp Speed”, where the US Government provided seed money to various companies to develop the vaccine.  However this was repudiated by Pfizer.  8 companies have received 11 billion dollars in an attempt to develop a vaccine, Pfizer is not one of them.

Pfizer, a pharmaceutical company based in Ireland, is developing a vaccine without US Government assistance.  The US government does have a contract to buy 100 million doses for 2 billion dollars from Pfizer.  With an option to buy 500 million more.

I think it speaks volumes of the lack of interest by the administration that their Covid Czar doesn’t know where they are spending billions of dollars.

A clinical trial with Hydroxychloriquine has been completed showing no more efficacy than placebo by testing 479 patients.  All the patients in the trial that were all demonstrating respiratory symptoms due to Covid.  Hopefully this will put that debate to rest. 

https://jamanetwork.com/journals/jama/fullarticle/2772922?guestAccessKey=39a5ea0f-7853-478d-9f94-6e83c06cc89b&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=110920&fbclid=IwAR1qpElbaLrNVHTkKR2KbuFTa6x769z_GTq0ppnAOqmWBLyVkZef5WMWTyQ

 

 

What Will Trump Do?

WWTD?  What Will Trump Do?

I have thought about some of the great dictators of the 20^th century, and how they were all insane.

Not insane like drooling on the mat, or randomly spouting nonsense, but insane from the point of view of normal people.  When looking at the same situation, they would do something that no one sane would do.  The term “Power corrupts” comes to mind, but I think there is more cause and effect than that.

No dictator gets to the top without support and competition.  To be at the top means you beat all the competition in a brutal environment where making the wrong decision could likely lead to your death.  You could say these dictators were more ruthless, cunning, or lucky, but I don’t think that matters.  I look at it from a probability point of view.

For example, say we have 256 wannabe dictators, and then, through various machinations there are now 128.  It doesn’t matter how, what matters is that we have 128 wannabe’s that made the right choices, and 128 did not.  Repeat that to 64, then 32, and so on, so that in the end there is one.  And he was there because he always made the right choice.  I think this develops a sense of infallibility.  So when something earth shaking truly occurs, they literally do not have the skills anymore to cope with failure. And they break.  Some examples: 

Stalin: When the Germans attacked and destroyed all the Soviet armies in 1941, Stalin went to his dacha and hid for 3 weeks.  He was dug out by Felix (Head of intelligence) and Timshenko (Head of the Army) and he fully expected them to shoot him for his failure.  Instead they told him to LEAD, they would run the country, but he had to do his part.  The rest is history.

Nicolae Ceaușescu:  Dictator of Romania, overthrown by the Velvet Revolution.  He fled the country.  He was safe!  But saw the news casts of his country falling apart and decided his people both loved him and needed him.  So he and his wife returned.  The crowd said “Thank you very much.”, and both he and his wife were executed.  His son saw the same footage and got on a plane to China.  Where he was last reported as a manager at an amusement park.

Saddam Hussein: When he realized his army would not fight to the last man, he hid in a bunker.  His son’s, both murderous bastards and rapists, at least had the decency to shoot it out with American troops.

Idi Amin: when overthrown, he fled to Saudi Arabia.  Which took him in because he had converted to Islam, and refused extradition.  Or maybe because he managed to smuggle around 100 million dollars out.

Hitler:  Adolf actually “broke” in the winter of 1941.  The Germans were in retreat before the full force of the Russian winter.  You can see it in his hand writing.  It goes from normal, to broken and opposite slant letters in the same word.  A sign of psychotic break.  When faced with capture, he hid and then committed suicide.

Mussolini: Benito Mussolini was first removed from power and taken into custody.  Then later rescued by SS Commandos, put in charge of Northern Italy.  Eventually he fled, but was captured and executed.

So, What Will Trump Do?  Hide awaiting extradition? Suicide?  Hide while sending his sons to war? Flee the country with his ill gotten gains? Time will tell.