I completed the recording of my presentation to the Rotary Club, thanks again to them for allowing me to speak. I should shortly have the link to the entire presentation, I believe on YouTube and will provide that when available.
Yes, I have been watching the Minnesota briefings and yes, I will comment on them, but it is pretty much more of the same.
No doubt now that the latest wave has crested and is receding rapidly, as they always do, in the Upper Midwest, including Minnesota. Any orders by any Governor had nothing to do with it. CV-19 has a mind of its own, and when it gets going, it is pretty much going to roll as it sees fit.
Let’s start off, as we like to do, by bursting some bubbles and being gloomy about the lockdown harms. The bubble burst this time is Germany. By God, those Teutonic devils had this CV-19 thing whipped like no other country, what is wrong with the rest of the world, why can’t we all be like the Germans. Oops, cases rising like everywhere, along with deaths and hospitalizations, as usual, almost exclusively among the elderly. And a population that is starting to say how about a little more balance in considering the greater good for the entire population. (German Article) The article implies that maybe there should be a harder lockdown. Why? That is the real question. Why cause immense damage to an entire population out of fear of a relatively small number of deaths to the elderly? And there is nothing wrong with asking that question. It should be the question asked by all so-called political leaders–where is the balancing point?
The gloomy news; not hard to find anywhere. This time it relates to delayed cancer care from the terrorization of the population. (AMJC Article) In the Medicare fee-for-service population, screenings for four common cancers dropped by at least 50% and as much as 85%. This means delayed diagnoses, more serious illness, more deaths and more expense. Rates of biopsies and chemotherapy treatments were also down substantially. This is real harm to real patients, this isn’t that fraction of made up CV-19 hospitalizations or deaths, but wait, only those deaths, even if made up, count, so just forget about all those cancer sufferers.
More gloomy news; an article regarding the harm caused by school closures. (School Article) Not sure how rigorous it is, but directionally accurate about the types of damage caused to children and about the harm being worse for minorities and low-income children.
And speaking of schools, this study purports to find a low role of children in transmission. (School Study) The authors are from Germany and find that closing schools was not associated with a reduction in cases and reopening them did not coincide with an increase in cases. Pretty consistent with most of the evidence. But by all means, let’s keep the schools closed to in-person instruction, we haven’t had enough child suicides yet.
Our Governor, who truly is a complete dolt, just blathers on and on when he has no clue what he is talking about, among others has claimed that what is unique about this epidemic is how many asymptomatic persons there are, especially among young people. He then says these asymptomatic cases are responsible for a bunch of transmission. Everything is wrong about this–there isn’t that much asymptomatic transmission and there isn’t any real evidence of a lot of transmission from younger people to older ones. And it turns out that even the notion that the presence of large numbers of asymptomatic cases is somehow unique among respiratory viruses is wrong. Here is a study from 2009 on influenza transmission. (PHR Article) According to this review, up to a third of influenza patients are also asymptomatic. Just as with CV-19, they are believed to be much less likely to transmit. When you read the article you are most struck by how similar many of the issues relating to CV-19 transmission are to those for influenza, right down to the role of aerosols and large variations in viral shedding.
Here is some good news, there is one part of the world in which the epidemic is probably completely over, for good. Manaus, Brazil, has an infection rate of over 75%. (Science Article) If that doesn’t get you to population immunity, I don’t know what will. But look the infection fatality rate was likely only .17%, down in influenza range. The per capita death rate seems high, but won’t be when other areas have similar extent of spread, and is far lower than New York’s or New Jersey’s. This is an interesting example at one end of the extreme of pretty much unmitigated spread through a pretty densely populated area. I only wish they had provided some charts of the case curve.
Cross-reactive adaptive immune responses from seasonal coronavirus infection to CV-19 ones are uncertain. This study, however, suggests that the absence of such responses may be associated with more severe disease. (Medrxiv Paper) In particular, antibodies from one of the four major seasonal strains were linked to much less likelihood of serious disease in a study of almost 250 patients.
But let us finish on a good down note. A study from England confirms much higher than average deaths from heart disease during the epidemic, caused by people fearful of seeking care even when having serious symptoms. Many of these deaths are occurring at the person’s place of residence. (UK Study)