Coronavirus

[Danzilla31]

So I have just clicked on this morning's edition of the Minneapolis Star Tribune, known here as the "Strib".

There is an interview with Dr Michael Osterholm. I think it fair to say that he is the world's most eminent epidemiologist.

I think he really gets to the nub of the issue going forward. Change must come and fast. This is nowhere near the havoc that can be wrought by a novel infectious agent. It could and will be far, far worse, unless fundamental changes are made in how the world is organized.

As far as our avocation, all those black boxes with a "bird's nest" of wires coming out of the back CAN NOT continue to say made in China!

The mantra has to be local, local and local. So the world has to be ordered on a more medieval scale, but without the feudalism, if you like.

That is an excellent article I really appreciate your linking it.

The way he breaks things down perfectly explained my state of mind for awhile

When I got so upset the other day at 3am on the steam vent cus I'm not sleeping well ( I should have picked up on that lol) This was really driving me

Every one was talking about taking such extreme measures but no one was really explaining why. You look at Italy and you see the carnage but still what or why are we doing this for? And most importantly What's the point? What's the end game of all of this? I think both him And you are right we don't have one quiet yet and were going to have to figure that out and come together but I think we will

When I was arguing with you actually catharticaly using you as my emotional venting bag ( I'm very sorry about that by the way) I didn't say something I wanted to I didn't want to incite panic or look like a jerk but it was my truth in my head. I felt and still feel that we already screwed up too much by that point. This is out and even extreme measures to lock it down may be too late to work we already screwed it up too bad for that

So if that's the case what's the smartest end game strategy to have balance with damage control because I still feel and it's okay if I take crap for this that just locking us down indefinitely is I'm not sure if it's realistic in the long run. And he does a great job explaining why I feel this way better then I could articulate I agree with him I'm an avid chess player I like his analogy there. Just making extreme bold move as a reaction without an end game is not an effective strategy in my humble opinion

As he stated the political slants the infighting I was like man someone just give me a straight answer in language I can understand because this is not my field of experience

He did very very well that was the best article I've read to date thank you again for posting it

 

[Dan]

There are two issues.

First the causation is lack of drainage. You can not cure any pus filled walled off infections with antibiotics. What I mean is that it is like trying to cure an abscess with antibiotics. You can't, you have to drain it.

The second issue is that sinusitis is very much a mixed infection of bacteria, and especially anaerobic bacteria and a collection of fungi. So you are dealing with a plethora of organisms that would require a toxic mix of a huge variety of different classes of antimicrobial and anti fungal drugs. So in any event you would need some of the abnormal fluid loculated in the affected sinus to culture and get antibiotic sensitivities. So you might as well just go ahead and drain it. If you drain and open up any closed infection, you don't actually need antibiotics. Nature will do the rest.

So the principle of treatment is drainage, and in the case of sinusitis creating drainage pathways, so the problem is much less likely to recur.

Here is a normal sinus CT

Here is a CT of sinusitis.

Note that the left maxillary sinus is opaque and the right one has an air fluid level. That is very stinky fluid that should be drained. That patient requires endoscopic surgery.

Apologies to Dan for infringing on his territory.

We should get back on topic, this is a Coronavirus thread and not a sinusitis thread.

One more bit about sinusitis and no I don't mind you chiming in TLS. The critical part and a design flaw of humans is the little asterisk by the U in the image. That skinny black tube called the ostiomeatal unit is the source of most of our problems. It is supposed to allow the large maxillary sinus M to drain. As my ENT explained it, in humans this is very narrow compared to other mammals as our frontal lobes changed the shape of our face. It is especially large in water diving mammals such as otters. Because it is so narrow it easily is clogged which leads to the long standing infections in the maxillary sinus. Most ENT procedures are designed to open this up either with a balloon, a laser or a tiny knife. In some cases a resection of the whole wall is done. While sometimes the material in the sinuses is pus, there are also inflammatory polyps which are hard to be rid of unless resected. Had all this myself in 2018.

Gene, RA is one of a wide spectrum of autoimmune disorders where the body attacks various things especially joints. RA isn't the cause of the sinus trouble, but most treatment of it is to tone down the immune response to yourself. This makes fighting infection more difficult since your immune response is unable to fully respond. It's why all those new monoclonal antibody drugs have those warnings about infection including TB. You have my sympathy, its between a rock and a hard place. Now back to Covid-19.

 

[Verdinut]

https://www.cbc.ca/news/health/coronavirus-canada-testing-symptoms-italy-1.5504780

From the article:
"While on sabbatical at the University of Padua, Crisanti has been participating in a mass testing experiment for COVID-19 infections in Vò, a town of roughly 3,400 people located west of Venice. Though the country's overall death toll is in the thousands and climbing, Crisanti said Vò has effectively stopped its local outbreak by testing — and retesting — every single resident, regardless of whether they showed any symptoms.

The town had its first confirmed COVID-19 case on Feb. 21, he said.

The initial round of testing that month showed three per cent of the population had been infected with the illness. Every single one of those residents was then put under isolation at home and not allowed to have any contact with others. Ten days later, the entire town was retested — at which point the rate of infection had dropped to 0.3 per cent, marking a 90 per cent decrease. "What we learned is that 25 per cent had influenza-like symptoms, and 75 per cent were completely asymptomatic," Crisanti said. "They were completely unaware."

He said given the high number of people who didn't show symptoms, the takeaway for other countries is to test widely, catch all possible cases early, and isolate them to prevent the virus from spreading like wildfire through a community."

Although we are testing at a higher rate in Canada than the US, it's pretty clear that it still isn't enough. And, if asymptomatic individuals outnumber the ill by 3 to 1 - even if they are less likely to pass it on - sheer weight of numbers combined with ignorance of their infection must be contributing to the exponential increase in infections, wouldn't you agree?

The problem is that massive testing would be too costly and wouldn't be feasible around the globe.

 

[killdozzer]

How absolutely awful. That is the epitome of being struck when you are down. Obviously I know you can see that this is one of the worst times for an event like that. As you can, please try to keep us unformed and reassure us you are OK. I am so very sorry. Never in my life, and I'm sure that goes for everyone here, has there been such a blizzard of ghastly news. We must start to celebrate all progress now.

We all need to use this time as a period of great reflection. We all need to be futurists now. That is tough when you are an old geezer like me and, thought you had seen the 'lot'. Wrong again. The world is for ever changed by this event. It is not going to go back together the way it was, not even close. We are now in a world for ever changed as I have pointed out previously since this crisis has unfolded. Metaphorically the world has shifted on its axis. Make no mistake this is a seismic shift.

Thank you, Mark! For a few days we had the upper hand. Started early with distancing, monitoring and testing, we believed we had it under the curve. Now I expect to see upsurge of corona in 13-15 days. I'm OK but completely cut off.

 

[Danzilla31]

https://www.cbc.ca/news/health/coronavirus-canada-testing-symptoms-italy-1.5504780

From the article:
"While on sabbatical at the University of Padua, Crisanti has been participating in a mass testing experiment for COVID-19 infections in Vò, a town of roughly 3,400 people located west of Venice. Though the country's overall death toll is in the thousands and climbing, Crisanti said Vò has effectively stopped its local outbreak by testing — and retesting — every single resident, regardless of whether they showed any symptoms.

The town had its first confirmed COVID-19 case on Feb. 21, he said.

The initial round of testing that month showed three per cent of the population had been infected with the illness. Every single one of those residents was then put under isolation at home and not allowed to have any contact with others. Ten days later, the entire town was retested — at which point the rate of infection had dropped to 0.3 per cent, marking a 90 per cent decrease. "What we learned is that 25 per cent had influenza-like symptoms, and 75 per cent were completely asymptomatic," Crisanti said. "They were completely unaware."

He said given the high number of people who didn't show symptoms, the takeaway for other countries is to test widely, catch all possible cases early, and isolate them to prevent the virus from spreading like wildfire through a community."

Although we are testing at a higher rate in Canada than the US, it's pretty clear that it still isn't enough. And, if asymptomatic individuals outnumber the ill by 3 to 1 - even if they are less likely to pass it on - sheer weight of numbers combined with ignorance of their infection must be contributing to the exponential increase in infections, wouldn't you agree?

I've seen the same thing your seeing so many interviews with infected that were in shock because the had no symptoms at all.

They were in shock they had it that's a sneaky sneaky disease and I think your right all experts in the field seem to state if we're really going to have a chance at slowing this were going to have to ramp up testing

Until we can really see the virus we can't properly know how to get a handle on it

Excellent point hope you and your family enjoyed your time outside beautiful pictures by the way

 

[GO-NAD!]

The problem is that massive testing would be too costly and wouldn't be feasible around the globe.

Yes, I'm sure it'll be costly, but S. Korea seems to have managed it sufficiently enough to really get a grip on it. With the costs already incurred by this scourge, I don't think the costs of increased testing should be a consideration right now. I'm not suggesting every single person should be tested. However, we need to widen the criteria for who we are testing.

 

[mtrycrafts]

The problem is that massive testing would be too costly and wouldn't be feasible around the globe.

Feasibility perhaps. Costly? How much has the US economy lost already and will lose in the next 6 month? Year?
Can we say depression?

 

[TLS Guy]

The problem is that massive testing would be too costly and wouldn't be feasible around the globe.

Nonsense. Data, Data and Data. South Korea has shown this is the most effective way to spend money. That is because you can effectively target your resources and minimize the disruption to hot spots.

It is far better spent on that than propping up airlines. In the world ahead if we need 10% of them I will be surprised. Boeing will go broke and there should be no attempt at a rescue. There are lots of others in that basket.

"Times they are a Changing!"

The UK has ordered 4,500 retired physicians and nurses back to work. They have also drawn up a flow chart of which patients will be offered potentially life saving therapy or not.

This chart was drawn up by NICE which is a government organization that determines the cost/benefit ration of treatments, especially drugs that can be provided under the NHS. They are particularly effective at denying proven therapies for cancer, cystic fibrosis, muscular spinal atrophy and diseases of that nature under the NHS.

At this time under the War Powers ACT there are no private hospitals. All private hospitals have been nationalized for the duration.

My wife and I were talking about this today, and see a significant chance we will get co opted. I don't know what use I would be now.

It is getting closer to home. A neighbor of ours at our Eagan town home and a nurse who had wide administrative responsibilities in the area of infectious disease, has just informed us that her daughter has just come down with fever and symptoms of Covid 19 and almost certainly has it.

I have just got off the phone with the chief nursing officer for the hospital in Bemidji MN, the first city on the Mississippi. I have known her for a long time, as she was formerly one of our senior administrators. They are making all preparations. They have 10 ventilators and few staff for critical care.
PPE is in very short supply. There are four cases in the hospital now probably, as there is still a delay in testing. So we are further along in this saga than we knew about. That is the take home of this. Everyone is much further along the road of this journey than they realize.

I think you all here realize the ramifications of this now.

 

[mtrycrafts]

They already have many cases of Corona beer !

Many cases? How about a whole bunch or railroad car full.

 

[Verdinut]

Feasibility perhaps. Costly? How much has the US economy lost already and will lose in the next 6 month? Year?
Can we say depression?

I believe that your country's governments waited a bit too long to act upon the pandemic menace that was suspected of occurring. As you know, the more we wait before acting, there are consequences and increased cost as well as more deaths are some of them.

Here in Quebec, the situation is at present under good control with slight regular increase in affected people reported despite more testing. However, in Ontario and in British Columbia, the results are not as good. One factor which did not help is that our Federal government delayed the interruption of incoming and outgoing commercial flights.

 

[Irvrobinson]

Nonsense. Data, Data and Data. South Korea has shown this is the most effective way to spend money. That is because you can effectively target your resources and minimize the disruption to hot spots.

Agreed.

It is far better spent on that than propping up airlines. In the world ahead if we need 10% of them I will be surprised. Boeing will go broke and there should be no attempt at a rescue. There are lots of others in that basket.

Really, Mark, you should control your emotions. While I'm not in favor of propping up *any* companies, politicians are probably going to do it as a jobs program. Fortunately it looks like they may be smarter about it than they were in 2008.

There are ten major US domestic airlines, not counting regional airlines. Your notion that we need only one airline sounds foolish. And that's just domestic airlines. Many, many of my friends have family around the world, and while there may be a pause in international air travel, there's no way in the long term that these folks are going to forsake their families. And what are their alternatives? Cruise ships? Get real. Solutions for safe flying will be found; solutions are always found when there's high demand.

Even if COVID19 kills off 10% of the world's population, people are going to go back to flying. Probably within this year.

In case you weren't watching, some airlines are restarting flights just for freight purposes. That trend is probably going in increase for a little while, not decrease. Globalization for manufacturing is not going away anytime soon. Globalization took years to build up, and it'll take many years to replace, even if we attempt it. I doubt it will be attempted at all, except perhaps for drug manufacturing. It won't surprise me if Congress gets nervous about being so dependent on China for drug ingredients. For electronic components? Very doubtful.

Domestically, I intend to go back to flying as soon as this emergency subsides. Most people I know feel this way. We have four children in three cities on two coasts, and I'm not going to give up seeing them for much longer, and driving is dangerous and tiresome for thousands of miles. Trains are worse than planes.

As for Boeing, do you really know anything about Boeing? Just for starters, they're a major defense contractor. Like $26B in annual revenue last year, more this year. Their commercial aviation division is bigger and more screwed up, the 737 MAX situation is one of the great stories of incompetence in US commercial history, but I doubt Boeing is going broke. Some of their suppliers may be in trouble, but that's a more manageable problem.

 

[mtrycrafts]

I believe that your country's governments waited a bit too long to act upon the pandemic menace that was suspected of occurring. As you know, the more we wait before acting, there are consequences and increased cost as well as more deaths are some of them.

Here in Quebec, the situation is at present under good control with slight regular increase in affected people reported despite more testing. However, in Ontario and in British Columbia, the results are not as good. One factor which did not help is that our Federal government delayed the interruption of incoming and outgoing commercial flights.

A bit too long? You are very generous.
I am not so. Way, way behind the eight ball.
Quebec? I have a sister and family living there.

 

[GO-NAD!]

Agreed.



Really, Mark, you should control your emotions. While I'm not in favor of propping up *any* companies, politicians are probably going to do it as a jobs program. Fortunately it looks like they may be smarter about it than they were in 2008.

There are ten major US domestic airlines, not counting regional airlines. Your notion that we need only one airline sounds foolish. And that's just domestic airlines. Many, many of my friends have family around the world, and while there may be a pause in international air travel, there's no way in the long term that these folks are going to forsake their families. And what are their alternatives? Cruise ships? Get real. Solutions for safe flying will be found; solutions are always found when there's high demand.

Even if COVID19 kills off 10% of the world's population, people are going to go back to flying. Probably within this year.

In case you weren't watching, some airlines are restarting flights just for freight purposes. That trend is probably going in increase for a little while, not decrease. Globalization for manufacturing is not going away anytime soon. Globalization took years to build up, and it'll take many years to replace, even if we attempt it. I doubt it will be attempted at all, except perhaps for drug manufacturing. It won't surprise me if Congress gets nervous about being so dependent on China for drug ingredients. For electronic components? Very doubtful.

Domestically, I intend to go back to flying as soon as this emergency subsides. Most people I know feel this way. We have four children in three cities on two coasts, and I'm not going to give up seeing them for much longer, and driving is dangerous and tiresome for thousands of miles. Trains are worse than planes.

As for Boeing, do you really know anything about Boeing? Just for starters, they're a major defense contractor. Like $26B in annual revenue last year, more this year. Their commercial aviation division is bigger and more screwed up, the 737 MAX situation is one of the great stories of incompetence in US commercial history, but I doubt Boeing is going broke. Some of their suppliers may be in trouble, but that's a more manageable problem.

Boeing probably would have gone broke long before this crisis if not for their defense business propping up the commercial side. There's no money to be made in civilian aircraft production.

 

[JerryLove]

The mantra has to be local, local and local. So the world has to be ordered on a more medieval scale, but without the feudalism, if you like.

Then local famines kill local people. Local disease bankrupts local insurance resulting in local collapse.

Most of the modern world only works at scale and only works globally (or near so).

People tend to think that the dark ages was when we forgot a lot of knowledge. That's not really accurate. It's the period where infrastructure broke down such that the knowledge could not be used.

The process of making a CPU involves something like half the periodic table. The materials are not available everywhere, not even on every continent. Further, the supply chain is only functional at large scales. It takes thousands of people to build a CPU. You can't go "local, local, and local" and expect to have 21-century (or even most of 20th century) life.

Sure. With 400million people: the US can do more domestically than it does. We can put those people building stuff for china our of business and create businesses to build the stuff we buy from China. I'm not sure the pork farmer will want to assemble iPhones at minimum wage, but that's not really the point.

The point is: you won't have a vertically integrated smartphone factory in every state. It doesn't work that way.

So rather than "local, local, and local" perhaps "redundant capacity, redundant distribution, emergency stockpile"

(I'm not saying "more local" isn't good. It is. If nothing else, reducing transportation is good for the environment; I'm saying what I understand you to be suggesting would look like the distant past in more than just economics.)

 

[Irvrobinson]

Boeing probably would have gone broke long before this crisis if not for their defense business propping up the commercial side. There's no money to be made in civilian aircraft production.

Oh, I don't know about that. Looking at Boeing's financial data from 2018, which was prior to the 737 MAX debacle coming to light, they earned $7.8B in profit from the commercial aviation division.

See page 3:

4Q19-Press-Release.pdf

 

[GO-NAD!]

Oh, I don't know about that. Looking at Boeing's financial data from 2018, which was prior to the 737 MAX debacle coming to light, they earned $7.8B in profit from the commercial aviation division.

See page 3:

4Q19-Press-Release.pdf

Could those be paper profits be based on underpriced aircraft that have been subsidized by the defense division? I've read articles about the aircraft industry (I'm not inclined to do a search atm, as I don't want to derail this thread) the gist of which is that no manufacturers would be profitable without being subsidized manner. That goes for Boeing, Airbus Bombardier and Embraer.

 

[TLS Guy]

View attachment 34792
One more bit about sinusitis and no I don't mind you chiming in TLS. The critical part and a design flaw of humans is the little asterisk by the U in the image. That skinny black tube called the ostiomeatal unit is the source of most of our problems. It is supposed to allow the large maxillary sinus M to drain. As my ENT explained it, in humans this is very narrow compared to other mammals as our frontal lobes changed the shape of our face. It is especially large in water diving mammals such as otters. Because it is so narrow it easily is clogged which leads to the long standing infections in the maxillary sinus. Most ENT procedures are designed to open this up either with a balloon, a laser or a tiny knife. In some cases a resection of the whole wall is done. While sometimes the material in the sinuses is pus, there are also inflammatory polyps which are hard to be rid of unless resected. Had all this myself in 2018.

Gene, RA is one of a wide spectrum of autoimmune disorders where the body attacks various things especially joints. RA isn't the cause of the sinus trouble, but most treatment of it is to tone down the immune response to yourself. This makes fighting infection more difficult since your immune response is unable to fully respond. It's why all those new monoclonal antibody drugs have those warnings about infection including TB. You have my sympathy, its between a rock and a hard place. Now back to Covid-19.

You are correct that the sinus drainage are a major design fault in humans. Sinusitis is a good candidate for being top of the list for conditions being wrongly diagnosed and generally mistreated.

 

[Irvrobinson]

Could those be paper profits be based on underpriced aircraft that have been subsidized by the defense division? I've read articles about the aircraft industry (I'm not inclined to do a search atm, as I don't want to derail this thread) the gist of which is that no manufacturers would be profitable without being subsidized manner. That goes for Boeing, Airbus Bombardier and Embraer.

I am not an expert on Boeing. I did have (for me) a large position in their stock for awhile, which means I did some research, but I never worked for them, so I don't have an insider's view. (When the details of the 737 MAX problem and the background was revealed, I sold everything, as I lost trust in their ability to execute. I sold at about $380, and was pissed that I missed selling at the all-time high of $440, but now that it's trading at $95 I'm more satisfied with my decision, ahem.)

Boeing's commercial aircraft development owes very little to the military. The military does buy some commercial aircraft for their own use, but as a percentage of total commercial aircraft sales it's pretty small. There is the case of the KC-46 tanker, which is based on the ancient 767 airframe, but that was a case of the commercial division subsidizing the defense devision, not the other way around.

(As an editorial aside, the KC-46 is another fiasco, but in this case Congress, the DoD, and Boeing conspired to make sure Boeing rather than Airbus, who appeared to have a superior solution, won the bid.)

Boeing's commercial division is more profitable than Airbus's because between the 777 and the 787 Boeing sold more wide body aircraft than Airbus does. Wide body aircraft have higher gross margins than smaller aircraft. And Airbus made a very unprofitable bet with the A380. If Mark is correct about international travel being permanently suppressed due to COVID19 then the tables may turn, because Airbus's narrow body planes are more successful than Boeing's.

Both of these commercial aircraft manufacturers are highly subsidized, but not by defense contracts. They provide numerous lucrative jobs in their manufacturing plants, so federal, state, and local governments (and their international equivalents) provide rich subsidies on their own.

 

[Irvrobinson]

You are correct that the sinus drainage are a major design fault in humans. Sinusitis is a good candidate for being top of the list for conditions being wrongly diagnosed and generally mistreated.

You guys believe in Intelligent Design? Really?

 

[GranteedEV]

I just read about it on facebook. Wow. Hope you're recovering, Gene.

Yes, I think that Remidisvir is the most promising drug to try.

favipiravir seems promising as well, from what I've read