COVID-19: We are all Lady Macbeth now

The New Neo Posted on by

The COVID-19 handwashing recommendations lead to a rise in OCD symptoms and anxiety.

Makes perfect sense:

But for some people with obsessive-compulsive disorder (OCD), to be warned they must scrub to protect themselves from an invisible enemy, and to do so in a ritualistic way with internal musical accompaniment, is akin to inviting a demon to come for tea. Some of these people have spent years trying not to wash their hands, often as a prescribed part of their treatment.

“It’s definitely put a lot of the internal OCD dialogue back into my life. It’s being reinforced by outside, authoritative voices,” says Erica (not her real name), a long-term OCD patient. “It’s a lot harder to tell yourself that the urge to wash your hands is irrational when everyone on your Twitter feed or on the news is saying: ‘Wash your hands. Nobody is washing their hands correctly.’”

The worsening outbreak affects people with OCD in other ways, too. Chiefly, the spike in anxiety about the virus can fuel existing obsessive fears of contamination and trigger destructive compulsive actions.

Did you know there was a debate tonight?

The New Neo Posted on by

That’s alright. I forgot, too.

It was absolutely wretched. The many examples there of what transpired are truly disturbing, but I’ll just highlight a few for now:

Gone are the days: assuming the risk

The New Neo Posted on by

People used to take things in stride. I realize that by saying that, I sound like an old curmudgeon. But maybe I now understand better why old curmudgeons sound like old curmudgeons.

I grew up, as the somewhat-older author of this essay “Say Your Prayers and Take Your Chances: Remembering the 1957 Asian flu pandemic” did, in an era when nearly all children got a series of diseases that are now mostly distant memories. The vast majority of us survived quite nicely, unlike in previous eras:

Before the Modern Revolution child mortality was very high in all societies that we have knowledge of – a quarter of all children died in the first year of life, almost half died before reaching the end of puberty

Royalty was not immune; look at the record of the children of Peter the Great, for example. It’s horrific. It’s also one of many reasons people tried to have as many children as possible, although a lot of women died in childbirth or shortly after. Another terrible risk that was common in prior eras.

It was much much better when I was growing up. But still, in a few short years and while I was a toddler I had measles, mumps, German measles (is that racist?), and chicken pox, and that’s just what I remember. Polio was rather common, too, although a vaccine was developed when I was in grade school; I remember what a big big deal that was, and what a hero Salk was considered to be.

My only cousin had measles encephalitis when I was about two, and died a few years later of complications from it. I remember his death very very well, and his disabilities too. That’s the sort of thing that makes a deep impression on a child. My mother told me later that, when I had contracted measles not all that long after my cousin had them, she sweated it out because the risks were very clear to her. Another couple who were good friends of my parents had lost a child from measles even before I was born, and I heard about that periodically, too.

No one had to impress on me the seriousness of measles. I knew. And polio? We saw the photos of all those kids in the iron lungs, and we saw children walking around with braces on their legs.

But that personal knowledge is gone, along with those diseases and many others (for the most part, anyway, at least in this country; I’ve written about the anti-vax movement elsewhere and am not going to take it up now, but the lack of fear of certain diseases is partly responsible for the movement).

It’s a wonderful thing that the incidence of most of those diseases has been remarkably reduced. Wonderful, fabulous, a great reduction in human suffering. But there’s been a cost, too, and it’s the increasing fragility of our psyches’ ability to withstand and endure even the prospect of an increase in disease and mortality that mirrors what my generation experienced.

As Clark Whelton, the author of the City Journal essay I linked to earlier, writes:

It’s not that Asian flu—the second influenza pandemic of the twentieth century—wasn’t a serious disease. Worldwide, this flu strain killed somewhere between 1 and 2 million people. More than 100,000 died in the U.S. alone. And yet, to the best of my knowledge, governors did not call out the National Guard, and political panic-mongers did not blame it all on President Eisenhower. College sports events were not cancelled, planes and trains continued to run, and Americans did not regard one another with fear and suspicion, touching elbows instead of hands. We took the Asian flu in stride. We said our prayers and took our chances.

Today, I look back and wonder if an oblivious America faced the 1957 plague with a kind of clueless folly. Why weren’t we more active in fighting this contagion? Could stricter quarantine procedures have reduced the rate of infection and lowered the death toll? In short, why weren’t we more afraid?

His answer is that we were more used to infectious diseases. But a corollary of that is that we would have had to have closed down shop indefinitely. There were so many illnesses around all the time that there was no way to escape. You might say we were fatalistic, you might say we were resigned, you might say we were stupid, you might say we assumed the risk, or you might say we understood that the drawbacks of that sort of reaction were immense as well.

Of course, I wasn’t around in 1918. I wasn’t around when smallpox and tuberculosis or the Black Death killed far far more of the people on earth than any of the plagues of my lifetime have come close to killing. I cannot even imagine how terrible those things were; I don’t even want to imagine. And I doubt that people took them in stride at all. And I think a good part of the dread and fear now is that in the back of our minds – or for some people, even the front of our minds – we know that such catastrophes are still possible. Human beings know they are intensely vulnerable.

But COVID-19 is not shaping up to be that sort of event, and there’s no reason to think it will be. However, although many measures are prudent – handwashing, increased testing, hospital preparedness, some measure of social distancing at least for a while – the degree of fear I see and hear is far greater than anything I can recall in my lifetime around a medical event.

And it’s not just medical events, either. Students demand that colleges protect them from ever feeling bad or bullied or offended by anything anyone says. Woman have become so reactive to the idea of sexual harassment that many have redefined it to include what used to be considered standard compliments on appearance. People start bitter twitter wars about things like cultural appropriation. There seems to be a hair-trigger over-reactivity, a new emotional fragility and vulnerability, that is akin to what can happen when a person fails to develop normal immunities of the physical type, to use a medical analogy.

[NOTE: On a different but related topic, I also can readily recall when a president – any president of any party – would be cut slack by his critics during an emergency, particularly a medical one. Those days of near-reflexive pulling together are gone, long gone. Now it seems the chief focus of the Democrats’ reaction to this crisis is to criticize Trump and score political points. There are hopeful exceptions, though, and that’s why I cheered the reactions of governors Newsom of California and Cuomo of New York:

[From Newsom]: [Trump and I] had a private conversation, but he said, ‘We’re gonna do the right thing’ and ‘You have my support, all of our support, logistically and otherwise.’ He said everything I could have hoped for. And we had a very long conversation and every single thing he said, they followed through on.

Cuomo:

This sort of thing used to be standard and expected. If a politician didn’t do it, people would have been critical of the omission. No more.]

Why hoard toilet paper?

The New Neo Posted on by

Hey, why not?

It lasts, if not forever, a long long time.

It’s pretty cheap – for now.

Doesn’t need refrigeration.

Never goes out of style.

One size fits all.

And no, people don’t think it protects them against disease – except in the sense that if they need to shelter in place for a long time, they might need quite a bit of tp and be unable or unwilling to go to the store to get it.

What’s more, the run on toilet paper (is that a pun?) increases the anxiety, and therefore there’s an increasing spiral of toilet paper buying due to the shortages.

Critical care beds: this may be part of what’s wrong in Italy

The New Neo Posted on by

The number of critical care beds may be – critical.

A while back, while I was trying to figure out why the situation in Italy has gotten so bad, one thing I came across was the idea that Italy doesn’t have that many hospital beds. But when I researched that, I discovered that, although not a star, Italy wasn’t particularly deficient in that regard.

But today I found this, which seems relevant. It’s the number of critical care beds per 100K of population in various countries. When someone is hospitalized with serious respiratory distress related to COVID-19 – or H1N1, or regular pneumonia, or sepsis – ventilation and special care is often needed to save lives. So this may be the more important thing to look at.

The data is a bit old for all the countries, but not so very old. You can see that Italy has 12.5 critical care beds per 100K population. China has 3.6 and South Korea 10.6. The US does rather well on this particular metric: 34.7.

As far as Iran goes, who knows? I doubt the number is at all high.

The death rate for each disease is not some sort of fixed thing. When I wrote about the 1918 flu pandemic, for example, I discussed the wide variation in death rates among countries (India having been especially hard hit). Differences among the health care systems in different countries – even among Western countries, which are not peas in a pod – are relevant today, as well, and this is only one of them. With a severe case of something like COVID-19, time is of the essence and enough respirators and critical care are essential to save threatened lives. Without them, people who might otherwise survive will die.

That’s why all this emphasis is on “flattening the curve” of the growth of a disease in order not to overwhelm the system.

Trump declares national emergency at news conference; Dow rises

The New Neo Posted on by

Here’s the news conference. I’ve queued it up for when Trump starts speaking:

It was long, it was comprehensive, and apparently it was reassuring.

I have only watched a little bit of it, but Trump seemed very knowledgeable and in charge, and the forces brought to bear on fighting this are impressive. He appeared “presidential,” which always hurt the left. That won’t stop a lot of people from trashing him, of course, but perhaps less effectively than before.

[NOTE: On the Dow rise and some press reaction.]

This video shows what the MSM is about

The New Neo Posted on by

After I watched this video, I felt the urge to send it to everyone I know. For just a split second I thought that, if they saw it, they couldn’t deny what they’re seeing.

But almost immediately after I had that thought, I realized that they could deny it and that they would deny it. They’d say that the news people involved used the phrase “Wuhan coronavirus” or “Chinese coronavirus” innocently and descriptively, but when Trump used the same words it meant something entirely different and was a racist dog whistle because racism engulfs his heart and mind.

I can’t watch the video without becoming furious and yet being impressed by what it reveals so succinctly about the MSM members involved: their poisonous hypocrisy and treacherous mendacity, delivered with such sober serious faces:

On the meaning of “pandemic”

The New Neo Posted on by

Now that WHO has declared COVID-19 a pandemic, it’s time for a definition.

The word “pandemic” can describe extreme situations like that in 1918, or milder situations that we barely remember, with far fewer deaths. If you look at the definition of the word, you’ll note that it doesn’t really have much to do with number of deaths so much as geography [my emphasis]:

For the sake of clarification, WHO does not use the old system of 6 phases — that ranged from phase 1 (no reports of animal influenza causing human infections) to phase 6 (a pandemic) — that some people may be familiar with from H1N1 in 2009.

In a virtual press conference in May 2009 on the influenza pandemic, Dr Keiji Fukuda, Assistant Director-General ad interim for Health Security and Environment, WHO said “An easy way to think about pandemic … is to say: a pandemic is a global outbreak. Then you might ask yourself: ‘What is a global outbreak’? Global outbreak means that we see both spread of the agent … and then we see disease activities in addition to the spread of the virus.”

In planning for a possible influenza pandemic, the WHO published a document on pandemic preparedness guidance in 1999, revised in 2005 and in February 2009, defining phases and appropriate actions for each phase in an aide memoir titled WHO pandemic phase descriptions and main actions by phase. The 2009 revision, including definitions of a pandemic and the phases leading to its declaration, were finalized in February 2009. The pandemic H1N1 2009 virus was neither on the horizon at that time nor mentioned in the document. All versions of this document refer to influenza. The phases are defined by the spread of the disease; virulence and mortality are not mentioned in the current WHO definition, although these factors have previously been included.

Also, in a March 2 post, I recommended reading an article with a quote I called “fact-based.” It went like this [emphasis mine]:

On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate [for COVID-19] is approximately 2%. In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.

Those pandemic influenzas of 1957 and 1968 were actually pretty bad, especially the one in 1957, which I happen to remember. But as I concluded in that same post, when I describe the 1957 pandemic:

There certainly was newspaper coverage then, and news filtered down to children – including me. But somehow the country didn’t self-destruct.

The stock market continues down

The New Neo Posted on by

I’m not even going to include a link, because you know it’s happening, and you’re probably following it yourself.

Some people are seeing this as a buying opportunity. I’m staying put, though – implementing a little social distancing from the market, something I always try to practice anyway in good times and bad.

What’s driving the fall? I think that – among the usual suspects like automated selling, which exacerbates such swings – it’s quite simply fear of the unknown. The fear is driven by the media and the left, but it’s not limited to that. When entire countries quarantine and/or adopt other draconian measures in an effort to stop the spread of a novel disease that no one quite understands, then people panic. Nightmare apocalyptic scenarios rush in, as well as “facts” that are not really facts, driven by the news cycle and the rumor mill that constitutes social media.

Facts can’t combat it, at least not now. “Wait and see” isn’t the way a lot of people are operating, either.

People may tire of the relentless push of the doomsday scenario, especially if doomsday fails to materialize and the number of COVID infections get under control and the patterns become more understandable and less frightening. Unfortunately, though, in this day and age, for many people, “under control” means zero risk. Zero risk is impossible. But the need for it is what drives phenomena such as that of the anti-vaxxers.

So, have it out in the comments here.

The question of asymptomatic spread of COVID-19, as well as its reproduction number

The New Neo Posted on by

I keep seeing and hearing references to the supposed fact that COVID-19 is known to be spread by asymptomatic people infected with the virus, in addition of course to symptomatic people. It was one of the first things I heard about the illness, and one of the most worrisome for obvious reasons.

I’ve continued to check to see if there’s official word on whether data has borne that out, and so far that doesn’t seem to be the case – and that, if such transmission happens, it’s rare.

Now, you don’t have to believe the officials. But I’m certainly more inclined to believe them than I believe some random person online, or in the MSM, or even a supposedly expert talking head on TV. Even without asymptomatic spread, of course, it’s wise to be cautious. I think in the next month or so much more will become known about the disease and about what the scope of it will be, and we may even learn that asymptomatic spread is definitely a thing.

But at the moment, this is typical of what I’m seeing from more official sources:

When can an infected person spread COVID-19 virus to others?

While not completely known, its likely mirrors that of other coronaviruses, in that spread occurs with fever and respiratory symptoms. While there have been initial reports of asymptomatic transmission, the CDC states that the data are not clear at this stage that asymptomatic spread occurs.

On a more general topic connected to COVID-19, another thing that’s good to remember is that, as the number of diagnosed cases goes up in the US, the number of infected people is partly a function of more testing. So beware of news that says something like “the number of cases doubled in 2 days” without also telling you what the change was in the number of tested people, and why. Of course, we should expect the number of cases to go up, but taking a certain reported rate of increase and imagining that’s the real rate of increase is premature.

As the CDC site says:

In addition to CDC, many public health laboratories are now testing for the virus that causes COVID-19.

With this increase in testing, more and more states are reporting cases of COVID-19 to CDC.

And while we’re at it, on the subject of the statistic known as the virus’ reproduction number – this article is helpful in learning about the meaning of such a figure and how it’s arrived at (hat tip: “Art Deco”). A few excerpts:

The formal definition of a disease’s R0 is the number of cases, on average, an infected person will cause during their infectious period…

The basic reproduction number represents the maximum epidemic potential of a pathogen. It describes what would happen if an infectious person were to enter a fully susceptible community, and therefore is an estimate based on an idealized scenario.

The effective reproduction number depends on the population’s current susceptibility. This measure of transmission potential is likely lower than the basic reproduction number, based on factors like whether some of the people are vaccinated against the disease, or whether some people have immunity due to prior exposure with the pathogen. Therefore, the effective R0 changes over time and is an estimate based on a more realistic situation within the population.

It’s important to realize that both the basic and effective R0 are situation-dependent. It’s affected by the properties of the pathogen, such as how infectious it is. It’s affected by the host population – for instance, how susceptible people are due to nutritional status or other illnesses that may compromise one’s immune system. And it’s affected by the environment, including things like demographics, socioeconomic and climatic factors.

The article then goes into some estimates of the reproduction rate of COVID-19. I’ll skip that, because the article is old and I don’t know whether those figures are outdated, but I’m going to assume they are. But these principles are basic ones:

…[P]rojections of the future number of cases of coronavirus are fraught with high levels of uncertainty and will likely be somewhat inaccurate.

The difficulties arise for a number of reasons.

First, the basic properties of this viral pathogen – like the infectious period – are as yet unknown.

Second, researchers don’t know how many mild cases or infections that don’t result in symptoms have been missed by surveillance but nevertheless are spreading the disease.

Third, the majority of people who come down with this new coronavirus do recover, and are likely then immune to coming down with it again. It’s unclear how the changing susceptibility of the population will affect the future spread of infection…

Finally, and likely the most important reason, no one knows the future impacts of current disease control measures. Epidemiologists’ current estimates of R0 say nothing about how measures such as isolation or quarantine efforts will influence the virus’ future spread.

We still don’t really know those things, and so we don’t really know the significance of whatever reproduction rates we are finding at the moment for COVID-19. Of course, a lower rate would be better than a higher one. But even a high rate, if it’s accompanied by a much lower ratio of serious disease or death compared to mild disease or asymptomatic infection, wouldn’t be so very bad. The very worst diseases have a high reproduction rate and a high percentage of deaths to infections.

To give you an example of that sort of illness, we have the terrible scourge of smallpox. Those of us who are of a certain age have a vaccination scar (mine is so small you can hardly see it). Those scars represent a victory of science over one of the worst diseases to afflict humankind. But I doubt that most young people have any knowledge of the phenomenon at all:

The risk of death following contracting the disease was about 30%, with higher rates among babies. Often those who survived had extensive scarring of their skin, and some were left blind…

Smallpox is estimated to have killed up to 300 million people in the 20th century and around 500 million people in the last 100 years of its existence. As recently as 1967, 15 million cases occurred a year.

So the death rate in infected people was 30%. What about the reproduction number?:

Gani and Leach have recently evaluated historical smallpox data and estimated values of 3.5–6 for the basic reproduction number R0 of smallpox (after discounting for hospital-associated cases). This means that each case would infect 3.5–6 other people on average if the population were completely susceptible.

That link reports on a study conducted on historical data from an outbreak in 1967 among a Nigerian group that refused vaccination:

The basic reproduction number, R0, was 6.87 (95 percent confidence interval (CI): 4.52, 10.1) for the whole course of infectivity, and RF = 0.164 (95 percent CI: 0, 1.31) for the fever period that preceded the rash.

You can see how a disease with such lethality and such high contagion could cause devastation. You can also see, from that last quote, how the reproduction can differ between an early (although symptomatic) stage of a disease and a later stage. It’s not a fixed amount.

I don’t know about you, but when I read about something like smallpox, I am very very very grateful for that little scar on my arm – and for all of us who were vaccinated back when smallpox still haunted the earth, and therefore played our tiny parts in its becoming a historical curiosity. Let’s keep it that way.