Coronavirus Chronicles — Who Catches COVID-19?

One of the most insidious pieces of misinformation spread by purveyors of nonsense is that healthy people don’t catch the virus. In that alternate universe, if anyone comes down with the plague it’s their own fault, for being an overweight couch potato or some other kind of contemptible loser.

Social media, in particular, can be a swamp. For some reason, a lot of Facebookers and Tweeters have a vested interest in convincing the world that only the defective people, the fat and the feeble, get COVID.

But even last year, there were stories of healthy and non-geriatric adults being laid low. Back in May of 2020, when the virus was still an ambitious novice, such reports were available, supplemented by before-and-after photos illustrating the point.

The first case discussed here was so long ago, this fellow was only the third COVID-19 patient in the Johns Hopkins Hospital, and the first to be placed on a ventilator because of it. Otherwise, that mechanical breathing apparatus is mainly used to keep patients alive during open-heart surgery; and even then, the goal is to discontinue its use as soon as possible.

Before and after

Ahmad Ayyad was on a ventilator for 25 days. The experience is so dreadful, the patient’s every instinct demands that they rip out the endotracheal tube and use it to beat the nearest torturer. A conscious person cannot be expected to endure it, so almost a month of Ayyad’s 40-year life was spent in a medically induced coma.

During that time, his 6’1″, 215-pound physique shrank by 60 pounds, and when he finally came around, he said, “My legs and arms were skinny and my chest was gone. I couldn’t believe how hard it was to just get to the edge of the bed and stand.” Did Ayyad deserve this for being an obese slob? Before COVID, says journalist Karen Nitkin…

[…] he competed in demanding obstacle course races that had him scrambling over walls and under barbed wire, lugging heavy objects, and traversing monkey bars and rings. On a typical day, he’d work in his family’s retail furniture business, then box and lift weights… He played basketball several times a week.

Ayyad had been, in other words, a superbly fit human — just like Mike Schultz, a Registered Nurse whose story appeared in the press the same month. Before: 43 years old, 190 pounds, no underlying health conditions, a gym rat who rarely missed a workout day. After longer than a month unconscious on a ventilator: An almost skeletal 140 pounds, with reduced lung capacity, and too weak to hold his cell phone. “It was so heavy. I couldn’t type because my hands shook so much.”

When interviewed by the press, both men had the same message for the public: It can happen to anybody.

A person can be in the prime of life, with no pre-existing conditions, conscientious about every aspect of health, and still almost die from COVID-19. Don’t listen to friends who say theirs was like a bad cold or the flu — there is no guarantee that yours will be. Even if a patient is sick enough to be chemically rendered unconscious and sleep through most of it, the experience will not be quickly recovered from, and will never be forgotten.

Don’t believe those who say healthy fit grownups can’t catch COVID, or kids can’t catch it, or people of a certain astrological sign can’t catch it, or any of that noise. Don’t catch it. Okay?

Your responses and feedback are welcome!

Source: “Ahmad Ayyad: Getting Strong Again After COVID-19,” HopkinsMedicine.org, 05/13/20
Source: “Nurse’s before-and-after COVID-19 photos show effects of weeks on ventilator,” WUSA9.com, 05/22/20
Image by frank_hb/CC BY 2.0

Coronavirus Chronicles — The Simple But Serious Needs of Schools

Earlier this year the Centers for Disease Control (CDC) issued COVID-19 recommendations for schools and childcare facilities. The most underutilized anti-COVID strategy, or maybe just the least talked about, is air hygiene. Compared to the very visible and highly politicized protective masks, clean air is pretty boring. But now, especially with everyone agitated about how to make schools safe, air is having its moment.

Open windows and portable air cleaning machines are useful. While earlier efforts were praiseworthy for their intention, investment in building-wide filtration systems is certainly more worthwhile than erecting acres of plexiglass barriers.

Practical suggestions and crazy dreams

This article from the CDC includes many detailed suggestions for homes, schools, and other interior spaces. The strongest general recommendation is to bring in as much outdoor air as possible. Unfortunately for a large number of Americans, outdoor air brings along the stench of factories or slaughterhouses, and of course the smoke from fires raging in some states. Ejecting air is important too, and many houses and apartments already have exhaust fans in their bathrooms and kitchens, which it might be wise to employ when company comes over.

“If it gets too cold or hot, adjust the thermostat” is a guideline totally out of touch with reality for a lot of people. Staying warm in winter or cool in summer is a major issue for many Americans who can’t afford even another $5 on their utility bills. But for institutions, especially those with COVID-associated government money to help them out, the physical plant’s HVAC system is definitely the wisest place to spend it, if we want COVID-19 to ever go away.

Much safer air could be achieved in schools with portable HEPA Filter Systems. Dr. Richard Corsi talks about the necessary parts and ongoing requirements, if America decides to take on the job of retrofitting every classroom with certain equipment. It could be done for less than $10 per student per year, with recurring costs (for replacement filters) of about $3 per student per year. That is a pretty good deal, and who wants to admit that a child’s life is not worth an annual $13? At any rate, Dr. Corsi explains,

That leads to a 60% reduction in inhalation dose of aerosol particles. Capacity exists. It can be done now.

Then, if everybody is properly masked, there is another huge advantage. He explains additional steps that can add layer after layer of protection. One of those is a DIY filtering machine that can be made by a teacher and a team of students. Another incredibly enlightening Twitter thread that covers many topics within this large and confusing landscape was posted by Dr. Eric Feigl-Ding.

Science and technology journalist Chris Baraniuk wrote a guide to choosing a home air purifier:

If viruses are what you want to remove from the air, ventilation experts generally recommend you get an air purifier or cleaner with a high-efficiency particulate air (HEPA) filter. These thick, spongy filters contain a mass of fibers that trap airborne material. They cover a wide range of particle sizes and are 99.7% efficient at snaring matter that is 0.3 microns in diameter.

Once you’ve chosen a model, you then have to decide where to place it in a room. You should pick as central a position as possible — don’t stick it in a corner… [T]he space around the device should be free of obstacles, so avoid placing it under a desk, for example.

And for heaven’s sake, read the specs, or the manual, or watch an instructional video, or something.

Your responses and feedback are welcome!

Source: “How to use CDC building recommendations in your setting,” CDC.gov, 02/26/21
Source: Dr. Richard Corsi on Twitter, 02/18/21
Source: “Should You Buy an Air Purifier for Covid-19?,” Medium.com. 12/02/20
Image by Mike Licht/CC BY 2.0

Coronavirus Chronicles — A Change of Mindset

In the attempt to subdue COVID-19, one of the biggest advances has been the realization that it spreads not by relatively heavy exhaled droplets that travel less than six feet, but by aerosol dispersion, which means it can fly through the air with the greatest of ease, and land just about anywhere. In May, the World Health Organization, in one of the quietest revolutions ever, adopted the aerosol theory. As Dr. Zeynep Tufekci, co-author of the Lancet article, “Why Did It Take So Long to Accept the Facts About Covid?” phrased it,

A few sentences have shaken a century of science… The change didn’t get a lot of attention. There was no news conference, no big announcement.
Then, on Friday, the Centers for Disease Control and Prevention also updated its guidance on Covid-19, clearly saying that inhalation of these smaller particles is a key way the virus is transmitted, even at close range, and put it on top of its list of how the disease spreads.

With an earlier acceptance of the importance of aerosol transmission, the course of events might have been very different. Dr. Tufekci says, “We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary.” A lot more attention would have been paid to ventilation and airflow, and on moving activities outdoors whenever possible. The persistent misunderstanding has also accounted for a massive amount of public expenditure on measures that are minimally useful. Dr. Tufekci writes,

In India, where hospitals have run out of supplemental oxygen and people are dying in the streets, money is being spent on fleets of drones to spray anti-coronavirus disinfectant in outdoor spaces. Parks, beaches and outdoor areas keep getting closed around the world.

People are probably soaking up tons of chemicals that do them no benefit, and do the coronavirus no harm. And of course, a fortune has been spent on tons of plexiglass, with numerous schools, libraries, and other indoor spaces being partitioned off with clear acrylic sheets when what is needed is exactly the opposite, the free movement of air from outside.

A paper published earlier this month confirmed with even more finality that “fine aerosols constituted 85% of the viral load detected,” and although good masks can block maybe 95% of aerosols, more is needed. Especially when not everybody can afford, or be persuaded to properly wear and maintain, good masks.

A report about the “Reopen and Rebuild America’s School Act of 2021” begins by admitting that many of the country’s public school buildings are outdated, hazardous, and even crumbling. A year ago, a Government Accountability Act report specified that around 36,000 schools across the nation need the heating, ventilation and air conditioning systems repaired or replaced in at least half their buildings. Experts agree that updating the HVAC systems should be part of a layered approach against COVID-19.

Your responses and feedback are welcome!

Source: “Why Did It Take So Long to Accept the Facts About Covid?” NYTimes.com, 05/07/21
Source: “Viral Load of SARS-CoV-2 in Respiratory Aerosols Emitted by COVID-19 Patients while Breathing, Talking, and Singing,” NIH.gov, 08/06/21
Source: “The Reopen and Rebuild America’s School Act of 2021,” PTA.org, 2021
Image by Stian Rødven Eide/CC BY-SA 2.0

Coronavirus Chronicles — What Will It Take to Make Schools Safe?

We talked about the American Academy of Pediatrics and the Centers for Disease Control (CDC) and what they both recommend for schools, namely, protective masks and vaccination for everyone who has the medical go-ahead for that process.

The CDC also recommends, quite appropriately, that any clinical providers who are not fully vaccinated against COVID-19 should take care of that loose end as soon as possible. It is a recommendation that has some teeth in it, as hospitals and other institutions are tightening up. In June, Texas’s Houston Methodist Hospital shed 150 employees who either resigned or were fired over refusal to be vaccinated.

That may sound like a lot of resisters, but on the other hand, an amazing 24,947 workers at Houston Methodist had been immunized to meet earlier deadlines. Journalist Dan Diamond wrote two months ago,

A growing number of health-care organizations have opted to impose vaccine mandates, including the majority of hospitals in D.C. and Maryland. The University of Pennsylvania Health System last month announced that it would require its roughly 44,000 employees and clinical staffers to be vaccinated by September.

So, in places where the importance of saving lives is taken into account, the realization is hitting. Sick people, and fellow employees, need to be protected.

But what about protecting those who are currently healthy, like students? As the old saying goes, an ounce of prevention is worth a pound of cure, and asking students, teachers, and other employees to wear serviceable masks is a reasonable request.

Slow on the uptake

For far too long, both the CDC and the World Health Organization held onto the idea that the SARS-CoV-2 virus was transmitted mainly by droplets, which are relatively heavy and fall to the ground quickly. This belief led to the six-foot social distance rule. Meanwhile, research increasingly found aerosol transmission, which is quite a different phenomenon.

In April, a Lancet article by six eminent authors described how “Ten streams of evidence collectively support the hypothesis that SARS-CoV-2 is transmitted primarily by the airborne route.” To name just a few,

[L]ong-range transmission of SARS-CoV-2 between people in adjacent rooms but never in each other’s presence has been documented in quarantine hotels.

[A]symptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally.

SARS-CoV-2 has been identified in air filters and building ducts in hospitals with COVID-19 patients; such locations could be reached only by aerosols.

(To be continued…)

Your responses and feedback are welcome!

Source: “CDC says delta variant easily transmissible, recommends universal masking in school,” AAPPublications.org, 07/27/21
Source: “More than 150 employees resign or are fired from Houston hospital system after refusing to get vaccinated,” TexasTribune.org, 06/23/21
Source: “Ten scientific reasons in support of airborne transmission of SARS-CoV-2,” TheLancet.com, 04/15/21
Image by Jernej Furman/CC BY 2.0

Coronavirus Chronicles — The AAP and Schools

In July, the American Academy of Pediatrics (AAP) addressed both vaccinations and masks. A piece by Melissa Jenco notes that, since the COVID-19 pandemic began, over four million American children are known to have been infected. While only 346 have died, there is also Long COVID to consider. How many cumulative years of a young life will be lived under the shadow of that misery?

And things are heating up. In late July, when Jenco wrote her article, 16% of the previous week’s new cases were children.

Four universities — Northeastern, Harvard, Rutgers, and Northwestern — teamed up to get a handle on the topic, and interviewed many thousands of adults during the summer. Their public surveys established that the idea of vaccinating kids, at least the older ones, is becoming more accepted. Mothers of young children have not yet changed their opinions very much.

Last winter, 54% of adults were in favor of requiring that public school kids be vaccinated, and that number grew to 61% this summer. Twice as many Democrats as Republicans are in favor of this measure. Compared to Democrats, more than four times as many Republicans resist vaccinating their own children.

Support for a school vaccination mandate is higher among city folk with more education and higher incomes. The racial breakdown shows that Asian Americans are most supportive. Wearing protective masks seems to be more acceptable, too. Even Asian Americans who were born here, or moved here young and never visited their places of origin, are exposed to media from their ancestral countries, where masking is taken for granted where there is a deep cultural tradition.

For the Los Angeles Times, Andrew J. Kampa wrote,

Raised on an ethic that elevates family and community above the individual, as well as a strong belief in science, many find it difficult to fathom why anyone would view masks as an infringement on personal freedom…

The AAP expressed a desire to return to in-person learning, urging every eligible person to be vaccinated, and for schools to use “layers of protection that include masks for everyone 2 years and older.”

Then, the institution spoke again, urging everyone in schools to mask up regardless of their vaccination status, as per the Centers for Disease Control and Prevention. This might be necessary to repeat again and again, because some people act as if it is an either/or proposition, either get vaccinated or wear a protective mask, but no. The Delta variant of COVID-19 commands us to do both, especially since even fully vaccinated people can spread the disease to others.

Vaccination is recommended for all people from 12 years old on up (minus the obvious and frequently repeated exceptions) even if they have already caught and recovered from some version of the virus. Bottom line,

The CDC recommends indoor masking for all teachers, staff, students and visitors to schools, regardless of vaccination status.

Your responses and feedback are welcome!

Source: “Survey: Support of school COVID-19 vaccine mandates growing, resistance to vaccinating children shrinking,” AAPPublications.org, 07/20/21
Source: “Some Asian Americans and immigrants wore masks readily,” LATimes.com, 12/26/20
Source: “CDC says delta variant easily transmissible, recommends universal masking in school,” AAPPublications.org, 07/27/21
Image by Bertrand Fan/Public Domain

Coronavirus Chronicles — Testing and Complications

The last couple of posts outlined a number of examples of why COVID testing is important, and spelled out how easily the statistical end of any testing program can become problematic. Unfortunately, there are even more ways in which things can go wrong. In one of his articles, writer and editor Nate Silver mentioned the false-negative test result, which in the early days accounted for around 30% of tests administered. In other words, about one person in three whose test came out negative was actually infected.

The word on false positives is more encouraging. Some very meticulous research was done in Iceland, where large numbers of people were tested whether they experienced any symptoms or not. In this testing of the population at large, the false-positive results amounted to less than 1%.

Silver runs through the various assumptions under which people labor, concerning the numbers of tests conducted, and who is chosen to be tested, and so forth. Timing is a significant factor, because…

[…] a 15-day delay between when someone gets infected and when their case shows up in the data as a positive test makes a huge difference. Even if everything else was going perfectly […] a 15-day delay would result in there being about 18 times more newly infected people in the population than the number of newly reported positive tests at any given time… [I]t still means we’re always looking two weeks into the past whenever “new” data is reported.

We will be looking at other problems the author described, but for now, the bottom line is that testing the general population, whether symptomatic or not, is vitally important if the statisticians and other scientists are to form an accurate picture of what is really going on. Since the vaccines have been available, and some people have now been vaccinated for many months, a new issue in this area is the breakthrough cases.

I can’t hear you!

According to epidemiologist Dr. Eric Feigl-Ding,

Breakthrough infections are those in which the SARS-CoV-2 RNA is detected in a person who has been fully vaccinated. [W]hat we still don’t have a good handle on is breakthrough infections. These require contact tracing, which is hard to do in super-spreading events. Finding the index patient is not an easy matter.

A cliché of visual humor is the person who refuses to listen to something they don’t want to hear. This is accomplished by plugging the ears and loudly repeating “la-la-la-la-la-la,” ad infinitum. The possibilities include closed eyes, a defiant stare at the speaker, or the abstracted, off-to-the-side option.

In May of this year, the Centers for Disease Control stopped tracking breakthrough cases. La-la-la-la-la-la.

Your responses and feedback are welcome!

Source: “Coronavirus Case Counts Are Meaningless,” FiveThirtyEight.com, 04/04/21
Source: “Epidemiologist Eric Feigl-Ding calls CDC’s mask reversal a ‘mess’,” WSWS.org, 05/21/21
Image by oddharmonic/CC BY-SA 2.0

Coronavirus Chronicles — Testing and Obstacles

The previous post mentioned some of the problems with COVID testing, extracted from a massive article by Nate Silver.

More than a year ago Silver, author of “The Signal and the Noise: Why So Many Predictions Fail — But Some Don’t,” set out to explain to a baffled public the vagaries of the testing situation. Although people hold many different assumptions, the basic realities of statistical computation have not changed.

The author illustrates in meticulous detail several major ways in which testing methodology can skew results, and pursues the questions of why and how the reported case counts “can differ from the actual number of infections.” Those are ominous words.

The first thing to realize is that countries do things differently, and even within a single country, there is a vast disparity between the practices of different states, counties, provinces, districts, and cities. Melding this universe of mandates, compliance, resistance, and data together into a meaningful picture is no easy task, and just about everything needs to be taken with a grain of salt.

We think of mathematics as abstract and pristine art, but producing the numbers that statisticians have to work with can generate numerous “messy, real-world problems.” For instance, unless a government makes incredibly strict rules, and enforces them relentlessly, no one can know the number or percentage of asymptomatic cases.

Epidemiology 101

Silver writes,

The most important number in any epidemiological model is R, or the reproduction ratio, which is how many people that a person in one generation passes the disease along to in the next generation. For example, if a disease has an R of 3, that means each infected person transmits it to three more people […] which becomes nine people, which becomes 27 people, which becomes 81 people, and so forth — the very nature of exponential growth is that it gets out of hand quickly!

This is a point that Childhood Obesity News has made many times, chiefly with the classic parable of the chessboard. There is also a solid mythological reference. Somehow sensing that creatures capable of infinite multiplication existed, the ancients spoke of a monster called the Hydra. “It had many heads and every time someone would cut off one of them, two more heads would grow out of the stump.”

Similarly, the coronavirus’s insane, monomaniacal drive to reproduce creates a crushing onslaught. Time is a very important factor, too. One problem is that…

[…] there’s a long lag between when someone is infected, when they develop symptoms, when they get tested and when those test results are reported. In Wuhan, China, the lag between the development of symptoms and test results being reported was around 10 to 12 days. And considering it usually takes at least a few days for symptoms to develop, the lag between infection and a case showing up in the test statistics is going to be longer still.

Your responses and feedback are welcome!

Source: “Coronavirus Case Counts Are Meaningless,” FiveThirtyEight.com, 04/04/20
Image by Biodiversity Heritage Library/Public Domain

Coronavirus Chronicles — The Limits of Testing

Back in April, writer Nate Silver made the sensible argument that “the number of COVID-19 cases is not a very useful indicator of anything — unless you also know something about how tests are being conducted.” He speaks of incomplete data, which conceals systemic and logistical problems that are too easily ignored.

For instance, in far too many locations, the medical personnel are being run ragged. Testing gets done as part of the triage process, to determine who needs immediate help the most. Silver points out that the frontline people are not focusing on the creation of a “comprehensive dataset for epidemiologists and statisticians to study.” They are a bit too busy trying to make sure that patients are discharged to home rather than the morgue.

And yet, the resulting numbers are not regarded as best guesses, or as sincere but possibly incomplete efforts, but as gospel carved in stone, with several types of experts eager to provide interpretation. So, what kinds of problems are we letting ourselves in for by tolerating this much slack? Silver wrote,

A country where the case count is increasing because it’s doing more testing, for instance, might actually be getting its epidemic under control. Alternatively, in a country where the reported number of new cases is declining, the situation could actually be getting worse, either because its system is too overwhelmed to do adequate testing or because it’s ramping down on testing for PR reasons.

Yes, the author “went there.” The public relations angle, or spin, is always an important, if unwelcome, part of the news-scape. When spokespeople have ego-inflating authority, and jobs from which they could be fired or unelected, they do not always adhere strictly to the truth. What is the use of hiding from that reality?

But leaving unworthy motives aside, it appears possible to deduce many different conclusions from what are, perhaps, too easily accepted statistics. For instance, here is a fairly mind-blowing bit of news from Imperial College London scholars, who guess that…

[…] the true number of people who had been infected with the coronavirus in the U.K. as of March 30 was somewhere between 800,000 and 3.7 million — as compared to a reported case count through that date of just 22,141.

That estimate, if accurate, would differ from the official count by several orders of magnitude. And, no matter what kind of testing is done, the individual benefit is not enough. This personal matter needs to also be a public health matter. People demand answers from science but resist providing the information needed. A large part of the value of testing is lost unless the accurate and complete numbers are passed along to trained statisticians who know how to extract meaning from them.

Your responses and feedback are welcome!

Source: “Coronavirus Case Counts Are Meaningless,” FiveThirtyEight.com, 04/04/21
Image by Delaware National Guard/Public Domain