The Thoughtfulness of Friends

Dear Family and Friends,

I read today that in these crazy times, Facebook has become the main news source for millions of people. And I thought, we can do better than that! I have friends, both on the far right and far left, who’ve shared ideas that are so insightful that I hope you will appreciate some of their musings on the Topic At Hand as much as I appreciated receiving them.

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Astute commentary from S., resident of Germany:

“…I looked at the Paul Offit analysis you quote, and do not find that convincing. A normal flu is estimated <0.1% Fatality Rate - not 0.5%.  I think there is no good justification from the numbers, to claim that COVID 19 is not much more dangerous than the flu. On the contrary. Because also in addition this virus has the ability to infect a lot more people than the flu. Let's just assume that 0.7% value from the Korean Study. And together with the extreme ability of COVID 19 to spread we would then be optimistically estimating only 50% of the US getting infected, expect a death toll of 50%* 330 Mio * 0.7% = 1 Mio. 

“My conclusion from these - COVID 19 gets around 5x more people than the flu - of which around 6x more than the flu die. So it is 30x more dangerous. 

“…[In terms of intervention,] look at Taiwan, not only Korea, how they seem to have dealt successfully with It (absolutely rigorous contact tracing seems to be key, a thing ironically much easier [here], then in the surveillance country that is the US).”

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A report from Japan:

“We're (mostly) working from home again this week. By all accounts we seem to be doing better over here than Canada [and the USA] is.

“The lock-downs seem pretty extreme for you guys - like what you described at the shops. [having to wait in line to get into stores or have the employees get your supplies while you wait behind a line.] I see photos and articles online shaming people for being outside or whatever.

“Pretty much everything is still open here. I can eat in or take out. When I do have to take the train somewhere I'm still shoulder-to-shoulder with strangers for 30 minutes.

“But it seems like we're doing alright?

“I just looked at the statistics yesterday and even though Japan is a much smaller, denser country with a larger portion of the population being old people who are high risk, and we've been dealing with the outbreak since January, we've had about 300 fewer cases than Canada so far.

“Now granted, that probably is due in part to under-reporting / under-testing, but I don't understand how the West's reaction has been so severe and yet seemingly ineffective. 

“Do you guys just not wash your hands, or what?

“I’m not an expert, but I don't think ‘social distancing’ has to mean you stop living your life. You put up hand sanitizer stations in public places, you wear masks, you reduce interaction where possible.

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M. points out how fear-based reactions can be dangerous: “…The other thing I see happening - and has been already but will be greatly increased and enhanced - is the sterilization of our world and our lives. It was already so bad, and now what? Have you seen the space suits they have to wear to spray stuff down? When/if I return to the healthclub, what chemicals will await me there? I'm not sure I want to elevate my heart rate and breathe in all that toxic soup when I return! Plus it will be like that everywhere, making it unavoidable … on top of vaccines…”

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This from M. and K., temporarily residing in Britain:

“…Last Friday the UK government joined several other European countries in basically putting their economy into a deep freeze for at least 3 months. In order to minimize unemployment they have offered to pay up to 80% of the wages of workers in exchange for companies not laying them off (or, in slightly more ominous locution here, making them redundant), which will both ease the burden on the existing unemployment system and enable a much more rapid ignition of the economy in a few months time. Nothing of the sort is being considered in the U.S. as far as I can tell [editor’s note: Jeff says the $2 trillion dollar US Aid Plan may actually turn out to be a truly bi-partisan effort if it passes tomorrow, which would be a step in the right direction!], which does not augur well for the U.S. economy, whose health was already something of a mirage even before the pandemic. Just as not all people are equally able to recover from COVID-19, not all economies will rebound the same way - due to pre-existing conditions.”

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R., resident of USA, points out that the COVID tests may be “sketchy.” If this is true https://pubmed.ncbi.nlm.nih.gov/32133832/?i=3&from=false+positi+ve+covid+19 , then it might be that death rates end up being much higher than South Korea’s numbers relate. Unless they were using different, more accurate tests. Hard to know at this moment. Good to be paying attention.

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Where are all the tests????

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Another report from Japan:

“…[here] life is already starting to return to normal. For example, swimming school opened back up a while ago. Calligraphy class starts back up in April.

“No word yet on whether preschool through 12th will open back up in April, which is the start of the Japanese school year, but I am hopeful. Our toddler's day are never closed.

“…the restaurants have been open this whole time and the trains have been packed like sardines, as usual, this whole time.

“Now, if that just doesn't tear the social distancing theory to shreds, then what does?

“…Have you seen the news about some of [the USA’s] "elected" "leaders" dumping stocks because of COVID 19 weeks ahead of publicly addressing it?”

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L. originally from Austria, points out: “…a country‘s preparedness for future outbreaks should be on the front burner; and a healthcare (health! Care!) system for all as well as a social safety net so people don’t have to live in fear. “

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One thought I had is about the "novel" feature of the virus. When more virulent/"new" influenza strains have resulted in largely elevated pandemic death rates, it's because not only are the strains somewhat more likely to result in death, but an entire population has never been exposed to them before: it’s an Enormous Virus Playground! Wouldn’t this increase the contagion factor?

For example, it's impossible to know without widespread testing, but I'm wondering if what's happening in Italy has to do with the fact that perhaps almost all of the likely-to-hug-each-other inhabitants of a relatively small geographic area were exposed to the virus within a very short span of time. Of course, it may be that the death toll will keep on rising for weeks, in which case that hypothetical would be wrong - but if let's say the first exposure was five or six weeks ago (with the first case on February 21), and the last remaining unexposed people were exposed last week, we could expect to see the nation’s curve spike crazily and then fall rapidly, once approximately .7 of the population had died and the rest had developed some sort of immunity to the virus.

Although of course, this virus seems much more likely to kill people who have already suffered from lung disease, heart disease, cancer, etc. - these people generally happen to be older, but I'm not convinced that age alone is a factor (unless there is some researcher out there who is controlling for all the very many drugs and Conditions that so many folks suffer from in the developed world, especially increasing as they age).

So, Italy might have a higher mortality rate than .7, and the USA could possibly expect worse than Italy, overall, if we factor in the many people here who have chronic illnesses.

It’s still hard to really imagine a “plan” for what happens after "flattening the curve" or "suppressing" the virus, or dealing with it in any other managerial style. I continue to have to assume that all people will be exposed over time, here and in most places, because I truly don't see how a country as large and non-united as the USA could even hope to halt a pandemic using Korea’s or Taiwan’s or China’s techniques. Many people think our lockdowns will save lives. I think it's unclear whether a haphazard, some-states-do-and-some-states-don't, variously-strict-lockdown-non-plan will save enough lives to matter - and nobody's even in charge of keeping track, as far as I can tell!

I wonder if the USA’s version of a lockdown will be ineffective at quelling the hardest-hit areas (like NY), and too draconian for Everyday Use or need in many other places that are more rural and less densely populated. Perhaps, still, a hand washing public safety campaign would make the most difference.

I can see individuals, especially if they live way out in the desert around here, quarantining indefinitely as self-preservation, which might save some lives. But most of the rest of us are dependent on the infrastructure and social engagement that we are used to, and I can't see healthcare OR public health strategy improving any time soon, even with a bipartisan bailout bill. So the current lockdown situation doesn't seem like a net gain.

It makes sense to me that densely populated places like NYC would have a contagious virus spreading like wildfire, even with a variously enforced lockdown but no organized surveillance like in Korea. Too many people were exposed before the lockdowns began, so the math dictates that it's spreading fast through the "holes" in the lockdown anyway. Maybe the fairly unorganized lockdown is working a lot better around here, where population is so sparse. But it feels a lot like throwing darts at the wall, in terms of an actual effective plan to deal with the virus long-term.

And what happens next? What result do we wait for before lifting the lockdowns? Until a vaccine is developed? Until we begin a public health campaign to remove government subsidies from Big Food and Big Ag, and make sure that Whole, Unprocessed Foods are available for all? (I know, I know, ridiculous, but I thought I’d sneak that in!) Until a certain percentage of residents in all large cities have been exposed to the virus? Until Trump's attention span moves on (i.e. three days ago)??

I wrote much of this in response to S., above, including: “…After I got your e-mail I spent a long time trying to find good case fatality rates for the flu over time and in specific countries, and found it surprisingly difficult to do. There does appear to be some differences, but either they are not statistically significant or not included in the Average. I did find that the source I had quoted originally (an epidemiologist who used .56 as his number for this year's bad flu season) appears to have made his numbers up right out of the air.

“…I now see what you mean. I can imagine a scenario where _in the future_, mutated versions of this coronavirus are similar to the flu - but its current contagion level, combined with its currently unknown but probably higher than the flu deathrate, combined with the fact that nobody before now has ever been exposed to it...means that _right now_ it's likely to be much worse than the flu. Unless mutations or other factors render it LESS fatal as time goes on, or if we suddenly discover some dietary intervention that will help us all build our immune systems to naturally become more resistant to infections during all our at-home days during these lockdowns... (Bad joke!)”

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Thank you all so much for being out there and for thinking so thoughtfully and sharing those thoughts. It feels a lot less lonely to be thinking together.

xoxo
Sarabeth