Trump is handling the Coronavirus infection quite well so far
First, credit to CB who made several stimulating comments to prior essays on COVID-19.
In this essay, you will find a mix of medicine, science (epidemiology), and politics. Where I speculate, this shall be clearly indicated. If material is not determined as speculative by me, then that material is considered by me to be reliable, considering the sources.
The video linked below is essential to be viewed in its entirety. It originates from Fox 10 Phoenix and is about 47 minutes long. Sound is lost between approx 12:30 to 14:00. Pixellation occurs irregularly but briefly. The screen is sometimes split to half-size but is quite legible without affecting the sound.
The Fox-titled video indicates the caption writer was completely oblivious to the content and implications of the interview.
[video:https://www.youtube.com/watch?v=IzI4hl1Rx3A]
The following material--verified ONLY on the strength of what I believe to be credible information is my observation of the information.
Attendees: President Trump, Secretary Alex Azar, Dr. Young and another senior doctor, Gov of Georgia (briefly). A few other non-speaking companions.
Medical information: The current complete US data as of this day: March 6, 2020. Some mention of international data but little and nothing new.
Testing material: quite accurate, although in relatively short supply. Here is why the testing equipment is so reliable.
1. Within weeks of COVID-19's discovery by Dr. Li Wenliang the Chinese government had secured genomic sequencing for the entire virus
2. The Chinese government immediately sent the genome sequence--but no actual viral material--to the CDC. Further discussion in the video assures me that excellent binational scientific cooperation is occurring. This was confirmed in the video.
3. Using genome sequencing from China, the CDC developed an extremely specific and sensitive marker, with precision that only molecular engineering could accomplish. In fact, the CDC has 3 individual genetic markers of COVID-19 (virus) infection.
4. The test material now standard for use in all government labs uses these 3 genetic markers
5. Testing material is suitable for use with equipment already in use in large, chain clinical labs, such as Quest.
6. Detection of only 1 of the three tested markers is as sensitive as detecting any of the other 2 markers.
7. No person who has requested a virus test has been refused. (This statement is ambiguous because it does not include to whom requests were made. For instance, a patient going to a for-profit lab might request a test, but because of financial and or availability constraints, that testing might not be performed.) My assumption is that the CDC statement refers only to CDC facilities directly.
8. Passengers from affected cruise ships will be sent to specific US hospitals to complete quarantine.
9. Test kit production is quickly ramping upward, currently expecting 10,000 test kits in next week with even faster production soon afterward.
Here is why I think Trump is handling COVID-19 properly
The entire interview had the ring of authenticity. I know when pontificating physicians are bloviating and I know when they are on the level. The two interviewed physicians are on the level.
Trump encouraged the doctors to speak. He did not steer topics away which he did not wish to be heard. All questions submitted to him or the two MDs were answered. There was no equivocation in any of the answers. No dodging or weaving.
Trump's demeanor was calm. Surprisingly, the press was polite. Can you believe that! He took questions from CNN reporters, of all people.
So the information I related above, plus other information appearing in the video I believe to accurate as of today's date (March 6). From observing videos, primarily of Dr. John Campbell, primary care UK NHS physician (presumably still actively practicing), but various other sources (including PubMed searches) also.
Reviewing some facets, while leaving out others is used here to simplify explanation without altering facts or eliminating contradictory evidence.
Disease initiation was in Wuhan, Hubei Province, China. It was first detected at least as early as Dec. 30, 2019. One of the first discoverers and first medical whistleblower was Dr. Li Wenliang of Wuhan. He died of the virus, about mid-January, 2020. Before he died, Dr. Li was forced to recant his "rumor-mongering) about the virus's existence.
However, even before publicly announcing the presence of the virus, I believe the Chinese has begun genome sequencing. Amazing the rapidity at which medical progress is occurring--right in from of our eyes. Progress previously taking years are now accomplished in weeks or even days. Younger people, not exposed to the state of medical science 45 years ago when I began medical training really have no conception of the technological medical wonders at their avail.
So now ramping up test kit development, the CDC which utilized Chine sequencing, has not only developed extremely accurate 3-marker tests, but is also cooperating with major pathology labs so that the labs are able to perform testing on their own equipment, plus is making state and county level testing available to public health labs locally.
Look at Trump's demeanor and put your politics aside for the while. He is calm and he is not acting. He is hands-on, very definitely hands-on here. He interrupted a trip from FL I think and diverted to a non-scheduled visit to Atlanta's CDC. He got Azar, the governor, and the two chief scientists for a Q&A session. Watch the Q&A again, tell me what your impression is if you disagree with my assessment.
Yes, he placed Pence in charge of the COVID-19 virus task force. This simply means that pence is going to do more direct but intense management over the entire health care apparatus, including CDC, FDA and any other agency. But Trump is definitely acutely aware, on a human level as well as a political level that proper management of this potential disaster is essential--not just a priority but essential.
Everything is taking secondary position here while this business is going on, one which might involve total national paralysis. A crisis which has temporarily paralyzed China. But now, within less than 3 months, China has engineered a dramatic turnaround. This management would not have been possible in the US, but, from my understanding, forcible detention in quarantine has been implemented to half the population (750M!) I am in awe of China's rapid mastery of this. Absolutely incredible. Absolutely incredible to me, who is a skeptical and clinical observer.
Trump was proactive. Unprecedentedly but absolutely urgently and correctly performed, was the quarantine to and from China. And I think medical evidence will subsequently show that Trump's current course has been spot on. This has to do with methods of transmission.
Methods of Transmission
This means how disease gets from point A to point X.
The following is my personal summation
So, here are listed methods of transmission, and there may be others also which are not listed.
Droplet, which includes sub visible particles; contact, including droplet to hand (via any route in contact with hand) and then to mouth. In other words the virus spreads--in humans--either droplet or contact hand-to-mouth.
The geographic spread is just as interesting as the case number. In epidemics, cases have an almost asymptotic increase, imperceptible at first. Then growing visibly and rapidly as if out of nowhere. And that's the issue.
Some thing does not come from NO thing. Where and how did the index case get here? Because some thing (virus) has to come from some place, not out of the ether. [Ether is where DNC gets their evidence]
Some oral-oral transmission, primarily due to cough proximity, will definitely occur, but this mode will not be the dominant driver of spread. Droplet infection, through possess fine aerosol is likely dominant in influenzal transmission.
My surmise is that the primary mode of contagion is tactile, usually preceded by oral secretions contact--but not always.
Such a situation would help explain the currently observed spread from country to country. Superficially to me--with absolutely NO medical supporting evidence except personal surmise--crudely resembles the spread of mold colonies on the surface of old cream cheese. If any of you have seen something liked moldy cream cheese, you know what I'm about.
That physical resemblance, between common household mold colonies and the variance in size and frequency resembles the current observed case distribution. Not so improbable though. Fungi are saprophytic. Dead cream cheese makes a great host. Live humans make a reasonable host for the virus. But for unknown reasons COVID-19 seems to be a picky eater.
Hope you've followed all this so far.
If my evaluations are correct, then if Trump continues handling this as he has up to now, he is doing absolutely the best thing medically speaking.
I choose not to discuss political considerations. This essay's title refers exclusively to Trump's medical crisis management.
You are welcome to research, correct, add, criticize. But please leave TDS out--or I shall have to quarantine you for having severe TDS, known to be somewhat contagious.
Comments
Thank you!
I appreciate your insights!
Marilyn
"Make dirt, not war." eyo
Your impressions, Ed, really require no critique.
You describe what took place, what was said, and the demeanor of the individuals involved in the unscripted and unstaged CDC press conference. I saw the same informal sincerity and openness in the CDC participants that you did.
Folks who read these pages are not anymore impaired by TDS than they are impaired by blind loyalty to the Democratic Party. Neither issue is causing reality distortions here. Our people can hold strong opinions about, and even anger toward, Donald Trump — and still make intellectually honest comments about policy disasters or election strategies without veering off on Vladimir Putin and Russian bots.
The scientists and politicians appearing in the CDC video you posted described the size and shape of the situation in the US — which, on the surface, matches corporate media reporting. But I was troubled by a couple of things I noticed. For one thing, they looked strange to me. They seemed stressed more than nervous, and sounded defensive. They spoke more like sales agents than scientists. And they were making a pitch, but I'm not sure what they were selling.
I've been closely following this story for awhile. It struck me that the timeline the CDC kept describing for the development of their Coronavirus test, was off. I also noticed that they refused to speculate or predict how this infection was going to play out in the US. If they are working for the American people, they would have told them what to expect. More importantly, the CDC gave this press conference without telling people things they must do immediately to protect themselves from the infection in their midst. The stats we are aware of are telling us that dozens or hundreds of infected people without symptoms are going about their business right now across America — at work, at home, at school, at the golf course or the soccer game — potentially infecting many others. What happens next is likely to happen all at once — in a single game-changing day.
This video was made on March 6th. The Atlantic published an article on the same day that tells a different story about the CDC's testing kits: The Strongest Evidence Yet That America Is Botching Coronavirus Testing. Compare what the CDC is saying (and what they are omitting) to what The Atlantic is reporting on March 6th.
.
The epidemiologists at the CDC are normally the group who regularly collect and publish test results data for pathogens and seasonal flu. But early this past week [March 3rd], the CDC abruptly announced that it would stop publishing the negative test results for the coronavirus, an extraordinary step that essentially keeps Americans from knowing how many people have been tested overall.
Could this have something to do with the steep drop that panicked the stock market? Had the White House called the CDC and told them to knock it off with counting the Infection's spread.
Two days later [March 5th], the CDC resumed reporting on COVID-19 — but only the number of tests that the agency itself has completed. Testing by state public-health departments or other laboratories was no longer included.
IMAGINE if you woke up the day after a US Presidential Election and headlines around the the world blared, "The Majority of Americans Refused to Vote in US Presidential Election! What Does this Mean?"
WHO has been recommending for at least two weeks
...that older Americans immediately isolate themselves. This morning I see that the CDC is doing the same.
.
Are you up for 'social distancing'?
Are you willing to do it for a month?
It's the only sure thing we have so far.
IMAGINE if you woke up the day after a US Presidential Election and headlines around the the world blared, "The Majority of Americans Refused to Vote in US Presidential Election! What Does this Mean?"
Perceptive observations, once again Pluto
I will now plead my case stating, without objectively verified proof, that I have been under immense stress as a physician. As a neurosurgeon, which I was, one takes immediate responsibility for a person's life. I know what that stress is like. I've dealt with it hundreds of times acutely and thousands of times chronically. I also have experience communicating to other physicians finding themselves in similar situations. It is not easy. If you doubt it, try telling someone you have never seen before that the person they love most is going to die in 30 minutes or 3 months. Try it. You won't like it--unless you are sadistic.
Repeating what I wrote in the essay, with the empathy coming from having "been there, done that", I firmly believe that what some consider as possible prevarication is simply the exercise of caution. These physicians bear on their exposed shoulders the health and well-being of millions. Repeat: these two doctors (and hundreds more whom you did not see at CDC) bear on their shoulders the fate of millions. If that were your situation, would you be relaxed? If you were a medical spokesperson in a situation, do you think that a relaxed attitude would be reassuring when coming from a physician and not a politician. I am not talking about physicians who have become political hacks. Dr. Young and the other physician whose name I forgot displayed demeanor I would have both expected and hoped for.
It was mentioned in the early portion of the video, that in the very early stages of this epidemic-in-progress, the CDC used less specific and less sensitive test kits designed before Chinese genome sequencing became available. As soon as those genetic road maps were made available BY China TO us, the CDC rapidly developed highly accurate test kits. Unless you have witnessed the rapidity of our ongoing revolutions in medicine, genetics, immunology, epidemiology, you may not experience the same appreciation for the rate of progress as I do.
I've been there on being the bearer of bad news
I vividly remember the first time I told someone that she would never read again. I was only 25 and that should never have been my responsibility but the doctor's. He was a brilliant doctor, but an asshole as a human being. This never got easier for me, but I still remember that first time. But I never had to tell she that they were going to die. I can't really imagine how one does.
People are still coming through airports from places that have high numbers of infected people and they then go on to put others in harms way if they are infected. This is where the government has dropped the ball. People are saying Obama did a much better job with the H2N2 or swine flu but not according to some articles I've read. I think it's like Bush's Katrina movement. It's a good way to cull the herd without looking like you're doing it.
There were problems with running a campaign of Joy while committing a genocide? Who could have guessed?
Harris is unburdened of speaking going forward.
Your comment reminded me why.
Is it any wonder? With Democrats and the MSM constantly on the attack and stirring up the sheeple about how bad Trump is and how our medical system is failing us and how we're all gonna die, is it really any wonder that medical personnel sound defensive and as though they're trying to tell people to get a grip?
please see my response to Pluto above
Example: pupillometry has been used to detect lying on the theory that epinephrine and norepinephrine circulatory release, occurring in microsecond increments directly affects pupil size. Those two hormones are secreted during periods of stress. The observations are unreliable in two circumstances: the person is unaware of the falsity of a statement or is a sociopath who doesn't care when lying or not lying. Think about the people we concern ourselves politically. Psychopaths abound, like H. Rodent Clinton and Bubba Bill.
So chief twitter handles pandemics well
funny, haven't seen him sneeze yet.
Thanks for this essay. n/t
He's late, but better than no response
We had one opportunity to self isolate the country, but no action was taken. We are now up the exponential curve of infections. The next tactic is to test and isolate on a very broad basis. I expect to see this in 2 to 3 weeks. We will have to emulate China, lockdown entire cities, and foreign travel. I just returned on a flight from the Caribbean. Saw lots of respirator masks in Logan airport, but no security or testing. A plane load from Korea arrived and the folks merrily disembarked. The only signage was to say that travel to China is restricted.
So we are now getting some characterization of the spread. R0 (R naught) seems to be around 6, that means that if you are infected and not quarantined that you will infect 6 people. The percentage of people who require hospitalization for those who have had a definitive outcome is 14%. The death rate for definitive outcomes is 6%. This data is from worldometers.info. The only way to contain this is to bring the effective R0 down below 1.0 through isolation and quarantine. If every American contracts COVID-19 then we will lose 20 million people, if these numbers hold. The only sane strategy is to stop the spread of COVID-19 by whatever means is necessary.
Capitalism has always been the rule of the people by the oligarchs. You only have two choices, eliminate them or restrict their power.
You described the correct tactics to use in the immediate future
If my theory is correct, that transmission at close range is from large droplets (cough, sneeze, etc.) and that contact at intermediate distance (i.e., no greater than arm's length away is by a combination of droplet and touch), then local community spread mechanism is evident. These types of spread to different communities, other than droplet, will mainly be through contact with slightly moist or very moist contact, not inhalation.
The site you mention its unknown to me. Clearly however, using the Diamond Princess as my guide, I demonstrate why R0 of 2.6 its unrealistic and exaggerated. Do the math. 3700 passengers and crew. Assume there is only one "patient zero" initially boarding the ship. Assume further that within 24 hours patient zero infects his contacts--possibly even before patient zero was contagious. Assume further, as I did in my example, that each new diseased person immediately infects his/her allotment of 2.6 people. This is an unrealistic assumption because infectivity does not begin until 12 to 24 hours after infection. But assume this any way. A logarithmic growth curve would begin. Think about the old penny doubling challenge (where on the first ches board square a single penny is placed, then on the next square that amount is doubled, and on the next square the resultant amount will be doubled again--and so on. At first the amount ope pennies is insignificant--but by the 32nd chessboard square, the amount to be added in enormous. Consider however that the board problem rules change. To make calculations easier, instead of pennies, we use a dollar to represent additions to each square--this is because, in real life 0.6 person does not exist but $2.60 does exist.
Day 1--$1
Day 2--$2.6
Day 3--$6.76
day 4--$17.58
Day 5--$45.70
Day 6--$118.82
Day 7--$308.92
Day 8--$803.18
Day 9--$2088.27
Day 10-$5429.50
Day 11--$14,116.71
etc.
Obviously the worst case scenario did not occur. Firstly, infections are not spread that rapidly. Secondly, in the absence of profuse exhalation of droplets by cough or sneeze, the rapidity of spread would be slower, even if due to a combination of droplet and touch.
Using the Diamond Princess, consider it to be a veritable human disease hot house environment as a laboratory. What was the R0 when as of Feb 27, 8 days after quarantine ended only 704 or so cases were detected. Somebody skilled in statistics could calculate the R0--but it would be quite a bit lower than 2.6.
The math will prove or disprove my thesis that, at least concerning the Diamond Princess, R0 is grossly over-estimated. It is les, probably not much greater than 1.5, if that--but someone do the math please. I'm a student of a disease which WHO epidemiologist Dr. Aylward said on or after March 3 "we don't know this disease".
Let’s not sugar coat the math
Especially now if the Grand Princess was to get left offshore.
The passengers aboard the Diamond Princess effectually were not quarantined from each other and crew, the ship was quarantined from shore.
3500/700 = 20% that eventually were infected upon the D.P. And several have since died.
We need to learn from mistakes made and cruise ships clearly are not the place to quarantine folks.
We know they are incubators/floating Petri dishes.
Test everyone and separate the wheat from the chaff on the G.P.
To hell with Trumps ‘numbers’!
These ‘numbers’ are actual people.
Your comment confirms my disease hot house theory
The whole ship was precluding disembarkation until the quarantine expiration. The ship was in the port but did not discharge patients into the general populace. After the ship's quarantine ended, Americans let back into the US were directly sent to isolation hospitals in Kansas.
The point of my mathematical exercise was to describe worst case scenario. Being more precise, under worst case scenario infection rate as of Feb. 27 was 19% to be precise. (704 / 3700). This is not even 20%. The rules say pandemics don't begin until a 30% population infection rate. Let's not move the goal posts.
Ok let’s not and instead talk about in situ examples
Which to some are very alarming.
70 Life Care Center employees show symptoms of coronavirus, spokesperson says
From CNN's Melissa Alonso
Seventy employees at the Life Care Center in Kirkland, Washington, are showing symptoms of novel coronavirus, according to Tim Killian, spokesperson for the facility.
There were 180 staff members employed at Life Care Center as of February 19.
Here's where numbers get foggy
Too many unknowns. For now.
You could be 100% correct.
On the other hand: How about that EPA RadNet air monitoring program, Sweet It Is: Over 130 stationary monitors throughout the USofA, several mobile units, and lots of volunteers sending in dusty filter samples twice a week.
Ask them if they are properly accounting for the short lived radioisotopes in the sample.
RIP
Not familiar with RadNet
A general point:
When a technician knows how to do the process, but the manager doesn't want to deal with the reality: What is a technician too do?
Part of the EPA's mandate was to maintain a database detailing baseline values for substances of environmental, health, et cetera concern. I, quite unexpectedly, discovered the EPA had mysteriously stopped monitoring the very process that got me interested in elementary particle physics oh so many years ago.
But, who cares? Apparently no one.
RIP
One option is to become a whistleblower
A real whistleblower like John Kyriakou--not a phony DNC/CIA piece of shit like Eric Ciarimella.
Except,
in this case, no one cares. No one is interested in documenting background radiation because it is … well … background.
As I have said many times in many ways people prefer reality to Reality and have no interest being corrected.
RIP
www.RipPhysics.com → RadNet
A Side-Note on Infection
Ed, I've read more than once that 75 percent of in-community infections come from someone touching their own face or eye, and not from aerosol droplets. I've seen new articles released on how to prevent yourself from touching your face. I've seen another stat (using data from China) saying that people who wash and sanitize their hands five or more times each day have 75 percent fewer infections that people who don't.
My assumption is that these stats refer to people going about their day during the epidemic and taking normal precautions. In China, most folks wear masks in Public.
Also, China has been doing intense studies centered on protecting health care workers. The military drafted 42,000 doctors and nurses and sent them in to deal with epicenters of infection. China provided them with the best protective gear in the world and tripled their salaries to give them more ways to gather food and avoid shopping. The entire country is treating them as heros, and losing even a single draftee to infection will be a blow to the nation's morale. The stakes are really high. We will learn a lot from their self-infection experiences, while they deliver medical care in a large scale public health environment. That information will come soon enough, I hope, to use China's results to help medical workers in the US in the coming weeks.
IMAGINE if you woke up the day after a US Presidential Election and headlines around the the world blared, "The Majority of Americans Refused to Vote in US Presidential Election! What Does this Mean?"
Hand-to-face is the ultimate disease pathway
Good information on technique.
I saw a recommendation that tells hand washers to wash above the wrist or to include forearms, where hands sometimes rest.
It's ironic (I think we had this discussion) that washing hands before fouching food or caring for oneself or caring for others was the one change that doubled the average human lifespan throughout most of the world. And, here we are again. Looking out for Number One.
IMAGINE if you woke up the day after a US Presidential Election and headlines around the the world blared, "The Majority of Americans Refused to Vote in US Presidential Election! What Does this Mean?"
Thank Dr. Semmelweiss for this
Now for a gross generalization. Mechanisms of large systems may be applicable to smaller systems, something which I believe to be true. My use of military metaphors is based on a systems analysis of how large battles are fought. But the techniques for winning large battles can be scaled down to model small battles. The prime example I use is Tulsi's war on her rivals. If in doubt, then feel free to consult my Tulsi essays.
This technique can be scaled down further, being careful when so doing, to smaller systems than human or large animal.
United States publication confirms fecal shedding
by symptomatic and asymptomatic patients.
Add bathrooms, especially public to your areas of extra precautions.
Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.
Thank you for your correct description
Wash your hands. Before putting them near food or into your mouth. 20 seconds. Warm water. Best technique is to emulate the 10 minute hand scrubbing surgeons use, but for a shorter duration--then dry your hands making sure no one touches that which dried your hands again--including you.