COVID-19 has a decided racial preference for Western blood, killing Americans and Europeans at more than ten times the rate of people in Japan, China, Hong Kong, Taiwan, Korea, or Vietnam. The chart below shows the COVID-19 death rate per million population in several significant countries countries. The US and Belgium is seen to be more than 100 times worse than China or Hong Kong, etc., based on data from http://www.worldometers.info. IN the figure, the death-rate rank of each country is shown on the left, next to the country name.
For clarity, I didn’t include all the countries of Europe, but note that European countries are the majority of the top ten in terms of deaths per million. Belgium is number one with over 1,400. That is somewhat over 0.14% of the population has died of COVID-19 so far.
Peru has the highest COVID-19 death rate in South America at over 1000 per million, 0.1%. The US rate is similar, 0.082%. These are shockingly high numbers despite our best efforts to stop the disease by mandating masks, closing schools, and generally closing our economies. Meanwhile, in China and Japan, the economies are open and the total death rate is only about 1/100 that of Europe or the Americas. Any health numbers from China are suspect, but here I tend to believe it. Their rates are very similar to those in Hong Kong and Taiwan. At 3 per million, China’s death rate is 1/400 th the rate of the US, and Taiwan’s is lower.
This is not for lack of good healthcare systems in Europe, or lack of preparation. As of December 1-10, Germany, a country of 80 million, is seeing a COVID death rate of 388 per day. Japan, a country of 120 million, sees about 20. These are modern countries with good record keeping; Germany is locked down and Japan is open.
The question is why, and the answer seems to be genetics. A British study of the genetics of people who got the disease particularly severely found a few genes responsible, among these, TYK2. “It is part of the system that makes your immune cells more angry, and more inflammatory,” explained Dr Kenneth Baillie, a consultant in medicine at the Royal Infirmary in Edinburgh, who led the Genomicc project. He’s theory is that versions of this gene can allow the virus to put your immune response “into overdrive, putting patients at risk of damaging lung inflammation.” If his explanation is right, a class of anti-inflammatory drugs could work. (I’d already mentioned data suggesting that a baby aspirin or two seems helpful).
As reported in Nature this week, another gene that causes problems is IFNAR2. IFNAR2 is linked to release of interferon, which helps to kick-start the immune system as soon as an infection is detected.
It could be accidental that Asians are just lucky interns of not having the gene variations that make this disease deadly. Alternately, it could be that the disease is was engineered (in China?) and released either as a bio-attack, or by accident. Or it could be a combination. Whatever the cause of the disease, that east Asians should be spared this way is really weird.
Suggesting that this is not biowarfare is the observation that, in San Francisco, the Asian, per case fatality rate is as high as for white people or higher. One problem with this argument is that there is a difference between death rate per confirmed case and death rate per million population. It is possible that, for one reason or another Chinese people in San Francisco do not seek to be tested until they are at death’s door. Such things were seen in Iran and North Korea, for example. It pushed up the per-case death rate to 100%. Another possibility is that the high death rates in the west reflect disease mutation, or perhaps eastern exposure to a non-deadly variant of COVID that never made it west. If this is the case, it would be just as odd as any other explanation of a100x difference in death rates. Maybe I’m being paranoid here, but as the saying goes, even paranoids have enemies.
Most people know that aspirin can reduce blood clots and thus the risk heart attack, as shown famously in the 1989 “Physicians’ Health Study” where 22,000 male physicians were randomly assigned to either a regular aspirin (325 mg) every other day or an identical looking placebo. The results are shown in the table below, where “Myocardial Infarction” or “MI” is doctor-speak for heart attack.
Treatment
Myocardial Infarctions
No Infarction
Total
fraction with MI
Aspirin
139
10,898
11,037
139/11,037 = 0.0126
Placebo
239
10,795
11,034
239/11,034 = 0.0217
Over the 5 years of the study, the physicians had 378 MI events, but mostly in the group that didn’t take aspirin: 1.28% of the doctors who took aspirin had a heart attack as opposed to 2.17% for those with the placebo. The ratio 1.28/2.17 = 0.58 is called the risk ratio. Apparently, aspirin in this dose reduces your MI risk to 58% of what it was otherwise — at least in white males of a certain age.
A blood clot showing red cells held together by fibrin fibers. Clots can cause heart attack, stroke, and breathing problems. photo: Steve Gschmeissner.
Further study showed aspirin benefits with women and other ethnicities, and benefits beyond hear attack, in any disease that induces disseminated intravascular coagulopathy. That’s doctor speak for excessive blood clots. Aspirin produced a reduction in stroke and in some cancers (Leukemia among them) and now it now seems likely that aspirin reduces the deadliness of COVID-19. Data from Wuhan showed that excessive blood clots were present in 71% of deaths vs. 0.4% of survivors. In the US, some 30% of those with serious COVID symptoms and death show excessive blood clots, particularly in the lungs. Aspirin and Vitamin D seem to help.
.The down-side of aspirin use is a reduction in wound healing and some intestinal bleeding. The intestinal bleeding is known as aspirin burn. Because of these side-effects it is common to give a lower dose today, just one baby aspirin per day, 81 mg. While this does does some good, It is not clear that it is ideal for all people. This recent study in the Lanset (2018) shows a strong relationship between body weight and aspirin response. Based on 117,279 patients, male and female, the Lanset study found that the low dose, baby aspirin provides MI benefits only in thin people, those who weigh less than about 60 kg (130 lb). If you weigh more than that, you need a higher dose, perhaps two baby aspirin per day, or a single adult aspirin every other day, the dose of the original doctors study.
In this study of COVID patients, published in July, those who had been taking aspirin fared far better than those who did not A followup study will examine the benefits of one baby aspirin (81 mg) with and without Vitamin D, read about it here. I should note that other pain medications do not have this blood-thinning effect, and would not be expected to have the same benefit.
While it seems likely that 2 baby aspirins might be better in fat people, or one full aspirin every other day, taking a lot more than this is deadly. During the Spanish flu some patients were given as much as 80 adult aspirins per day. It likely killed them. As Paracelsus noted, the difference between a cure and a poison is the dose.
I’m not crazy about the COVID isolation, but there are up-sides that I’ve come to appreciate. You might too. Out of boredom, I was finally got into meditation. It was better than just sitting around and doing nothing.
It’s best not to look at isolation as a problem, but an opportunity. I’ve developed a serious drinking opportunity.
And it’s an opportunity to talk to myself. I told myself I’ should quit drinking. Then I figured, why should I listen to a drunk who talks to himself.
A friend of mine was on drugs, but then quit. Everyone in his house is happy, except for the lamp. The lamp won’t talk to him anymore.
The movies are closed, and the bars, and the gyms. It gives me another reason not to go to the gym.
Did you know that, before the crowbar was invented, crows used to drink at home.
The real reason dogs aren’t allowed in bars: lots of guys can’t handle their licker.
There’s time to spend with my children. And they look like me.
I like that I don’t commute. Family events are over zoom, funerals (lots of funerals), meetings, lectures. They come in via the computer, and I don’t have to dress or attend. No jacket, no pants… no travel …. no job.
My children are spending more time with us at home. We have virtual meals together. I discovered that I have a son named Tok. He seems to like my dad-jokes.
My wife is finding it particularly tough. Most every day I see her standing by the window, staring, wondering. One of these days, I’ll let her in.
I asked wife why she married me. Was it for my looks, or my income, or my smarts. She smiled and said it was my sense of humor. 🙂
My wife is an elementary school teacher. She teaches these days with a smart board. If the board were any smarter, it would go work for someone else. It’s necessary, I guess. If you can’t beat them, you might as well let the smart board teach. I think the smart board stole the election. It began by auto-correcting my spelling. Then it moved to auto correct my voting. The board is smarter and better than me (Hey, who wrote this?)
I’ve learned to love masks, though some of them are hot.
You’d think they’d reduce the number of administrators in the schools, given that it’s all remote. Or reduce the price of college. It would be nice if they’d up the number of folks who can attend. So far no. Today the Princeton alumni of Michigan is sponsoring video-talk by Princeton alumnus, George Will. I wanted to attend, but found there was limited seating, so I’m on the waiting list (true story). By keeping people out, they show they are exclusive. Tuition is $40,000 / year, and they keep telling us that the college is in service of humanity. If they were in the service of humanity, they’d charge less, and stream the talk to whoever wants to listen in. I have to hope this will change sooner or later.
Shopping for toilet paper was a big issue at the beginning of the pandemic, but I’ve now got a dog to do it for me. He goes to the store, brings it back. Brings back toothpaste too. He’s a lavatory retriever. (I got this joke from Steve Feldman; the crowbar joke too.)
I don’t mind that there are few new movies. There are plenty of old movies that I have not seen, and old TV shows too.
This fellow is the new head of Biden’s COVID-19 task force. He’s got a science-based plan for over-population and the disease.
I like that people are leaving New York and LA. It’s healthy, and saves on rent. Folks still travel there, mostly for the rioting, but lockdowns are nicer in Michigan.
More people are hunting, and hiking, and canoeing. These are active activities that you can do on lockdown. The old activities were passive, or going out to eat. Passive activities are almost a contradiction in terms.
We’re cooking more at home, which is healthier. And squirrel doesn’t taste half bad. If I live through this, I’ll be healthy.
I’m reading more, and have joined goodreads.com. I’ve developed a superpower: I find can melt ice cubes, just by looking at them. It takes a while but they melt.
A lot more folks have dogs. And folks have gotten into religion. Wouldn’t it be great, if after death we fond that dyslexic folks were right. There really is a dog.
Let’s love the virus. If we don’t, the next crisis will be worse.
There was an election last week. My uncles voted for Biden, which really surprised me. They were staunch Republicans when they were alive. My aunt got the ballot and convinced them. She was a Democrat when she was alive.
Before COVID, the other big crisis was global warming. Al Gore and Greta Thunberg claimed we had to shutter production and stop driving to save the planet. COVID-19 has done it. The next crisis is over-population. COVID is already curing that problem — not so much in China, but in the US, Europe, and South America.
Just As a final thought, let’s look at the bright side of the virus. If we don’t, the next crisis will be worse. Take Monty Python’s advice and Always look at the bright side of life.
My son works at a company called Homodeus. It’s part of 4Catalyzer, an umbrella of seven medical biotechnology companies with a staff of 300 scientists and engineers. One of the Homodeus products, still waiting FDA guidance is a COVID-19, RNA self-tester called Homodeus Detect. It tests for COVID RNA directly, not for antibodies, with tests are much faster than hospital tests, taking 45 minutes, but more complex than the unreliable test strips. So far, the Detect tests have shown no false positives or false negatives. That would suggest 100% reliable, except but there are a fair number of invalid tests. The invalid tests are lares due to the complexity, and also to the fact that you are testing snot, essentially. There is no blood-taking involved, unlike with the test strips, but just a nasal swab, and the cost is moderate, about $35 per test. However you have to do some lab work. After you swab your nose, you put the swab in a heated liquid bath where chemicals break up the snot and dissolve the shells on any viruses or pollen present. After 30 minutes, you pass the liquid onto a detector strip that contains a conjugate protein that binds to SARS-CoV-2 RNA. Your answer appears 15 minutes later as one of three lines: one for positive, one for negative, or one indicating an invalid test. Invalid tests show up more often than they like, about half the time, especially when the test is done by amateurs.
Getting an invalid test result is a downside of the current product, but I don’t think it should prevent sales. You get better at doing the test, and speed and lack of false positives and negatives is a bigger plus. It seems worthwhile to fast-track offer this test for doctors offices and hospital admissions, at least. I’d also like to see it used for airplane boarding and interstate travel, so that a person traveling might avoid the two week quarantine that many states impose. I’d certainly pay $200 or more to avoid a two-week quarantine, and if I have to do a second or third test, I’d do that too.
At least some people realize it’s a big advantage to know if you are currently infections.
Because this test measures virus RNA, and not antibodies, it indicates infection virtually as soon as you’re infected. That’s a benefit for those wishing to fly, or to meet with people, an advantage that is not lost on Elon Musk at least (see tweet). The test also shows negative as soon as the virus is gone, and that’s big. In recent months the FDA has fast-track approved an antibody indicating test from Abbott Labs, but that test has many false readings and only indicates infection several days afterward, and it does not indicate when you are no longer infectious.
The FDA has not offered to fast track this test, or any other like it for approval. They have not even indicated what sort of reporting and privacy requirements they want, so things sit in limbo, both for Homodeus, and for competing companies. Here is a story in USA today: https://www.usatoday.com/story/news/2020/07/29/fda-opens-door-rapid-home-covid-19-tests/5536528002. One big issue that the FDA is contact tracing. The FDA would like to be able to trace all the contacts of anyone who tests positive, while maintaining privacy as demanded by the 4th Amendment.
One way around the 4th amendment concerns would be to require anyone who uses the test to sign a waiver allowing the government to trace their contacts. Alternately there could be a block-chain enabled app that would come with the test. An app coms already providing a timer for when to move to the next step, and it includes a machine-vision system to help analyze dim lines on the indicator. Perhaps the FDA would accept block chain as a way to allow full reporting while maintaining privacy The FDA has yet to provide guidance on what they want, though. Without guidance or fast-track approval, things sit in limbo. Here is a scathing legal analysis from the Yale Law Journal.
You can get a free test, but have to do it at Homodeus headquarters in Guilford, Connecticut. It’s free, and results appears in about 45 minutes.. Homodeus has been manufacturing the test in quantity; if you are interested, use the following link to sign up: https://www.homodeusinc.com/research. Healthcare providers are particularly welcome.
Why did the FDA fast-track approve Abott’s antigen/ antibody test. Maybe because the tests rethought to not lead to lower mask use. Alternately, Abott has more political pull. You can read the FDA’s explanation here. In my biassed opinion the Homodeus product is good enough to fast track especially for hospitals and healthcare providers. It could save lives while allowing the economy to reopen.
Robert Buxbaum, November 15, 2020 (with massive help from Aaron M. Buxbaum)
A few days ago, I asked for and received the PCV-13 pneumonia vaccine, and a few days earlier, the flu shot. These vaccines are free if you are over 65, but you have to ask for them. PCV-13 is the milder of the pneumonia vaccines, providing moderate resistance to 12 common pneumonia strains, plus a strain of diphtheria. There is a stronger shot, with more side-effects. The main reason I got these vaccines was to cut my risk from COVID-19.
Some 230,00 people have died from COVID-19. Almost all none of them were under 20, and hardly any died from the virus itself. As with the common flu, they died from side infections and pneumonia. Though the vaccine I took is not 100% effective against event these 13 pneumonias, it is fairly effective, especially in the absence of co-morbidities, and has few side effects beyond stiffness in my arm. I felt it was a worthwhile protection, and further reading suggests it was more worthwhile than I’d thought at first.
It is far from clear there will be a working vaccine for SARS-CoV-2, the virus that causes COV-19. We’ve been trying for 40 years to make a vaccine against AIDS, without success. We have also failed to create a working vaccine for SARS, MERS, or the common cold. Why should SARS-CoV-2 be different? We do have a flu vaccine, and I took it, but it isn’t very effective, viruses mutate. Despite claims that we would have a vaccine for COVID-19 by early next year, I came to imagine it would not be a particularly good vaccine, and it might have side effects. On the other hand, there is a fair amount of evidence that the pneumonia vaccine works and does a lot more good than one might expected against COVID-19.
A colleague of mine from Michigan State, Robert Root Bernstein, analyzed the effectiveness of several vaccines in the fight against COVID-19 by comparing the impact of COVID-19 on two dozen countries as a function of all the major inoculations. He found a strong correlation only with pneumonia vaccine: “Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.” Root-Bernstein also looked at the effectiveness of adult inoculation and child inoculation. Both were effective, at about the same rate. This suggests that the the plots below are not statistical flukes. Here is a link to the scientific article, and here is a link to the more popular version.
An analysis of countries in terms of COVID rates and deaths versus pneumonia vaccination rates in children and adults. The US has a high child vaccination rate, but a low adult vaccination rate. Japan, Korea, etc. are much better. Italy, Belgium, Spain, Brazil, and Peru are worse. Similar correlations were found with child and adult inoculation, suggesting that these correlations are not flukes of statistics.
I decided to check up on Root-Bernstein’s finding by checking the state-by state differences in pneumonia vaccination rates — information available here — and found that the two US states that were hardest hit by COVID, NY and NJ, have among the lowest rates of inoculation. Of course there are other reasons at play. These states are uncommonly densely populated, and the governments of both made the unfortunate choice of sending infected patients to live in old age homes. At least half of the deaths were in these homes.
Pneumonia vaccination may also explain why the virus barely affected those under 20. Pneumonia vaccines was available only in 2000 or so. Many states then began to vaccinate about then and required it to attend school. The time of immunization could explain why those younger than 20 in the US do so well compared to older individuals, and compared to some other countries where inoculation was later. I note that China has near universal inoculation for pneumonia, and was very mildly hit.
I also took the flu shot, and had taken the MMR (measles) vaccine last year. The side effects, though bad, are less bad than the benefits, I thought, but there was another reason, and that’s mimicry. It is not uncommon that exposure to one virus or vaccine will excite the immune system to similar viruses, so-called B cells and T-cell immunity. A recent study from the Mayo Clinic, read it here, shows that other inoculations help you fight COVID-19. By simple logic, I had expected that the flu vaccine would help me this way. The following study (from Root-Bernstein again) shows little COVID benefit from flu vaccine, but evidence that MMR helps (R-squared of 0.118). Let men suggest it’s worth a shot, as it were. Similar to this, I saw just today, published September 24, 2020 in the journal, Vaccines, that the disease most molecularly similar to SARS-CoV-2 is pneumonia. If so, mimicry provides yet another reason for pneumonia vaccination, and yet another explanation for the high correlations shown above.
As a final comparison, I note that Sweden has a very high pneumonia inoculation rate, but seems to have a low mask use rate. Despite this, Sweden has done somewhat better than the US against COVID-19. Chile has a low inoculation rates, and though they strongly enforced masks and social distance, it was harder hit than we were. The correlation isn’t 100%, and masks clearly do some good, but it seems inoculation may be more effective than masks.
Today, Michigan and several other, Democrat-run states are in fairly broad COVID lockdown. The justification for this is that it is “THE science”, as if this were the only possible behavior if you believe the disease is deadly and contagious. The other fellows, the governors of Republican-run states are framed as deniers of the science. Strangely enough, although this disease is most -definitely contagious and deadly, killing 209,000 Americans so far, about 0.064% of the US this year, it is far from clear that a broad lockdown is the only way to stop the disease. Sweden avoided a general lockdown, leaving its schools and restaurants open, and has seen the disease follow an almost destructive path to that of the US, with a death rate that is currently slightly lower than ours. See the excess death plot below. Sweden seems to have avoided a second, summer spike.
Mortality is Sweden vs the US; Ignore the last 2-3 weeks, it takes time for this data to be compiled
It’s bad enough for “THE SCIENCE” when you see the anti-science, no-lockdown solution provide the same result, or close. Earlier in the summer I noted that Sweden and Michigan had near the same outcome, with Sweden slightly better. It’s now the case that Sweden is doing better than the US, and much better than the D-lead lockdown states. The highest six death rate states are all D-lead, lockdown states, NY, NJ, Mass, Conn, LA, and RI, and rates are double the US average in New York and New Jersey. Perhaps the solution is a general opening, like in Sweden, but before we rush to this, it’s probably worthwhile to do some re-thinking.
Deaths per week, under 18. Any excess deaths caused by COVID-19 are invisible here, lost in the scatter.
One thing that Swedes seem to have appreciated that the US experts didn’t is that the disease hardly affects those the under 18, and that’s basically the entire K-12 student body. Sweden therefore left their K-12 schools open, while we closed ours in the US beginning in early April. At right I’ve plotted the US deaths per week for under 18 for the last three years, that is from before COVID till now. There is no evidence of excess COVID-19 deaths for this group. If anything anything, the under 18 death death rate is lower after COVID than before. This resistance of this group helps explain part of why the Swedish approach didn’t cause increased deaths. Kids in Sweden got the disease, but didn’t die of it, and likely infected their parents. The Swedes didn’t bother trying to protect everyone, but only the most vulnerable, the old people. Sweden was not completely successful at this, but we were perhaps worse, despite the general lockdown.
The excess deaths US for the 65+ bracket plotted by week of the year for 2020 (blue), 2019 (grey) and 2018 (yellow). Nearly 200,000 of the excess deaths of 2020 — the vast majority — are in this age bracket.
But what about the middle-age people that the kids would have infected, the parents and teachers. For middle age people, those in the 18-65 range, it seems to make a difference how physically fit you are, and the Swedes tend to be fit. Obesity is a big co-morbidity for this disease, and Americans tend to be obese, with things getting worse during the lockdown. Swedes also wash their hands more than we do (or so is their reputation) and they go out in the sun. There is evidence that the sun helps, and vitamin D too. A stark way of seeing how much fitness helps, for even those over 18 is to consider that, of the 1.3 million men and women of the US military, there have been only 7 COVID deaths. That is a rate 1/100 of the national average for a population that is entirely over 18. This is not to say that the death rate is quite 5 per million, (7/ 1.3 million = 5 per million), but it’s probably below 50 per million. That is to say, at least 10% of the military was likely infected.
I’m inclined to agree with Dr. Fauchi that we are not yet at herd immunity, or even close, even in states like Michigan where death rates have leveled out. Only 20% of the state shows antibodies and real herd immunity would require 75% or so. Further supporting this, our death rates are 1/2 that of New Jersey. If we were at herd immunity, that could not have happened. It is possible though that we have a sort of pseudo herd immunity, where many people in the MI population have some level of T-cell immunity. T-cells do a good job eating disease (here’s a video) but they get overwhelmed when we are exposed to more than a low dose of virus. This dose-response is common in respiratory diseases, and Dr. Fauchi has related it to T-cell immunity, though he does not speak in these directions often.
Michigan death rates to September 2020 The disease seems to be over, though only about 20% of the state shows antibodies.
T-cells can cause someone to be immune to a few viral hits, but not immune to higher doses. Assuming that’s what’s going on in MI and MA, and NJ, I’m inclined to suggest we can open up these states a bit, according to the Swedish model. That is make careful efforts to clean public transport, and encourage hand washing and surface cleaning. That we prohibit large gatherings, and we take care isolate those over 65 and protect old age homes. In the US, virtually all the deaths were of people over 65, and about half were people over 85, with men being particularly vulnerable. A heterogeneous opening of this sort has been recommended by scientists as early as March.
There are three major problems with lockdowns that keep us from all virus particles. These lockdowns kill the economy, they leave us with lousy education, and they likely leave us as at-risk for the disease later on, when the lockdown is lifted. Instead a heterogeneous opening leaves the economy running and exposes us to some small exposure, at a level that our typical level of T-cell immunity may be able to handle. Over time we expect our T-cell immunity will rise and we’ll be able to take off our masks entirely. It’s a nice route to a cure that does not require a vaccine.
The above approach requires us to trust that people will do the right thing, and requires us to accept that each may do it in his/her own way. Some may not wear the mask all the time, but may chose exercising, or staying in the sun and taking vitamin D. Some may keep to masks, or focus on hand washing. Some may try unapproved drugs, like hydroxychloroquine. We will have to be able to accept that, and our experts will have to be able to step back from running everything. In China and Russia, the experts tried run every aspect of farm production, using only science methods. The result was famine. A similar thing happened in Ireland and got a potato famine. It’s good to have expert advice, but as far as making the actual decision in each location, I put a lot of weight on the choices of those who will bear the consequences.
Robert Buxbaum September 30, 2020. As a summary, I’m for opening schools, opening most states, with masks, and hand-sanitizer, at lower occupancy ( ~50%), limiting large gatherings, going to zoom as much as possible, and isolating the aged particularly the old age homes. I also recommend vitamin D and iodine hand sanitizer.
There are two main routes for catching flu. One is via your hands and your eyes and nose. Your hands pick up germs from the surfaces you touch, and when you touch your eyes or nose passages, the germs infect you. This was thought to be the main route for infection, and I still think it is. I’d been pushing iodine hand sanitizer for some time, the stuff used in hospitals, saying that that the alcohol hand sanitizer doesn’t work well, that it evaporates.
The other route, the one touted by the press these days is via direct cough droplets, breathing them in or getting them in your eyes. Masks and face shields are the preferred protection from this route, and the claim is that masks will stop 63% of the spread. The 63% number has an interesting history, it comes from this test with infected hamsters. Hamsters are 63% less likely to infect other hamsters when they wear a mask. Of course, the comparison has some weaknesses: hamsters don’t put their fingers in their noses, nor do they rub their eyes with their hands, and hamsters can be forced to keep the mask barrier all the time — read the study to see how.
A more realistic study, or more relevant to people, in my opinion showed a far lower effect for masks, about 20%. During the HiNi flu pandemic of 2009 a group of 1437 college students at a single university were divided into three randomized groups, see the original report here. Students at a few chosen residence halls were instructed to wash their hands regularly, use sanitizer, and wear masks. Students at other halls were either told to wear masks only, or told to go on as they pleased. This was the largest group, the control. They included students of the the largest residence hall on campus. The main results appear as the graph below, Figure 1 of the report. It shows a difference of 6% or 20%, depending on how you look at things, with the mask plus hand-health group, MPHH, doing the best.
After 6 weeks of monitoring, approximately 36% of the control group had gotten the flu or some collection of flu symptoms. The remaining 64% of the residents remained symptom free. This is he darkest line above.
Of the FM Only group, the medium line above, those instructed to wear face masks only. 30% of this group showed flu symptoms, with 70% remaining symptom free. Clearly masks do help with humans, but far less than what you’d expect from the news reports.
Sweden kept the primary schools open and allows people to wear masks and social distance at they see fit. The death toll to August 1 is identical to Michigan, or slightly bette Sweden’s top virologist recommends that the US follow suit. Open up and trust people.
The group that did best was FMHH, the group who both wore facemarks and used hand health, regular hand washing plus hand sanitizer. This group reported an average of 3.5 hours per day of mask use above the control group average. This is about as good or better than I see in Michigan. Adding the hand health provided an additional 1% improvement, or a 3% improvement, depending on how you look at these things. The press claims hand health is wasted effort, but I’m not so sure. I argue that the effect was significant, and that the hand sanitizer was bad. I argue that iodine hand wash would have done better at far less social cost.
I also note that doing nothing was not that much worse than mask use. This matches with the observation of COVID-19 in Sweden. With no enforced social distancing, Sweden did about the same as Michigan — slightly better, despite Michigan closing the schools and restaurants, and imposing some of the toughest requirements for social distancing and mask use.
Other things that affect how likely you are to get flu symptoms. I find these rustles more interesting than the main face-mask result.
There were other observations from the university study that i found isignificant. There are racial differences and social differences. The authors didn’t highlight these, but they are at least as large as the effect of mask use. Asians got the flu only 70% as often as others, while black students got it 8% more often. This matches what has been seen in the US with COVID-19. Also interesting, those with a recent flu shot got flu more often; those with physical activity 13% more often. Smokers got the flu less than non-smokers and women got it 22% more often than men. The last two are the reverse with COVID-19. I could speculate on the reasons, but clearly there is a lot going on.
Why did Asians do better than others? Perhaps Asians have had prior exposure to some similar virus, and are thus slightly immune, or perhaps they used the masks more, being more socially acceptable. Why were smokers protected? It’s likely that smoke kills germs; was that the cause. These are speculations, and as for the rest I don’t know.
I am not that bothered that the students probably didn’t wear their masks 100% of the time. Better would be better, but even with mask use 100% of the time, there are other known routes that are almost impossible to remove: clothing, food, touching your face. I still think there is a big advantage to iodine hand wash, and I suspect we would be better off opening up a bit too.
Sweden has scientists; Michigan has scientists. Sweden’s scientists said to trust people to social distance and let the COVID-19 disease run its course. It was a highly controversial take, but Sweden didn’t close the schools, didn’t enforce masks, and let people social distance as they would. Michigan’s scientists said to wear masks and close everything, and the governor enforced just that. She closed the schools, the restaurants, the golf courses, and even the parks for a while. In Michigan you can not attend a baseball game, and you can be fined for not wearing a mask in public. The net result: Michigan and Sweden had almost the same death totals and rates, as the graphs below show. As of July 28, 2020: Sweden had 5,702 dead of COVID-19, Michigan had 6,402. That’s 13 more dead for a population that’s 20% smaller.
Sweden’s deaths pre day. There are 5,702 COVID dead since the start, out of a population of 10.63 million. There are 79,494 confirmed COVID cases, but likely a lot more infected.
Sweden and Michigan are equally industrial, with populations in a few dense cities and a rural back-country. Both banned large-scale use of hydroxy-chloroquine. Given the large difference in social distance laws, you’d expect a vastly different death rate, with Michigan’s, presumably lower, but there is hardly any difference at all, and it’s worthwhile to consider what we might learn from this.
Michigan’s deaths pre day. There are 6,426 COVID dead since the start, out of a population of 9.99 million. There are 88,025 confirmed COVID cases, but likely a lot more infected.
What I learn from this is not that social distance is unimportant, and not that hand washing and masks don’t work, but rather it seems to me that people are more likely to social distance if they themselves are in control of the rules. This is something I also notice comparing freezer economies to communist or controlled ones: people work harder when they have more of a say in what they do. Some call this self -exploitation, but it seems to be a universal lesson.
Both Sweden and the US began the epidemic with some moderate testing of a drug called hydroxychloroquine (HCQ)and both mostly stopped in April when the drug became a political football. President Trump recommended it based on studies in France and China, but the response was many publications showing the didn’t work and was even deadly. Virtually ever western country cut back use of the drug. Brazil’s scientists objected — see here where they claim that those studies were crooked. It seems that countries that continued to use the drug had fewer COVID deaths, see graph, but it’s hard to say. The Brazilians claim that the anti HCQ studies were politically motivated, but doctors in both Sweden and the US largely stopped prescribing the drug. This seems to have been a mistake.
US hospitals stopped using HCQ in early April almost as soon as Trump recommended it. Sweden did the same.
In July, Henry Ford hospitals published this large-scale study showing a strong benefit: for HCQ: out of 2,541 patients in six hospitals, the death rate for those treated with HCQ was 13%. For those not treated with HCQ, the death rate was more than double: 26.4%. It’s not clear that this is cause and effect. It’s suggestive, but there is room for unconscious bias in who got the drug. Similarly, last week, a Yale researcher this week used epidemiological evidence to say HCQ works. This might be proof, or not. Since epidemiology is not double-blind, there is more than common room for confounding variables. By and large the newspaper experts are unconvinced by epidemiology and say there is no real evidence of HCQ benefit. In Michigan and Sweden the politicians strongly recommend continuing their approaches, by and large avoiding HCQ. In Brazil, India and much of the mideast, HCQ is popular. The countries that use HCQ claim it works. The countries that don’t claim it does not. The countries with strict lock-down say that science shows this is what’s working. The countries without, claim they are right to go without. All claim SCIENCE to support their behaviors, and likely that’s faulty logic.
Hydroxychloroquine and COVID-19 fatality rates in different countries as of early June 2020. This isn’t enough to prove HCQ effectiveness, but it’s promising, and suggests that increased use is warranted, at least among those without heart problems.
Given my choice, I’d like to see more use of HCQ. I’m not sure it works, but I’m ,sure there’s enough evidence to put it into the top tier of testing. I’d also prefer the Sweden method, of nor enforced lockdown, or a very moderate lockdown, but I live I’m Michigan where the governor claims she knows science, and I’m willing to live within the governor’s lockdown.There is good, scientific evidence that, if you don’t you get fined or go to jail.
…And [the leper] shall cover his face to the lip, and call out unclean, unclean… (Lev. 13: 45)
Video and TV-learning has been with us for a long time. It’s called PBS. It’s entertaining, but as education, it sucks. You can see the great courses on DVD too. The great professors teaching great material. It’s entertaining, but as education, they suck.
Consider PBS, the public broadcast system, it was funded 50 years ago and given a portion of the spectrum to be a font for at-distance education. At first they tried showing classroom lectures from the best of professors. Few people watched, and hardly anyone learned. Hardly anyone was willing to do catch every lecture, or do any of the reading or any of the assigned homework. Some did some problems, but only if they already knew the subject, sort of as a refresher . No viewer of record learned enough to perform a trade based on PBS-learnign, nor achieved any academic proficiency that would allow them to publish is a reviewed journal, unless they already had that proficiency. A good question is why, but first lets consider the great DVD lectures in science or engineering . They too have been around for years, but I’ve yet to meet anyone of proficiency who learned that way. Not one doctor, lawyer, or engineer whose technical training came this way. Even Sesame street. My sense is that no one ever learned to read from this, or from the follow-on program reading rainbow, except that they had parental help — the real teachers being the parent. My sense is that all formal education over video is deficient or worthless unless it’s complimented by an in-person, interaction. The cause perhaps we are not evolutionarily developed to connect with a TV image the way we connect with a human.
Education is always hard because you’re trying to remold the mind, and it only works if the student wants his or her mind molded. To get that enthusiasm requires social interaction, peer pressure and the like, and it requires real experience, not phony video. Play is a real experience, and all animals enjoy play. it convinces them they can do things, This stag on a now-empty soccer field is busy developing soccer skills and is rewarded here with a reaching his goal. Without the physical goal there would be no practice, and without the physical practice there would be no learning.
For people, the goals of the goals of the teacher must be made to match those of the student. The teachers goals are that they student should love learning, that he or she should acquire knowledge, and that he or she should be prepared to use that knowledge in a socially acceptable way. For the student, the goals include being praised by peers, and getting girls/ boys, and drinking. Colleges work, to the extent they do, but putting together the two sets of goals. Colleges work best in certain enclaves — places where the student’s statues increases if he or she does well on exams or in class, where he or she can drink and party, but will get thrown out if they do it so much that their grades suffer. Also colleges make sure to have clubs and sports where he or she can develop a socially acceptable way to deal with others. Remove the goals an rewards, and the lessons become pointless, or “academic.”
A cave painting from France. It’s diagrammatic, not artistic. It shows where you stand, how you hold the spear, and where the spear is supposed to go, but the encouragement to do it had to be given in person..
It might be argues that visual media can make up for real experience, and to some extent this is true. Visual media has been used since the beginning, as with this cave painting, but it only helps. You still need personal interaction and real-life experience. An experienced hunter could use the cave picture to show the student where to stand and how to hold the spear. But much of the training had to be social, with friends before the hunt, in the field, watching friends and the teacher as they succeed or fail. And — very important — after the hunt, eating the catch, or sitting hungry rubbing one’s bruises. This is where fine-points are gained, and where the student became infected with the desire to actually do the thing right. Leave this out, and you have the experience of the typical visitor to the museum. “Oh, cool” and then the visitor moves on.
In a world of Zoom learning, there is no feast at the end, no thrill of victory, and no agony of defeat. The students do not generally see each other, or talk to one another. They do not egg each other on, or condemn bad behavior. They do not share stories, and there is no real reward. There is no way to impress your fellow, and no embarrassment if you fail, or fail to work. The lesson does not take hold because we don’t work this way. A result is that US education as we know it is in for a dramatic change, but the details are sill a little fuzzy.
As best I can tell, our universities managers do not realize the failure of this education mode, or the choose to ignore it. If they were to admit defeat, they would lose their job. They can also point to a sort of artificial success, as when an accomplished programmer learns a bit more programming, or when an accomplished writer learns a new trick, but that’s not real education, and it certainly isn’t something most folks would pay $50,000 per year for.
Harvard University claims it will be entirely on-line next year, and that it will charge the same. We will have to see how that works for them. You still get the prestige of Harvard, though you can no longer join the crew team, or piss on the statue of John Harvard. My guess is that some people will put up with it, but not at that price. Why pay $50,000 — the equivalent of over $100/hour when you can get a complete set of DVDs on the material for $100, and a certificate. Without the physical pain or rowing, or the pleasure of pissing, there is no real connection to your fellow student, and a lot of the plus of Harvard is that social connection.
On line education isn’t strange; it just isn’t education.
I expect the big mid tier colleges to suffer even more than the great schools. I don’t expect 50,000 students to pay $40,000 each to go to virtual Indiana State. Why should they? Trade-schools may last, and mini-colleges, those with a few hundred students, that might be able to continue in a version of the old paradigm, and one-on-one or self-learning. This worked for Lincoln, and Washington; for Heraclitus and for Diogenes. Self study and small schools are good for self-reflection and refinement. The format is different from on-line, more question and answer. Some folks will thrive, others will flounder — Not everyone learns the same– but the on-line university will die. $40k of student debt for on-line lectures followed by an on-line, virtual graduation? No, thank you.
The reason that trade schools will work, even in a real of COVID, is they never focussed as much on personal interaction, but more on the interaction between your hands and your work. This provides a sort of reality check that doesn’t exist in typical on-line eduction. If your weld breaks, or your pipe leaks, you see it. Non-trade school, on-line eduction suffers by comparison, since there is no reality in the material. Anything can be shown on screen. My undergrad college, a small one, Cooper Union, used something of a trade school approach. For example, you learned control theory while sitting underneath a tank of water. You were expected to control the water height with a flow controller. When you got the program wrong, the tank ran dry, or overflowed, or did both in an oscillatory way. I can imagine that sort of stuff continuing during COVID lockdowns, but not as an on-line experience.
It seems to me that the protest and riots for Black Lives serve as a sort of alternative college, for the same type of person. It relieves the isolation, and provides a goal. My mother-in-law spent her teenage years in Ravensbruk concentration camp, during the holocaust, and my father-in-law survived Auschwitz. They came out scarred, but functional. They survived, I think, because of a goal. A recognition that the they were alive for a reason. My mother-in-law helped her sister survive. For many these days, ending racism by, tearing down statues is the goal. The speeches are better than in on-line colleges., you get the needed physical and social interaction, and you don’t spend $50,00 per year for it.
Robert Buxbaum July 24, 2020. These are my ramblings based in part on my daughter’s experience finishing college with 4 months of on-line eduction. The next year should see a shake-out of colleges that are not financially sound, I expect.
Brazil has decided to go its own route in response to the Corona virus pandemic. They’re using minimal social distancing with a heavy reliance on hydroxychloroquine (HCQ), a cheap drug that they claim is effective (as has our president). Brazil has been widely criticized for this, despite so far having lower death rate per million than the US, Canada, or most of Europe. In an open letter, copied in part below, 25 Brazilian scientists speak out against the politicalization of science, and in favor of their approach to COVID-19. The full letter (here). The whole letter is very worth reading, IMHO, but especially worthwhile is their section on hydroxychloroquine (HCQ), copied below.
….. Numerous countries such as the USA, Spain, France, Italy, India, Israel, Russia, Costa Rica and Senegal use the drug (HCQ) to fight covid-19, whereas other countries refrain from using HCQ as one of the strategies to contain the pandemic, betting on other controversial tactics.
Who then speaks here in the name of “science”? Which group has a monopoly on reason and its exclusive authorization to be the spokesperson of “science”? Where is such authorization found?One can choose an opinion, and base his strategy on it, this is fine, but no one should commit the sacrilege of protecting his decision risking to tarnish with it the “sacred mantle of science”.
Outraged, every day I hear mayors and governors saying at the top of their lungs that they “have followed science”. Presidents of councils and some of their advisers, and of academies and deans in their offices write letters on behalf of their entire community, as if they reflect everyone’s consensual position. Nothing could be more false.Have they followed science? Not at all! They have followed the science wing which they like, and the scientists who they chose to place around them. They ignore the other wing of science, since there are also hundreds of scientists and articles that oppose their positions and measures.
Worse, scientists are not angels. Scientists are people, and people have likes and dislikes, passions and political party preferences. Or wouldn’t they? There are many scientists, therefore, who do good without looking at whom, I know and admire many of them. But there are also pseudoscientists who use science to defend their opinion, their own pocket, or their passion. Scientists have worked and still work hard and detached to contribute to the good of humanity, many of whom are now in their laboratories, risking their lives to develop new methods of detecting coronavirus, drugs and vaccines, when they could stay “safe at home”. But, to illustrate my point, I know scientists who have published articles, some even in major journals such as “Science” or “Nature”, with data they have manufactured “during the night”; others who have removed points from their curves, or used other similar strategies. Many scientists were at Hitler’s side, weren’t they? Did they act in the name of “science”? Others have developed atom bombs. Others still develop chemical and biological weapons and illicit drugs, by design.
The Manaus’ study with chloroquine (CQ) performed here in Brazil and published in the Journal of the American Medical Association (JAMA) [1], is emblematic to this discussion of “science”. Scientists there used, the manuscript reveals, lethal doses in debilitated patients, many in severe conditions and with comorbidities. The profiles of the groups do not seem to have been “randomized”, since a clear “preference” in the HIGH DOSE group for risk factors is noted. Chloroquine, which is more toxic than HCQ, was used, and it seems that they even made “childish mistakes” in simple stoichiometric calculations, doubling the dosage with the error. I’m incapable of judging intentions, but justice will do it. The former Brazilian Health Minister Luiz Henrique Mandetta quoted this study, supported it, and based on it, categorically stated: “I do not approve HCQ because I am based on ‘science, science, science’!”.
Another study published by Chinese researchers in the British Medical Journal (BMJ) and which is still persistently used against HCQ was also at least revolting [2]. In it, the authors declared: “we administer 1,200 mg for 3 days, followed by 800 mg for 12 to 21 days, in patients with moderate to severe symptoms”. In other words, they gave a huge dosage of the drug that could reach the absurdity of 20 grams in the end, and it given was too late to patients (HCQ should be administered in the first symptoms or even earlier). And even worse, overdosing on HCQ or any other drug for severe cases is poisonous. What do you think, was it good science? The recommended dosage in Brazil, since May 20th, 2020, by the new Ministry of Health, for mild symptoms is 2 times 400 mg in the first day (every 12 hours) and 400 mg for 5 days for a total of 2.8 grams.
In other published studies, also in these internationally renowned journals such as The New England Journal of Medicine, JAMA and BMJ [3-5], once again, “problems” are clearly noted, since or the patients were randomized in irregular ways, placing older, more susceptible or most severe and hypoxemic patients in the higher (lethal) dose groups, or more men (almost 3 times more deadly by covid than women), or more black people (in the USA, black people have displayed higher mortality) and more smokers, and where most of the deaths occurred in the first days of the studies (signs that were deaths of critically ill patients, who at this stage would be more “intoxicated” than “treated” with HCQ), or they administered HCQ isolated, when it is known that it is necessary to associate HCQ at least with azithromycin. One of these studies [5] administered HCQ only on the sixteenth day of symptoms (for really early treatment, HCQ administration should be started up to fifth day), in other words, at the end of the disease, when the drug can do little good or nothing to the patient.
These studies indicate that some scientists either forgot how “science” is done or that there is a huge effort to disprove, whatever it takes, that HCQ works. How can someone or even Councils and Academies of Medicine cite such studies as the “science” of their decisions? How can that be?
On the contrary, the study published – and today with more than 3 thousand patients tested – and carried out by Dr. Didier Raoult in France [6], using the correct dosage and at the right time, with a very low mortality rate (0.4%), and the Prevent Senior’s clinical experience in Brazil – also quite encouraging – are disqualified with very “futile” arguments such as: “Didier Raoult is a controversial and unworthy researcher”, “At Prevent Senior Clinic they were not sure of the diagnosis” (but none of the hospitalized patients with clear COVID symptoms died), “Placebo effect” (what a supernatural power of inducing our mind that reduces mortality from 40% to zero, I want this placebo!), “Study performed by a health plan company” (I do not doubt that this people indeed want to save lives, because the patients were their customers who pay their bills), and similar ephemeral arguments.…
I admire the spunk of these fellows going agains the doctors, WHO. Beyond being a critique of bad research on a particular drug, it is a defense of science. Science is a discussion, a striving for truth. It is not supposed to demand blind allegiance to a few politically appointed experts. They’ve convinced me that the tests sponsored by the world health organization seem designed to show failure, and reminded me that there is rarely a one-size-fits-all for problems and all times.
I also find striking the highly critical response of my local newspapers and TV reporters. While they both like to highlight efforts by South America as they try entering the first world, with help from Bill gates and leftist politicians, they have been uniformly condemned Brazil for its non-left approach and now for use of HCQ. They want Sous Americans to think, but only if their conclusions are no different from those of their favorite, liberal thinkers.
