Patterico's Pontifications

3/18/2020

Study: Vast Majority Of Coronavirus Fatalities In Italy Were People With Previous Health Conditions

Filed under: General — Dana @ 12:43 pm



[guest post by Dana]

Bloomberg is reporting on a new study out of Italy indicating that nearly all of Italy’s coronavirus fatalities were people with previous health issues:

More than 99% of Italy’s coronavirus fatalities were people who suffered from previous medical conditions, according to a study by the country’s national health authority.

After deaths from the virus reached more than 2,500, with a 150% increase in the past week, health authorities have been combing through data to provide clues to help combat the spread of the disease.

[…]

The new study could provide insight into why Italy’s death rate, at about 8% of total infected people, is higher than in other countries.

The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities, finding that just three victims, or 0.8% of the total, had no previous pathology. Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions.

More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.
The average age of those who’ve died from the virus in Italy is 79.5. As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions.

While data released Tuesday point to a slowdown in the increase of cases, with a 12.6% rise, a separate study shows Italy could be underestimating the real number of cases by testing only patients presenting symptoms.

Untitled

The report also notes that the median age of the Italians infected is 63.

About testng only patients presenting symptoms… Here in the U.S., it is problematic trying to get a test for those who show symptoms, as well as those who don’t show any symptoms, and that can lead to disastrous consequences:

Morgan Thornberry, a 38-year-old organizer in San Diego, went to an urgent-care clinic earlier this week with a fever, a dry cough, and nausea. The symptoms had started the week before, on the day she was released from the hospital for an unrelated stay.

She went to the clinic with the same question as, it seemed, everyone else: Was she sick with COVID-19, the disease caused by the new coronavirus? The six people behind her in line were all wearing surgical masks.

She still doesn’t know. Though tests showed she was negative for influenza and strep throat, the clinic doctor said he could not test her for COVID-19. “The doctor said he wanted to test me, but the San Diego County Department of Health criteria wouldn’t allow him to,” Thornberry told me.

[…]

For more than a week, federal officials have promised that tests for the new coronavirus would soon be widely available. “Anyone who wants a test can get a test,” President Donald Trump said during a visit to the Centers for Disease Control and Prevention last week. (Secretary Alex Azar, who leads the Department of Health and Human Services, later clarified that a doctor or public-health official would need to approve and prescribe it.)

But the majority of Americans still cannot get tested, as interviews with doctors, patients, and dozens of state public-health officials reveal. While the most stringent federal guidelines are gone, a chaotic patchwork of rules now governs who can and cannot get a COVID-19 test. In many states, symptomatic patients still cannot get tested for the coronavirus unless they meet certain limited criteria—even if their doctor wants to test them.

The report goes on to say that there are a number of entities involved in making testing rules (including states, counties, and cities, as well as by individual hospitals and health systems), and that they generally base these rules on the CDC guidelines, how they are enforced in reality varies state-by-state, and even hospitals-to-hospital.

All of which in turn means:

Under the most widely used criteria, only people who have either traveled recently or have had known contact with a laboratory-confirmed COVID-19 patient can get tested, even if they have all the symptoms of the disease. This means that a city or region’s first community case may not qualify for a test, especially if the person is not sick enough to be hospitalized.

“If those are the requirements, you will miss almost all mild symptomatic transmission, and only become aware [that the coronavirus] is present in your community when it gets into a group of vulnerable people and starts killing them,” William Hanage, an epidemiology professor at Harvard, told me by text message.

On a wider scale, the rules frustrate doctors, nurses, and other front-line medical workers as they try to take care of patients without endangering themselves. Even in the absence of local rules, doctors must sometimes involve dozens of people throughout a sprawling hospital bureaucracy before they can authorize a single test. The rules have prevented medical staff from getting themselves tested: In several cases, a doctor who had symptoms of COVID-19 told me they were denied a test because they could not prove they were exposed to a laboratory-confirmed case.

The rules almost certainly mean that the United States is still greatly understating the number of people nationwide who are sick with COVID-19, experts say.

–Dana

97 Responses to “Study: Vast Majority Of Coronavirus Fatalities In Italy Were People With Previous Health Conditions”

  1. I was unable to find an English translation of the Italian study that is the subject of the Bloomberg report. If you do, please let me know in the comments.

    Dana (4fb37f)

  2. What person under 50 goes to urgent care “with a fever, a dry cough, and nausea“? Hunker down. Stay home. You will survive. Others you infect maybe won’t.

    Munroe (de43d8)

  3. This:

    The symptoms had started the week before, on the day she was released from the hospital for an unrelated stay.

    Dana (4fb37f)

  4. What person under 50 goes to urgent care “with a fever, a dry cough, and nausea“? Hunker down. Stay home. You will survive. Others you infect maybe won’t.

    Munroe (de43d8) — 3/18/2020 @ 12:59 pm

    Just because the risk is higher for older people doesn’t mean it’s zero for people under 40. A friend of mine who’s 40 spent 4 days in the hospital for pneumonia in December. She wasn’t tested for Corona virus so we don’t know for sure what she had. But she had just flown in from Shanghai. So…..

    Time123 (daab2f)

  5. Why is it that South Korea was able to administer so many test, while the U.S. seems to have a shortage of testing kits?

    Bored Lawyer (56c962)

  6. Of course the risk is not zero for those under 50. I’ve had pneumonia twice. Ms. Thornberry did not have pneumonia, judging from her symptoms. You don’t go to urgent care for what she had. Not now.

    Munroe (de43d8)

  7. Why is it that South Korea was able to administer so many test, while the U.S. seems to have a shortage of testing kits?

    Good question. Further, the U.S. used a CDC test that didn’t work for weeks and refused to buy the WHO tests that did. The Chinese, among others, are suspicious about this. The Chinese government are shaping the narrative that this was, perhaps accidentally (or not!), released by the U.S. Essentially their propaganda narrative goes something like this:

    America accidentally released it at Fort Detrick. CDC shut down Fort Detrick’s operations.

    China is its main geopolitical, economic, and, increasingly, military rival and the U.S. didn’t want to be hurt while the Chinese weren’t. Further, the prestige of the United States is important for military and economic reasons and if it was revealed the U.S. had released this upon the world, that would be very damaging.

    The U.S., therefore, launched a biological attack using its most dangerous strain (probably an unreleased one) at Wuhan near both the infamous wet market and China’s only BSL-4 lab, each of which served the purpose of providing alternative explanations for the outbreak, giving America plausible deniability while establishing Chinese culpability.

    America buried, through lack of testing and then intentionally flubbing testing, its COVID-19 cases with the seasonal flu until it couldn’t.

    America did not count on the degree that textile workers in Northern Italy come from this region of China and therefore that it would hit its allies in Europe hard.

    Now here we all are.

    And if that isn’t what happened—which it may well not be (it could be the wet market or an inadvertent Chinese release at their Wuhan lab)—it’s still along the lines of what much of China’s government claims to believe happened, which means poor relations, to say the least.

    Make America Ordered Again (23f793)

  8. #7 —

    You may want to consult this:

    https://www.snopes.com/fact-check/us-coronavirus-test/

    In my opinion, the fact that so few can be tested right now is why we are stuck in lockdown. So it’s a big deal. But it may be the usual human error that got us there.

    Appalled (1a17de)

  9. Way off topic!

    Rev. Hoagie, are you lurking out there? I was thinking of you today. I hope you are well.

    felipe (023cc9)

  10. Why is it that South Korea was able to administer so many test, while the U.S. seems to have a shortage of testing kits?

    Dr Brix covered this several times at yesterday’s press conference:

    We were adamant about having a high-quality test based on our commercial vendors. Over the next few months, you will begin to see that other tests that were utilized around the world were not of the same quality, resulting in false positives and potentially false negatives. These tests were studied, and studied by the FDA, to really ensure that they are that level of quality. And we’ve given the states the permission to ensure that same level of quality.

    When the dust settles we will see if she is right. Assuming other nations submit all of there data.

    BuDuh (5d25d6)

  11. Both Politifact and Snopes siding with the administration? Maybe what is really important is dawning on them.

    BuDuh (5d25d6)

  12. Felipe, I’d be willing to swap out a certain most interesting man in the room for the ol’ Revrun. Same Schiff to my ears.

    Dr.Brix is aaight….in the competency sense and the central casting sense.

    urbanleftbehind (130913)

  13. BTW, some are starting to ask the quesiton I asked yesterday:

    Will Aggressive COVID-19 Control Measures Cost More Than They Are Worth?

    Politicians seem to be proceeding on the dangerous assumption that cost-effectiveness does not matter.

    https://reason.com/2020/03/18/will-aggressive-covid-19-control-measures-cost-more-than-they-are-worth/?utm_medium=email

    Also:

    If 18 Months of Extreme Social Distancing Is What It Takes To Stop Coronavirus, We’re Doomed

    https://reason.com/2020/03/18/coronavirus-quarantine-imperial-college-london-covid-19/?utm_medium=email

    Bored Lawyer (56c962)

  14. If plenty of people have it unnoticed, then it is less dangerous. I read a column where Holman Jenkins said that if on;y sick people were tested, getting the flu would appear to be 75 times as deadly than it is.

    This person wants random sampling but probably to few people were infected for this to be of any use.

    https://www.wsj.com/articles/its-dangerous-to-test-only-the-sick-11584288494

    Testing only sick or symptomatic patients will not get us to the truth. To see why who we test matters, consider the flu. Its mortality rate is around 0.1%—meaning that of everyone infected with the flu, tested or not, 1 in 1,000 die of it. If we only tested people who are hospitalized with flu-like symptoms, the mortality rate jumps 75-fold. Similarly with the coronavirus, testing only sick and symptomatic people will result in an overestimate of mortality, which would heighten fear and anxiety and worsen their economic effects.

    The way to learn the truth is to test a random sample of the population in major cities with an outbreak.

    But I think you need to get to a true 3% or 4 positive rate for this to be of any worth. Maybe you could up the percentage by asking people who think they suffered from acold in the last month to volunteer for a etest.

    But also they should use chloroquine iand Kaletra and anthing else that looks good. (not the anti-ebola IV treatment.)

    Waiting for a study to be completed is nonsense up with which we should not put! (but they should watch for counterindications.)

    If this is war, then it should be treated like a war, and in a war, you act on the basis of incomplete information.

    Picking commanders who are good at getting things right. That’s all you can do.

    Sammy Finkelman (e4c3a1)

  15. 14. When politicians can depend on taxpayer money for their schemes, cost-effectiveness is never a consideration.

    Gryph (08c844)

  16. South Korea calls its policy

    Trace

    Test

    and

    Treat.

    They haven’t closed the soccer stadiums.

    hey still have a fatality rate of 0.7%. Not as low as Singapore’s 0 out of — well we don’t know. It’s around 300 diagnosed now but some recent.

    Sammy Finkelman (e4c3a1)

  17. I want to drive home this point:

    The report goes on to say that there are a number of entities involved in making testing rules (including states, counties, and cities, as well as by individual hospitals and health systems), and that they generally base these rules on the CDC guidelines, how they are enforced in reality varies state-by-state, and even hospitals-to-hospital.

    All of which in turn means:

    Under the most widely used criteria, only people who have either traveled recently or have had known contact with a laboratory-confirmed COVID-19 patient can get tested, even if they have all the symptoms of the disease. This means that a city or region’s first community case may not qualify for a test, especially if the person is not sick enough to be hospitalized.

    “If those are the requirements, you will miss almost all mild symptomatic transmission, and only become aware [that the coronavirus] is present in your community when it gets into a group of vulnerable people and starts killing them,” William Hanage, an epidemiology professor at Harvard, told me by text message.

    On a wider scale, the rules frustrate doctors, nurses, and other front-line medical workers as they try to take care of patients without endangering themselves. Even in the absence of local rules, doctors must sometimes involve dozens of people throughout a sprawling hospital bureaucracy before they can authorize a single test. The rules have prevented medical staff from getting themselves tested: In several cases, a doctor who had symptoms of COVID-19 told me they were denied a test because they could not prove they were exposed to a laboratory-confirmed case.

    The rules almost certainly mean that the United States is still greatly understating the number of people nationwide who are sick with COVID-19, experts say.

    This isn’t an argument to shift/hide the blame… but an observation.

    When you have this complicated bureaucracy structure you will inevitably encounter what you see today.

    Basically, the failures we’ve seen so far is an indictment as to why these “Top-Down” bureaucratic framework isn’t ideal to rapidly confront these challenges.

    No President, Agency Heads, State Officals, Insurance Co, Local Hospital or private Lab companies are going to collectively move smoothly to address pandemics.

    It’s just not going to happen.

    We don’t HAVE enough tests to be more liberal here, so we’re forced to apply rules that complies with specific indications to qualify for these tests, which generally are:
    a) travels from existing hotspots
    or
    b) exposed to known cases
    …maybe
    c) certain exigency governed by local officials (different state by state).

    Yes, that makes it harder to diagnose cases earlier on and COVID-19’s virulence compounds further transmissions. This is what we’re dealing with now.

    But the current indication requirements are in placed to conserve the existing stock to confirm cases that complies with those indications, so that proper treatments are applied in a timely manner. Furthermore, for even suspected COVID-19 infections, providers CAN prophylacticly prescribe COVID-19 effective treatments along with certain broad-spectrum treatments for other respiratory infections.

    Short Term: what you’re seeing from every level of government and local entities is what we want. Folks are treating this seriously.

    Long Term: once the pandemic is over, every level of government down to local private entities must pick up the mirror and assess what went wrong or what could be better. For instance, how could we devise a rapid-response team to spin up new tests when new virulent strains are identified and who orchestrates this? The lessons learned from this pandemic will inform us how to be better prepared for the next pandemic.

    whembly (fd57f6)

  18. https://www.bbc.com/news/world-asia-51836898

    Professor Gye Cheol Kwon, the chairman of the Laboratory Medicine Foundation, calls this the Korean “bali bali” gene. Bali means quick in Korean. He says this because the South Koreans managed to design and create a test, set up a network of labs across the country and get it all to work in 17 days….Prof Kwon believes the accuracy of South Korea’s Covid-19 test is around 98%

    And they keep only the most serious cases in he hospital, something that will probably also be done here.

    Sammy Finkelman (e4c3a1)

  19. Munroe, Sorry to belabor a point you already knew. Just seeing a lot of ppl under 40 acting like their immune.

    Time123 (69b2fc)

  20. ‘The rules almost certainly mean that the United States is still greatly understating the number of people nationwide who are sick…’

    Period.

    DCSCA (797bc0)

  21. This just in:

    https://www.businessinsider.com/malaria-pill-chloroquine-tested-as-coronavirus-treatment-2020-3

    ….China has found that chloroquine is effective against COVID-19, the state-owned Xinhua news agency reported on February 17. Countries including China, South Korea, and Belgium have added chloroquine to their treatment guidelines.

    US physicians don’t appear to be waiting for data either. Prescriptions for chloroquine have surged, according to recent tracking data from IQVIA cited by Raymond James. For the weeks of February 21, February 28, and March 6, weekly prescriptions grew from 531 to 957 to 1,290.

    Doctors in the US have broad authority to prescribe approved medications for so-called off-label uses, or conditions that the drug isn’t approved to treat.

    In the past month, the UK has added both chloroquine and hydroxychloroquine to a list of drugs that drug wholesalers cannot export because UK patients need them and exporting them may lead to a shortage in the UK.

    Early reports of success ‘should be taken seriously’

    Andrea Savarino is an Italian scientist who has worked at the Italian National Institute of Health, the country’s top medical research body, since 2006. He has been studying chloroquine and its potential uses for even longer than that, starting as a virologist in 1994.

    During the 2003 outbreak of SARS — also a coronavirus — Savarino showed in laboratory research that chloroquine may be a useful weapon against it. But by the time his research was published in The Lancet in November 2003, the outbreak had dissipated and there were no human cases available to test.

    “There has been a number of press releases, unfortunately not yet papers, but even the local experiments are things that should be taken seriously,” Savarino told Business Insider. “Chloroquine plus the HIV inhibitors has produced interesting results, at least curative results, both in China and Australia.”

    {Ignore China. but Australia and other places you can probably trust. The question is can it also harm people?]

    In Australia, researchers at the University of Queensland have said a combination of chloroquine and Kaletra led to the recovery of some of the first COVID-19 patients in Australia.

    “It’s a potentially effective treatment,” David Paterson, the director of the university’s Centre for Clinical Research, told the Australian news site News.com.au.

    Savarino said he had heard anecdotal accounts from other countries as well, including Japan, India, and Thailand.

    “Given these promising results, I am of course optimistic, but I cannot give percentages of success as of now,” Savarino said. He emphasized the need to collect more data before reaching conclusions.

    Savarino said he was developing an online platform to collect hydroxychloroquine data on COVID-19 patients across Italy and eventually other countries. He said he hoped to get the site going in the next few days and would make the data widely available as soon as possible.

    Ultimately, Savarino thinks a combination of two or three drugs will be found to be the most effective treatment for COVID-19, like how therapies using multiple drugs have become the standard for treating HIV, he said.

    Sammy Finkelman (e4c3a1)

  22. 20. Just seeing a lot of ppl under 40 acting like their immune…

    Remember the mindset of “the young” – indestructible.

    DCSCA (797bc0)

  23. urbanleftbehind (130913) — 3/18/2020 @ 1:39 pm

    Thanks, man. I do not know how you know, but I appreciate the info!

    felipe (023cc9)

  24. I’ve also heard hydroxychloroquine + azithromycin (z-pak) has been effective, which the z-pak can also be effective against other respiratory infections.

    whembly (fd57f6)

  25. After the 2015 MERS snafu in South Korea, my guess is they modified their approach much like how this administration is modifying the US approach. At that time information on contagious hot spots was withheld from the South Korea citizens leaving them in a state of fear. The current Bali Bali plan is working because a previously frightened population is more than happy to sacrifice personal information becoming public because of the country’s previous failure. In the US nobody seemed to be aware of the actual numbers of the 2009 H1N1 until now. Maybe a more educated/frightened/compliant population is what the US needs.

    BuDuh (5d25d6)

  26. There are an estimated 20,000 different drugs approved by the FDA.

    https://www.nytimes.com/2020/03/17/science/coronavirus-treatment.html

    Kevan Shokat, a chemist at U.C.S.F., is poring through 20,000 drugs approved by the Food and Drug Administration for signs that they may interact with the proteins on the map created by Dr. Krogan’s lab.

    Dr. Shokat and his colleagues have found 50 promising candidates. The protein BRD2, for example, can be targeted by a drug called JQ1. Researchers originally discovered JQ1 as a potential treatment for several types of cancer

    There’s even other ideas:

    Other researchers have taken startling new approaches. On Saturday, Stanford University researchers reported using the gene-editing technology Crispr to destroy coronavirus genes in infected cells.

    Sammy Finkelman (e4c3a1)

  27. 25. Gun sales have spiked so a lot of knuckleheads must believe a pistol works, too. The caliber of results may vary. 😉

    DCSCA (797bc0)

  28. Good post. Very helpful. Thank you.

    DRJ (15874d)

  29. whembly, I think doctors will find a way around bureaucracy. They likely already are in Texas, which is why there have been twice as many private lab tests as public lab tests.

    DRJ (15874d)

  30. z-pak is an antibiotic (for bacteria). I don’t know that it has any anti-viral action. I assume it’s included to prevent opportunistic infections and the chloroquine is doing the heavy work.

    It looks like Del Bigtree, whose video I referenced here last week, was right about it.

    Make America Ordered Again (23f793)

  31. Pretty good article about why and where Italy and Iran got slammed:

    “ By any common-sense measure, both countries should have much lower numbers of confirmed cases and deaths because they are geographically far from the epicenter of the outbreak. The reason these two countries are suffering the most outside China is mainly due to their close ties with Beijing, primarily through the “One Belt and One Road” (OBOR) initiative.

    OBOR is Beijing’s foreign policy play disguised as infrastructure investment. Here’s how it works: China and country X agree to do an infrastructure project in country X. Country X has to borrow from a Chinese bank to finance the project. A contract is always awarded to Chinese companies, which then bring supplies and Chinese employees to country X to build the project. Clearly, the country that benefits most from this initiative is China.

    The OBOR provides new markets and consistent demand for China’s goods and services, creates employment opportunities for Chinese workers, and gives China access to strategically important locations and natural resources. Beijing’s real objective is to leverage its newly gained financial power to greatly expand its geopolitical influence as well as its economic and military footing from Asia to Europe and Africa.

    While this initiative has worked out well for China’s strategic interests, it hasn’t done the same for participating countries. At least eight countries that signed on the OBOR initiative are so indebted to the Chinese that they had to hand over their strategic assets to China to offset their debt. Despite these worrisome precedents, leaders in both Italy and Iran eagerly signed up to OBOR in 2019, hoping the red capital from Communist China would rescue their nations from economic woes. Now they are paying a dear price for it.”

    https://thefederalist.com/2020/03/17/iran-and-italy-are-paying-a-hefty-price-for-close-ties-with-communist-china/
    _

    harkin (b64479)

  32. More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.

    Of these three, hypertension is quite treatable and any of a number of drugs can bring BP back into a normal range. I’d need more detail before I considered this to be contributing and it seems to skew the statistics.

    Kevin M (ab1c11)

  33. I don’t think there is a shortage of testing kits at private labs now that the Roche system is approved, Bored Lawyer. The breakdown is in finding people to do the nasal swabs. It sounds simple and probably is, but hospitals, labs and doctor’s offices don’t want sick people standing in line on their premises for a hazmat procedure.

    You have to have doctor’s orders to get the swab, and basically the only place to get the test in Texas was if you were seriously ill and admitted to a hospital. Not surprisingly, officially Texas did not have many cases.

    The Texas health department has addressed this by sending mobile trailers that only do the nasal swabs. They started deploying them late last week and are focusing on health care workers and people with doctor’s orders who could not get swabs. Big cities have trailers that stay in place and smaller cities share. One is in my town today. I think we will see a lot more cases diagnosed in the next two weeks.

    DRJ (15874d)

  34. Added to above:

    “ Lombardy and Tuscany are the two regions that saw the most Chinese investment. Nearly a year later, the first Wuhan coronavirus infection case in Italy was reported in the Lombardy region on Feb. 21. Today, Italy is experiencing the worst coronavirus outbreak outside China, and Lombardy is the hardest-hit region in the country. As of March 14, Italy reported 24,747 cases and 1,809 deaths. Now the entire country is in lockdown until at least April 3. Its economy is expected to contract 7.5 percent in the first quarter, opposite what Conte had hoped……..

    …… Facing domestic economic and political challenges and international isolation, Iran has sought out China as an ally against the United States, relying on economic ties and military cooperation with Beijing to fend off U.S.-imposed sanctions. China has been keeping the Iranian regime afloat by purchasing Iranian oil, selling the Iranian regime weapons, and transferring nuclear technologies.

    But 2019 was the year Iran officially signed up to OBOR. China sees Iran as a crucial player to this initiative because Iran is not only rich in oil but also lies in a direct path of an ambitious 2,000-mile railroad China wants to build, which will run from western China through Tehran and Turkey into Europe.

    Today, Iranian health officials trace the country’s coronavirus outbreak to Qom, a city of a million people. According to the Wall Street Journal, “China Railway Engineering Corp. is building a $2.7 billion high-speed rail line through Qom. Chinese technicians have been helping refurbish a nuclear-power plant nearby.” Iranian medical professionals suspect either Chinese workers in Qom or an Iranian businessman who travelled to China from Qom caused the spread of the coronavirus in Qom.
    _

    Much more at link above.
    _

    harkin (b64479)

  35. Why is it that South Korea was able to administer so many test, while the U.S. seems to have a shortage of testing kits?

    A number of reasons.

    1) WHO did not offer the US their test kits because they prioritize countries without virology establishments. CDC didn’t ask for them either.

    2) Long-standing CDC procedure for viral outbreaks is to do all the testing in-house. They were set up to do 40-50 tests daily. This is the procedure that they finally axed, but there is apparently no clear replacement yet.

    3) When CDC did start sending tests out — something they typically did not do — they were buggered in several different ways.

    4) Local bureaucracies have created their own rules and systems, and failed to inform the public. In some places you go to a clinic, in others you go to a major hospital, in others you go somewhere else.

    Here where I live, there are two “drive-thru” testing centers, featuring long lines of cars full of people who are surprised that they can’t get tested when they are asymptomatic. People show up at urgent care, or at their cdoctor’s office and expect to get tested and the aren’t set up for that.

    ————

    The next time I see a bureaucracy respond to a sudden cheese-movement with alacrity will be the first.

    Kevin M (ab1c11)

  36. This is a really helpful page on testing information for every state. They are updating as necessary. For California, testing availability/protocols:

    As of March 13, California had 18 public health labs testing for coronavirus, with three more expected to be offering tests by next week. There are some private labs testing as well, though the state is not tracking their testing data.

    For a patient to be tested by a public health lab, their provider must contact the local public health department for approval and instructions.
    Most test results are available within 48 to 72 hours. The state has requested all labs notify the Department of Public Health about positive results.

    If the state is requiring *all* labs to notify them of positive results, it’s confusing as to why they wouldn’t also track the testing data as well.

    Dana (4fb37f)

  37. Though tests showed she was negative for influenza and strep throat, the clinic doctor said he could not test her for COVID-19. “The doctor said he wanted to test me, but the San Diego County Department of Health criteria wouldn’t allow him to,” Thornberry told me.

    This is probably someone’s fault, but it is not Donald Trump’s fault. Blame him for what he IS responsible for, God know there’s enough there.

    Kevin M (ab1c11)

  38. What person under 50 goes to urgent care “with a fever, a dry cough, and nausea“? Hunker down. Stay home. You will survive. Others you infect maybe won’t.

    Munroe (de43d8) — 3/18/2020 @ 12:59 pm

    She had been released from the hospital after being treated for something else. Maybe a surgery or maybe another illness. Whatever it was, it was serious enough to require hospitalization.

    Anyone who gets sick shortly after being hospitalized is supposed to follow up with their doctor, urgent care, and/or go back to the hospital. (Maybe her doctor told her to.) Hospitals release people quickly but they are very clear that if you have a problem, something may be wrong so get help. My guess is she did.

    DRJ (15874d)

  39. 30

    whembly, I think doctors will find a way around bureaucracy. They likely already are in Texas, which is why there have been twice as many private lab tests as public lab tests.

    DRJ (15874d) — 3/18/2020 @ 2:34 pm

    Aye. That’s what they’re supposed to do. 😉

    You know the bureaucracy is lit, when even during normal times if you don’t qualify for Medicaid for expensive treatments (ie, cancer), they tell you to divest your assets to family members so that they can qualify.

    Gaming the system is the name of the game. It’s no wonder why:
    a) healthcare pricing structures are opaque and..
    b) why overall the US spends inordinately on healthcare.

    whembly (fd57f6)

  40. If the state is requiring *all* labs to notify them of positive results, it’s confusing as to why they wouldn’t then track private labs testing data as well.

    HIPAA rules have been relaxed to allow for that, I think.

    Kevin M (ab1c11)

  41. @34

    The Texas health department has addressed this by sending mobile trailers that only do the nasal swabs. They started deploying them late last week and are focusing on health care workers and people with doctor’s orders who could not get swabs. Big cities have trailers that stay in place and smaller cities share. One is in my town today. I think we will see a lot more cases diagnosed in the next two weeks.

    DRJ (15874d) — 3/18/2020 @ 2:45 pm

    I think you’re right.

    The various Healthcare institutions deployed out multiple mobile testing trailers throughout the state last weekend.

    whembly (fd57f6)

  42. I’m not sure Kevin M. I was texting with a neighbor whose daughters are respiratory therapists at large hospitals in So. Cal. One is at a well-known teaching hospital and the other at a Kaiser hospital. She said that HIPAA laws were prohibiting them from knowing who has been tested as well as anyone who has tested positive. They said the only reporting agency is the CDC. That was 4 days ago.

    Dana (4fb37f)

  43. @5. Why is it that South Korea was able to administer so many test, while the U.S. seems to have a shortage of testing kits?

    That’s more or less what Romney asked over the weekend; ‘why SK can test so many people and America can’t seem to organize a similar response.’

    ‘The South Korean healthcare system [NHS] is run by the Ministry of Health and Welfare and is free to all citizens at the point of delivery. The system is funded by a compulsory National Health Insurance Scheme that covers 97% of the population. Foreign nationals living in South Korea enjoy the same access to universal healthcare as the local people.’ – source,wikiSK

    They have an infrastructure in place w/established protocols and organization to put the testing kits quickly to work. None of this half-azzed Walmart tent business in Seoul. American society isn’t of the mindset to operate like that.

    DCSCA (797bc0)

  44. Bored Lawyer (56c962) — 3/18/2020 @ 1:41 pm

    Good questions. It depends on what the damage would be absent these measures, of course. If they save 1 million US lives, that’s one thing. If they save “only” 30,000? We don’t do this for the flu, which kills more than that.

    Then there’s the other side — the dire predictions of economic collapse assume that no one adapts, and no one figures out how to make money helping people to adapt. ZOOM was up 7% today.

    Part of the answer is also political, and optical. Rafts of body-bags piling up at the morgue make for bad press if you’re trying to defend inaction. A civilization sometimes does things that are not strictly advantageous to its individual members, even on balance.

    Kevin M (ab1c11)

  45. #44: So is the Italian system, which failed utterly.

    Kevin M (ab1c11)

  46. The various Healthcare institutions deployed out multiple mobile testing trailers throughout the state last weekend.

    Golly. What a good idea– Google the UK NHS mobile vans for details.

    DCSCA (797bc0)

  47. An excellent report here on where California is at with testing:

    By Tuesday, the number of public health labs conducting testing had increased to 21. And the state has also turned to academic medical centers as well as private companies to fill in those gaps. UC San Francisco, UC Los Angeles, UC San Diego, and Stanford are all offering tests for the novel coronavirus — and UC Davis is currently racing to get three different types of tests online.

    Nam Tran, associate professor and senior director of clinical pathology at UC Davis, said one of the tests that runs on an SUV-sized instrument created by Roche Diagnostics should come online within weeks and is expected to churn out 1400 results per day. He called it a “game changer.”

    As for private companies, Quest Diagnostics has been running 1,200 tests a day out of its lab in San Juan Capistrano, Newsom said Monday — and could ramp up to 10,000 tests per day across the country with the addition of another laboratory by the end of this week.

    Dana (4fb37f)

  48. Chloroquine lists for over $1300 at Walmart, but with GoodRX they’ll sell it for only $74.38.

    Go figure.

    Kevin M (ab1c11)

  49. Kevin M (ab1c11) — 3/18/2020 @ 2:42 pm

    More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.

    Given the prevalence of high blood pressure and heart disease, in general, I’d like to see the statistical analysis on this. Otherwise, it could just as well say more than 80% of the Italians who died were born in Italy. Sarcasm aside, this does just sound like another way to say they were old.

    frosty (f27e97)

  50. @47

    The various Healthcare institutions deployed out multiple mobile testing trailers throughout the state last weekend.

    Golly. What a good idea– Google the UK NHS mobile vans for details.

    DCSCA (797bc0) — 3/18/2020 @ 3:07 pm

    It’s not a new idea and many healthcare organizations already do this prior to this outbreak.

    The main reason was to reach the remote areas to provide labs and other services.

    The biggest thing with COVID-19, is to make the public (and providers) aware where these services are located.

    whembly (fd57f6)

  51. GoodRX is generic. (and that is still way too expensive) This doesn’t tell you anything about the optimal dose, and how you would determine it.

    Sammy Finkelman (e4c3a1)

  52. They’re going to get out home self tests. Now the normal way they take a swab is painful.

    Sammy Finkelman (e4c3a1)

  53. The UK vans are typically ambulances that do testing after the patient is screened on the phone. They work great, mostly in big cities, but the area they have to cover is limited compared to the US. In addition, our ambulance personnel are too few and too highly trained to spend on calls like that.

    Plus, frankly, the British must be much better behaved. We would horribly abuse that honor system approach. There are plenty of Americans who call ambulances with frivolous requests. Coronavirus house calls would explode our system.

    DRJ (15874d)

  54. @46. How it is managed is obviously a critical factor– having a system in place and mismanaging it makes it relatively useless. And the mean age and existing population w/a PHC is an element. If a ‘yuge’ chunk of South Koreans were over 65 and had emphezima, all the testing in the world wouldn’t stop the cases or deaths from spiking. But if you’re gonna get sick, better to be ill in Seoul than Milan.

    DCSCA (797bc0)

  55. Dana, thank you for you posting this and other essays. I try to stay out of these discussions, since I actually have a PhD in microbiology. So many “experts” kind of makes my head hurt. And it inevitably turns to scoring points or political bluster.

    Again, I follow Vincent Racaniello and the CDC.

    Simon Jester (6eeac7)

  56. @54. They’re more than just ‘ambulances’- been in them; Google it for the images- they’ve even got some older vehicles for sale; they’re mini-mobile clinics and are often stationed around city parks and in less affluent sections of major cities– and out in the countryside and villages- distant from a major hospital facility- they’re a Godsend for the citizenry. They’re really cool pieces of technology.

    DCSCA (797bc0)

  57. Last week New York City had 92 cases reported total (and soon 2 deaths) Now it has 1,871 cases and 11 deaths. Mayot De Blasio concedes anything done requires state approval – he is considering a duplicate of what is going on San Francisco.

    Mass transit needs to keep operating for essential services – for one thing health car workers need it. Service cuts they’ll think about later. (I think this would upset people’s schedules, and of course, crowd people more together.)

    People in jail in risk groups to be removed from jail population. Some fewer arrests, and a protocol for police how to do it safely.

    Stores or businesses told to cut workforce in half?

    New York Stock Exchange: Trading halted at one point. Dow Jones Industrial average dropped 2300 points, then recovered to a drop of 1300 points. One trader tested positive so floor to be closes starting Monday and only electronic trading done. Floor is needed for close of trading auction.

    Sammy Finkelman (e4c3a1)

  58. that HIPAA laws were prohibiting them from knowing who has been tested as well as anyone who has tested positive.

    I was under the impression though that county health authorities did receive individual reports on positive cases. There was some complaint in SoCal (last week?) that they weren’t sharing that with cities though.

    Kevin M (ab1c11)

  59. GoodRX is generic.

    Both are generic. Different prices for the same pill from the same source in the same dose and quantity.

    Kevin M (ab1c11)

  60. Other drugs show promise like Avigan. For now, it looks like antivirals and antimalarials that focus on the lungs.

    DRJ (15874d)

  61. Probably the best element of U.S. h/c ops is the ‘medevac’ system employing helicopters to get patients quickly to hospitals. Everytime I see those old film clips of American military personnel shoving helicopters overboard off carriers as Vietnam fell, I think of all the small towns and cities in ‘flyover country’ that could have used one of them as an air ambulance.

    DCSCA (797bc0)

  62. @#51. See #57.

    DCSCA (797bc0)

  63. DCSCA (797bc0) — 3/18/2020 @ 3:15 pm

    But if you’re gonna get sick, better to be ill in Seoul than Milan.

    Probably there ia second pathogen, communicated in the hospitals, and no good treatment given.

    Kevin M (ab1c11) — 3/18/2020 @ 3:28 pm

    Different prices for the same pill from the same source in the same dose and quantity.

    The market is broken. A difference in price of 18x and when that’s true, even the low price is maybe 6 times what it should cost.

    Sammy Finkelman (e4c3a1)

  64. The 1,847 must be a nationwide figure. Today 100 new cases were reported in New York. It was 2 NYSE traders who tested positive.

    Some workers at nursing home caused 35 elderly people to die.

    Sammy Finkelman (e4c3a1)

  65. You’d think the Pentagon or some old dweeb in the DoD would have some kind of defensive ‘germ warfare’ protocol to dust off and review for any kind of overly to this situation.

    Maybe it’s all in an old metal filing cabinet in ta basement bomb shelter some place, next to the boxes of Nabisco saltine crackers, date stamped October, 1962 for freshness.

    DCSCA (797bc0)

  66. ^overly = overlay

    DCSCA (797bc0)

  67. Simon Jester,

    Would love to hear your take on matters. You’ve always provided (or pointed us to) interesting information from the sciences.

    I am trying to post a wide array of information from which readers can digest as they want, and draw their own conclusions. A childhood friend is a researcher at Princeton, and is going to be doing a webinar that will present a comprehensive overview of COVID-19 from three different perspectives: issues around emerging diseases spread from animals to humans; our country’s public health response during the outbreak; and the household-level response that everyone should undertake to respond to the pandemic.

    Dana (4fb37f)

  68. “The goal here should be to move from the Chinese model (lockdown) to the South Korean model (testing, monitoring, self-quarantining for specific symptoms — and everybody else going to work) as fast as possible. We’re buying time to make that shift. Let’s not waste the time.”

    Testing seems to be the biggest hurdle of all. Not enough testing being done, not enough labs doingd the testing, very limited drive-through locations for testing, and simply unable to get it.

    Dana (4fb37f)

  69. And these gems on the local news–before being directed to close for inside dining and only offer drive thru/take out, local restaurant managers reported patrons were stealing TP from their restrooms. Some people were caught in a county sheriff sting and arrested for price gouging — trying to sell TP and hand sanitizer for as much as 200% above they ae normally priced.

    Reaganomics!

    DCSCA (797bc0)

  70. harkin,

    I read you Federalist piece. It was filled with unsupported conclusions, unattributed statements, and general fluff.

    Read it again critically, and I think you’ll agree.

    Ragspierre (d9bec9)

  71. And as you get suckred w/tents in Walmart parking lots check this out, compliments of the ‘US Defense Health Agency.’ Ever heard of it?!

    Largest military hospital outside the US built in Weilerbach

    https://www.deutschland.de/en/germany-year-usa-20182019-new-us-military-hospital-in-weilerbach

    It will be the largest military hospital ever built outside the US. The dimensions defy the imagination: 5,000 rooms, 42 specialty departments, nine operating rooms. The US Congress has allocated $990 million for the new building.

    DCSCA (797bc0)

  72. Republican congressman from Florida, Mario Diaz-Balart, has tested positive for coronavirus. I wonder if he was also at at Mar-a-Lago last weekend, where a number of attendees have since tested positive?

    Dana (4fb37f)

  73. Mar-a-Lago: the fever-swamp

    Figuratively, and now literally…

    Dave (1bb933)

  74. testing, monitoring, self-quarantining for specific symptoms — and everybody else going to work

    With widespread treatment, which will require mass production of chloroquine and a few other drugs, but especially that.

    Make America Ordered Again (23f793)

  75. The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities,

    You could have stopped reading right there. Italian medical studies are notorious for “pre-selected samples” which is a polite way of saying “fake and fraudulent”. Nobody trusts them.

    nk (1d9030)

  76. Some people were caught in a county sheriff sting and arrested for price gouging — trying to sell TP and hand sanitizer for as much as 200% above they ae normally priced.

    If progressives are consistent they will waive these off as low-level offenses, release the culprits with an order to return to court at a later date, then sentence them to some diversionary program without bothering to care whether or not there is any follow-through. Or, if they are in the Di Blasio wing of the party they will just ignore the offense and concentrate on bigger fish.

    JVW (54fd0b)

  77. @77. Actually, the arrested price gougers were nailed in what was conservative Republican Duncan Hunter’s district- who was sentenced to 11 months in prison yesterday.

    DCSCA (797bc0)

  78. An ‘old friend’ once again, shows the way:

    https://www.history.nasa.gov/Apollomon/Apollo.html

    The program management conceptwas recognized as a critical component of Project Apollo’s success in November 1968, when Science magazine, the publication of the American Association for the Advancement of Science, observed…

    ‘In terms of numbers of dollars or of men, NASA has not been our largest national undertaking, but in terms of complexity, rate of growth, and technological sophistication it has been unique. . . . It may turn out that [the space program’s] most valuable spin-off of all will be human rather than technological: better knowledge of how to plan, coordinate, and monitor the multitudinous and varied activities of the organizations required to accomplish great social undertakings. Understanding the management of complex structures for the successful completion of a multifarious task was an important outgrowth of the Apollo effort.’

    Go to the site, read complete project management section – it is brief. This is how to manage a crisis.

    ” Let’s work the problem people. Let’s not make things worse by guessing.” – Gene Kranz, Flight Director, Apollo 13, April 13, 1970

    DCSCA (797bc0)

  79. “ What person under 50 goes to urgent care “with a fever, a dry cough, and nausea“? Hunker down. Stay home. You will survive. Others you infect maybe won’t.”

    This guy argues different. He waited too long trying to tough it out. I think there’s somewhere between ‘immediately’ and ‘wait over a week’ if things are getting serious that might work better.

    https://twitter.com/jwdaddy80/status/1239704023998984193?s=20

    And as someone who had major lung issues every winter for five years that for some reason (knock wood) failed to return in 2015, it sounds horrific. I thought I was gonna die in my sleep breathing was so difficult.
    _

    harkin (b64479)

  80. “ harkin,

    I read you Federalist piece. It was filled with unsupported conclusions, unattributed statements, and general fluff.

    I read it twice and it seems straight and fact-based.

    Either point out the “ unsupported conclusions, unattributed statements, and general fluff“ or not.

    harkin (b64479)

  81. The coronavirus that originated in Wuhan, China, has now swept through 126 countries, infected close to 170,000 people worldwide, and is responsible for more than 6,400 deaths as of March 15.

    Geez…that’s the very first sentence. Is that conclusion supported? It is not.

    But you, obviously, will believe what you want. Too bad.

    Ragspierre (d9bec9)

  82. @83 That’s some quality pro-China propaganda. Please tell us how this really came from the US and the Chinese are just poor heroic victims.

    frosty (f27e97)

  83. That’s some quality pro-China propaganda. Please tell us how this really came from the US and the Chinese are just poor heroic victims.

    It’s nothing but a tiny bit of critical thinking.

    I can’t any more tell you where the virus came from than the author of that piece.

    Why be such an asphole?

    BTW, it isn’t me but your good buddy MAOA who’s been all over the threads suggesting it came from the US and that the Chinese might just have a beef. I’ve never seen or heard tell of any push-back from you.

    Ragspierre (d9bec9)

  84. Even Vox says it:

    Why new diseases keep appearing in China

    https://youtu.be/TPpoJGYlW54

    (Note: some disturbing images)
    _

    harkin (b64479)

  85. “Why be such an asphole?”
    __ _

    Vinny Johnson
    @Vincent65419510

    Wuhan virus has everybody Kung-Flu fighting!
    __ _

    gary cameron
    @The_TrueProject
    ·
    Its spread was fast a lighting.
    The death toll was a little bit frightening.
    We can fight back with expert timing.

    __ _

    harkin (b64479)

  86. Vox, huh…

    Well, that makes it a scientific fact!

    Ragspierre (d9bec9)

  87. @85 All of the info we have now points to Wuhan as the source. Occam’s razor suggests we go with the simplest answer. If we develop better evidence that it came from some place else we can adapt.

    The Chinese government is currently spinning it didn’t start here at full volume. We know they’ve lied. We have every reason to believe they are still lying. The difference between the Chinese and Italian/Iranian numbers suggests they are lying a lot.

    The old “you can’t prove that to the degree I’d be willing to accept” isn’t critical thinking and neither is name calling.

    frosty (f27e97)

  88. The old “you can’t prove that to the degree I’d be willing to accept” isn’t critical thinking and neither is name calling.

    That’s a straw man. The point I was making…and it stands…is that article is full of unsupported conclusions, unattributed statements, and general fluff. It isn’t a matter of her proving anything, because I doubt she has the scientific chops. It’s about sound writing.

    All of the info we have now points to Wuhan as the source.

    That simply is NOT true. Occam never advocated shutting your eyes, or adopting as fact something you are taking on blind faith.

    Do, did, will the ChiComs lie? Of course.

    If you don’t like being identified as something, don’t BE something.

    Ragspierre (d9bec9)

  89. Ragspierre (d9bec9) — 3/19/2020 @ 7:46 am

    All of the info we have now points to Wuhan as the source.

    That simply is NOT true.

    Do you have anything else other than Chinese propaganda that points to some other source?

    I don’t consider Genomic epidemiology of novel coronavirus (hCoV-19) blind faith. It certainly looks a lot more scientific than China using the plot from The Stand.

    frosty (f27e97)

  90. You don’t read all that well, huh?

    This phylogeny shows evolutionary relationships of hCoV-19 (or SARS-CoV-2) viruses from the ongoing novel coronavirus COVID-19 pandemic. This phylogeny shows an initial emergence in Wuhan, China, in Nov-Dec 2019 followed by sustained human-to-human transmission leading to sampled infections. Although the genetic relationships among sampled viruses are quite clear, there is considerable uncertainty surrounding estimates of transmission dates and in reconstruction of geographic spread. Please be aware that specific inferred transmission patterns are only a hypothesis.

    Site numbering and genome structure uses Wuhan-Hu-1/2019 as reference. The phylogeny is rooted relative to early samples from Wuhan.

    The use of the term “source” may be confusing. I don’t think there is much uncertainty about the outbreak being centered in Wuhan. There is NO certainty about its actual source.

    That is, nobody knows if it STARTED in Wuhan, or was brought to Wuhan. Or who or what by.

    Including the author of the piece harkin cited.

    Ragspierre (d9bec9)

  91. Ragspierre (d9bec9) — 3/19/2020 @ 1:10 pm

    You are hanging a pretty big hat on what is basically a standard disclaimer about statistical uncertainty in data. Given what we know now more data will only reduce the uncertainty absent the plot twist where the US military brought it to China.

    That is, nobody knows if it STARTED in Wuhan, or was brought to Wuhan. Or who or what by.

    Do you have any supportable hypotheses for any other origin? If so I’d like to see it. Is there any actual evidence anywhere that this virus appeared anywhere prior to Wuhan? Do you have a theory for how it got to China naturally without creating an outbreak at the point of origin?

    Because this sounds exactly like the standard line from China. Let’s cast doubt on the source. The mysterious “was brought to Wuhan by who or what” and cue the suspense music. Soon we’ll hear “no one can ever really know where it started”.

    frosty (f27e97)

  92. Do you have any supportable hypotheses for any other origin?

    Sure. Piece of cake. It came from a nearby rural district. Or from Iran. Or from any place people and/or things moved into Wuhan. See? That’s a hypothesis or several.

    Is there any actual evidence anywhere that this virus appeared anywhere prior to Wuhan?

    Nope. Just as there’s no actual evidence it didn’t. What we DON’T know would (and WILL) fill volumes. I have every confidence we MAY know the origin with some scientific certainty.

    Do you have any supportable hypothesis…blah, blah, blah.

    Sure. I have a number of them. But, see, I’m not making a conclusory statement about its origin. I’m also not putting statements in the mouths of various people without attribution, or drawing loopy conclusions on the thinnest veneer of causation. The nice lady did all that.

    What I’ve written sounds nothing like what’s come from China. You just lie like a rug and conjure straw men.

    Ragspierre (d9bec9)

  93. Ragspierre (d9bec9) — 3/19/2020 @ 2:51 pm

    Do you have any supportable hypothesis…blah, blah, blah.

    Sure. I have a number of them.

    No. You just have things you’ve typed into a comment. A supportable hypothesis would have evidence. You might as well be pretending the lizard people brought it from their Mars base.

    You didn’t even try to explain how an outbreak didn’t happen at this other source or hasn’t been traced back to it. You are just pretending any number of possible alternatives are just as plausible as Wuhan being the source. Back in January, the Chinese weren’t even denying it came from the wet market in Wuhan. Now, this has to be discredited.

    frosty (f27e97)

  94. You just have things you’ve typed into a comment. A supportable hypothesis would have evidence.

    That’s two lies.

    You didn’t even try to explain how an outbreak didn’t happen at this other source or hasn’t been traced back to it.

    Not my job. I don’t have sufficient information, and neither do YOU or the lady with the apparent agenda who wrote that mess.

    You are just pretending any number of possible alternatives are just as plausible as Wuhan being the source.

    That’s a lie.

    Back in January, the Chinese weren’t even denying it came from the wet market in Wuhan.

    To the extent that claim by you is even true, there has been a lot of misinformation around this. Remember when Sammy was just SURE it came from Pangolins, based on some bad genetics being reported?

    You just cling to your group-think defense of this really remarkably badly written piece. I will keep on thinking and reading critically.

    You are a TWOT (total waste of time)

    Ragspierre (d9bec9)

  95. @96 I’m not interested in defending the original piece. You spewing Chinese propaganda is interesting.

    That’s two lies.

    An unsupported hypothesis doesn’t require evidence and that’s what you’ve been floating. A supportable once does. And considering you just types some random ideas into the comment block as possible other alternatives I’m at zero lies.

    I’m not clinging to anything. As soon as I see any new evidence I’ll readjust. I’m sure you’ll still be pushing whatever nonsense is floating around at the time.

    frosty (f27e97)


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