Monday, March 30, 2020

Sunday, March 29, 2020

Sunday 29th March Update

At the End of the Day

There are a lot of people out there pointing fingers and placing blame. Some of it is due to uncertainty. Some to downright fear. Some is just playing politics as usual. But a lot of it is coming from a society that no longer understands that manufacturing things and shipping them takes time. A society that is used to having everything done and done perfectly right now! A society that thinks that just because a lot of people need one, a cure will be discovered right now and made available tomorrow. A society, in other words, that no longer lives in reality. We just got served the check. It seems to this author like finger pointing and politics playing ought to take a step back and remember the basics. Basics like:If you can't say something nice about someone, don't say anything at all" and "You should walk a mile in that man's shoes before you judge the choices he has had to make." I wonder how many of those trying to place blame here and there have really thought about what they would have done as POTUS or a state governor upon being given such a challenge to face? Do they understand the legal limitations of those roles? If you can help in some way, then do so. If you can't help then stay out of the way of those who are doing what they can, with what they have, where they are. And kindly stop with the armchair quarterbacking. Think you could have done better? Then go and get on your local ballot and do better for your community in the future and be thankful that these were not your decisions to have to make. Because, at the end of the day, once again, this is not something a government can stop. Only large numbers of personally responsible people making good decisions can do that. And pointing fingers and placing blame doesn't help anyone, it just makes you look bad and drives those who may have already lost their homes and businesses because of this virus into a deeper depression. America needs all those people. We need everyone to make this work and we will need everyone we have left to recover when it has passed, so play nice.
"15 By him therefore let us offer the sacrifice of praise to God continually, that is, the fruit of our lips giving thanks to his name. 16 But to do good and to communicate forget not: for with such sacrifices God is well pleased. 17 Obey them that have the rule over you, and submit yourselves: for they watch for your souls, as they that must give account, that they may do it with joy, and not with grief: for that is unprofitable for you. 18 Pray for us: for we trust we have a good conscience, in all things willing to live honestly." ~ Heb 13:15-18

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Wednesday, March 25, 2020

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Yes, I heartily concur, Don't lick toilet seats or drink fish tank cleaner ... unless directed to do so by your doctor ... and even then , I think I would get a second opinion first because, common sense.

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Anyone who has been in NY in the last week is instructed to self quarantine for the next 14 days.

Friday, March 20, 2020

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Thursday, March 19, 2020

Sunday, March 15, 2020

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This is the easiest way to save people's lives ever. Be a hero. Wash your hands, stay home and if you can't stay home, be mindful and stay away from people.

Thursday, March 12, 2020

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Covid19 and America

This author has fielded so many queries and seen so much spin and misinformation out there regarding Covid19(COrona VIrus Disease 19), that it seems necessary to post something.

1. The sky is not falling and, even if it were, it wouldn't be Donald Trump's or the GOP's or the democrat's fault. This is a virus, it is not a political windfall and should not be treated like one by either side. This author hopes that any politician who acts as though it is should be soundly defeated in the next election.

2. This is a serious situation and yes, it is worse than the flu. But panicking helps no one and isn't really necessary.

3. Martial law is neither compatible with the founding philosophies or the Constitution of this nation and it isn't necessary - unless Americans turn out to be a good deal stupider and more selfish than has formerly been the case in our history.  (Yes, this author has been asked about this possibility more than once, so thought it worth addressing.)

Here is the good news/bad news of the situation.

The bad news:  There is a new corona type virus spreading across the globe. It is predicted to infect up to 70 % of the world's population in the next year. That means it is likely that 7 out of 10 people will get it because it is new and there is no "herd immunity".  There is also no vaccine and no amount of breast beating and/or innovation will create one that has been suitably tested for at least a year.

The good news: The virus does not seem to be severe in younger people or children.

The bad news: The virus is affecting older people and the mortality rate seems to be higher than the seasonal flus with which we are familiar. (Which are also caused, in large part by viruses in the corona virus family.) "Seems to be" because we do not and will not have reasonably correct numbers until this has run it's course in a nation where testing has been widespread and available from the start. So far, it appears that South Korea has the best numbers available.

The really good news: For most people the virus will be mild enough that they may not even know they have had it.

The really bad news: About 10-20% of those who get it will have a severe presentation. Severe enough to require hospitalization or other medical intervention.  And this is where the bad news is really bad news. This is where the threat posed by this virus arises. And this is the part that the talking heads on both sides of the political aisle seem to be ignoring in their reports.

The reason this is so bad is because of how quickly this is spreading and because it can be spread by asymptomatic people - like the seasonal flus that come through every year. This is where the math of it all comes in.

The Math of it all.
The USA has a population of about 320 million people.
If 70 % of those people get this over the next year that means about 224,000,000 will get it.  ( .70 x 320,000,000 = 224,000,000.  Please feel free to double and triple check the math because this author has made egregious mistakes with decimal points before.)
 If 224,000,000 get this over the next year that means that 10 - 20% or 22,400,000 - 44,800,000 will have severe presentations requiring hospitalization or other medical intervention.  (.2 x 224,000,000 = 44,800,000)

There are only about a million hospital beds total in the USA and most of those are already taken by other patients and/or are not designed to handle those who need to be quarantined.

This is the problem. If we get even the lower percentage of 22 million severe cases in one year, the hospitals will not be able to deal with that number and many, many more people will die than would otherwise be the case. Oh but China has stopped it, you may say. Yes they did. By taking draconian measures that would be shameful to implement against the personally responsible and self reliant population of a free nation.

So here is the deal. The GOAL of the quarantines, self isolating, closing of borders, travel restrictions and all the rest, is to slow this down so that the health care system isn't overwhelmed. 

What do we do? 
Pray. Pray for the health of your neighbors and your nation. Pray for the loss of those who are going to die from this and the loss of all the knowledge and experience they will take with them as they are likely to be our oldest people. Pray for their families and friends as they mourn those losses. Pray that we, as a nation, can find the common ground and sanity to be united by this challenge rather than divided.

Be responsible. Responsible people will isolate themselves as much as possible. What? It's going to kill you to avoid going to events for the next year? No, but it may very well save someone else if you choose to stay home. Be a real hero and stay away from people for a bit as you may. Work from home if you can. If you are an employer whose employees can work from home, see that they do.

 Homeschool or use an on-line schooling option. Use this time to re-connect with your children and get to know them better. You won't regret having had the time with them as life goes forward.

Be thoughtful of others. Be mindful of all those whose employment depends on people going out and about and do what you are able to help them get through this too. If your child takes lessons from a local musician, don't just cancel their lessons, Those people need to make a living too. Set up video lessons through the internet. Help your church set up a video sermon option. Brainstorm.

Shop responsibly. Responsible people don't hoard. They just buy a little extra each time they go to the store and set up a rotation system with the supplies that they have. It's a good idea for always, not just pandemics. And it leaves product on the shelves for those who are unable to have a store of those things for times like this.

Be kind and be generous. Kind and generous people, share what they have - like sharing all those n95 masks with the people who need them - specifically, health care workers. Doctors and nurses are our front line here, so leave those masks on the shelves for them when they need them- and they are very likely to need them. Or, if you have a store of them because you have prepped  or you're a construction worker or someone who uses them for non health care work - offer what you have to your local health care facilities as it becomes apparent that they have need of them. Don't risk the harmful things they are supposed to protect you from, but if you have extra - share them to where they will do the most good.

Check on your neighbors - especially the elderly ones. You don't have to go into their homes(and shouldn't risk spreading this to them by doing so) but you could wave or give them a call once a week or so. Also - not just for pandemics and most of us already do that, one hopes.

Work. If you have had it and recovered, go back to work after you are no longer shedding the virus. Keep the economy going and the supply chains as operational as possible.

Wash your hands, often and well. Keep your coughs covered and use common sense. Politicians aren't the solution - you and I are. Be kind, be generous, use common sense and most of all rise to the challenge this poses. People who possess the moral and ethical values along with the strength of character to be a free people do not need a government nanny to do the right thing.

"1 From whence come wars and fightings among you? come they not hence, even of your lusts that war in your members?
2 Ye lust, and have not: ye kill, and desire to have, and cannot obtain: ye fight and war, yet ye have not, because ye ask not.
3 Ye ask, and receive not, because ye ask amiss, that ye may consume it upon your lusts.
4 Ye adulterers and adulteresses, know ye not that the friendship of the world is enmity with God? whosoever therefore will be a friend of the world is the enemy of God.
5 Do ye think that the scripture saith in vain, The spirit that dwelleth in us lusteth to envy?
6 But he giveth more grace. Wherefore he saith, God resisteth the proud, but giveth grace unto the humble.
7 Submit yourselves therefore to God. Resist the devil, and he will flee from you.
8 Draw nigh to God, and he will draw nigh to you. Cleanse your hands, ye sinners; and purify your hearts, ye double minded.
9 Be afflicted, and mourn, and weep: let your laughter be turned to mourning, and your joy to heaviness.
10 Humble yourselves in the sight of the Lord, and he shall lift you up.
11 Speak not evil one of another, brethren. He that speaketh evil of his brother, and judgeth his brother, speaketh evil of the law, and judgeth the law: but if thou judge the law, thou art not a doer of the law, but a judge.
12 There is one lawgiver, who is able to save and to destroy: who art thou that judgest another?
13 Go to now, ye that say, To day or to morrow we will go into such a city, and continue there a year, and buy and sell, and get gain:
14 Whereas ye know not what shall be on the morrow. For what is your life? It is even a vapour, that appeareth for a little time, and then vanisheth away.
15 For that ye ought to say, If the Lord will, we shall live, and do this, or that.
16 But now ye rejoice in your boastings: all such rejoicing is evil.
17 Therefore to him that knoweth to do good, and doeth it not, to him it is sin." ~ Mark 4

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What's The Big Deal About Covid19 Anyway?

 The flu is worse  right? Well not really. Part of the problem is that we are downplaying the numbers instead of analyzing them.  Since most people seem to be unaware of what the numbers mean in the Covid19 spread, it seems like a good time to  have a look at them. But rather than just continuing to share videos from the British guy (Dr. John Campbell), it seems like a good time to put such an analysis in a printed form for those who prefer it. Since this author is neither an engineer nor a physician, she looked about for a reasonable and easily understood breakdown of what is coming.

 It is also worth noting that the fatalists who insist that it is coming and "we're all going to be exposed sooner or later, so why get upset?" are correct to a point. Yes, it is coming and no we can't avoid it. Why prep? Why get everybody in a tizzy about this virus? Because it will have a significant impact on our daily lives - if only due to the disruptions of the supply chain and health care systems - some of which are already being felt.

 The goal is to slow down the spread of the virus so that our health care system isn't overwhelmed by it. 

Ms Specht on twitter sums it up nicely.
(She abbreviates a bit because it's Twitter: M = "Million", HCW - Health Care Worker, PPE = Personal Protective Equipment, [digit, 1, 2, 3 and etc]/n = the sequence number of her tweets)

From @LizSpecht on Twitter:

"Liz Specht
@LizSpecht
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 1/n

Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 2/n

We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. 3/n

We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. 4/n

As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population. 5/n

What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted. 6/n

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). 7/n

Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). 8/n

By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) 9/n

If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd. 10/n

If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption. 11/n

As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now. 12/n

Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing). 13/n

There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.) 14/n

As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day. 15/n

One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused. 16/n

How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China. 17/n

Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor. 18/n

Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix. 19/n

HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above. 20/n

We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going. 21/n

Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically na├»ve population works. 22/n

Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease. 23/n

I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan. 24/n

Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong. 25/n

But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”. 26/n

These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system. 27/n

And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared? 28/n

Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out. 29/n

One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year. 30/n

Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population. 31/n"
"12 For thus saith the Lord, Thy bruise is incurable, and thy wound is grievous.

13 There is none to plead thy cause, that thou mayest be bound up: thou hast no healing medicines." ~ Jer 30:12-13

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