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2021.03.01

Get the J&J (single-dose) Vaccine to the Homeless

Because it's single-dose, the J&J vaccine is a smart choice for populations where it's difficult to impossible to guarantee they'll come back for a second shot: homeless people, transients, people in county jails (short-term facilities with a lot of turnover), mental-health outpatients.

2021.02.03

Instead of a Ring, Indian Callers Hear a PSA about SARS-CoV-2

India replaced phone rings nationwide with PSAs about handwashing, mask wearing, and now vaccination. So whenever someone in India makes a call -- from landline or mobile -- the caller hears a public safety message. That is genius.

Sidebar: I do think a summer slowdown is a significant contributor to India's dropping cases, just as we saw during our summer. But promoting awareness in such a robust way (and Amitabh Bachchan's voice is so distinctive and authoritative!) of how to stop the spread is likely an even bigger factor. 

Given that India faces a lot of circumstances that support the virus spread, including high density both of particulate matter in the air (pollution) and of population, the success of the public information campaign is particularly apparent. 

Small fines for not wearing a mask in public -- with a mask provided along with the ticket -- combined with such a focus on ensuring everyone gets the vital information about how to stop this deadly disease is a great approach. 

We could learn a LOT from India on this one.

Best-case scenario would be a more contagious but much milder variant becoming dominant in India -- so a key will be sequencing as many samples as possible to find out if that's what's happening. As I wrote back in spring, our best hope with this virus is that once it has made its initial first-time-in-human-history pass through our immune systems we will be better able to handle it or it will moderate (or both) such that, though it continues to exist and spread, it doesn't keep killing us. 

No matter what, though, SARS-CoV-2 is just a warning shot.

If we don't take heed and act accordingly -- that means ramping up global pandemic response coordination and preparedness, maintaining enormous and consistently refreshed PPE and medical supply stockpiles, and greatly increasing intensive-care surge capacity -- we'll get hit even harder by the next emerging virus. 

So many more people will die than the half-million-plus who've already died with covid-19 in the US in under a year and the two million-plus globally. 

And keep in mind that data indicate that less than 20% of the US population has had covid-19, which means that those half-million deaths are from only (possibly less than) one-fifth of the population having had the disease. 

That means we're looking at a LOT more deaths to come as the other four-fifths of the population gets exposed. And, of course, one can get it over and over again, so it's not as though once everyone's had it we're in the clear. We're not. We need to get vaccinated (to reduce the risk of severe disease), wear masks (to reduce the spread, because even vaccinated people can contract and spread the virus), and get a LOT smarter about this whole thing NOW.

For the entire month of January 2021 we lost on average WAY MORE than a 9/11 worth of Americans  EVERY DAY to covid-19 in the United States.

2021.01.07

While we were distracted by the coup attempt yesterday...

4100 more Americans died of covid-19. 

That's the HIGHEST ONE-DAY DEATH TOLL of any country anywhere on Earth in the entire history of this virus.

And the first wave hasn't even crested yet.

In just the past two days, approximately 8,000 Americans have died with covid-19 as either the direct or indirect cause of the death.

That's the death-toll equivalent of THREE 9/11s IN TWO DAYS. And it's just the beginning. 

Y'all know I've been saying since May that the whole first year of this virus is still the first wave. It is. And it hasn't even crested yet. The wave is still building. 

It was aided by rallies, by Thanksgiving and Christmas and New Years gatherings, by people not understanding that EVERY indoor space you share with people carries a significant risk of infecting yourself or others even with a mask on -- and EVEN MORE SO if y'all don't have masks on. (Shoutout to my family members who are reading this -- I love you, and yes, I'm talking to YOU.)

And remember there's a 2-week to 2-month (or more) lag between infections and deaths, so what we're seeing now is mostly not people dying after being infected at Christmas, but people dying after being infected AT THANKSGIVING. 

The Christmas-gathering deaths are yet to come. The New-Year-party deaths are yet to come. The worst is yet to come. 

(The deaths from all those maniacs who stormed the Capitol are yet to come. They rode in, maskless, on crowded buses from faraway hotspots. They crowded together, maskless, and then got themselves pepper-sprayed and started coughing all over each other and wiping their eyes. They left their SARS-CoV-2 all over the US Capitol building for our members of Congress and staffers to pick up.)

Hospitals in many parts of the country are already at, and even over, capacity. Even more will be soon. 

And it doesn't help that the vaccine does NOT prevent infection and does NOT prevent transmission of the virus. It helps make it less likely that you'll die from infection, which is great -- go get the vaccine as soon as you can! -- but it's not a silver bullet. You can still get the virus even if you've been vaccinated, you can get the virus again even if you've already had it before, and you could still accidentally kill someone by transmitting the virus if you're not super careful. The science shows all of this. Clearly. 

Self-sequester. Wear a mask EVERY TIME you are ANYWHERE NEAR ANYONE you don't live with full-time. REALLY THINK ABOUT how this virus spreads. If you don't understand yet, call me or message me and I'll be happy to talk with you about it until all your questions are answered. Or read through this very page, where I've discussed it in detail. 

We are VERY LITERALLY all in this together.

So much damage has already been done.

We need to get smart about this, collectively, NOW. 

Spread the word.

 

2021.01.07

But surfaces aren't a problem anymore, right?

Sorry, wrong. Still a risk.

A little before 7pm yesterday, when it was announced that the House and Senate would reconvene in their chambers at 8pm following the national-embarrassment of an insurrection that afternoon, I posted the following to Facebook:

An old friend replied:

"I have read some recent stuff that it may be a lot harder than originally thought and researched to get infected from surfaces. That it’s mostly dead virus cells being found on surfaces and the primary means of transmission is through the air from droplets from others.... Just saying, and I’m not going to go and find all the sources where I read that. Because I don’t totally trust it yet and still sanitize my hands when going places. But I don’t think my kids or I have had it yet and we’ve been careful and when I was reading that surface infection may be a minimal risk, it at least relieved some of the stress."

I've heard that, too, and alas it's inaccurate, like so much misinformation floating around to help people feel less at-risk. 

Surface infection is not a minimal risk; it's just somewhat less of a risk than airborne transmission. As people became more aware that airborne was an issue, focus was shifted to that -- perhaps to help people understand that masks are vital, which they are. But surface transmission, including on food, is way more significant than is being widely shared. 

This coronavirus operates like other coronaviruses transmissionwise. An experiment in 2012 used a bovine coronavirus strain as a surrogate for the human ones (a reasonable thing to do) and found the virus "retained infectivity for at least 14 days on fresh romaine lettuce in a refrigerator" ... sooooo that's why I haven't eaten a salad since March. SARS-CoV-2 has been shown multiple times to survive long-distance shipping on packages of frozen foods. 

The fact that the virus remains infectious on refrigerated foods is the reason that the one time I got takeout in the past 10 months I microwaved the cole slaw to inactivate any potential virus, then cooled it back down in the refrigerator. Why? Because it's totally possible that in the process of making the slaw, or packaging it, it was scooped by someone breathing SARS-CoV-2 all over it, and if so, the experimental data suggests the virus could very plausibly be both present and viable on that cold food. 

As to non-food surfaces, all the way back in April a Princeton/NIAID/CDC study that was very well conducted found that "SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces, although the virus titer was greatly reduced ... after 72 hours on plastic and ... after 48 hours on stainless steel." So surfaces are fine after some time, but that amount of time is measured (except in the case of copper) in days, not hours. 

Here's the useful paper on experiments done to see if infectious SARS-CoV-2 survives the cold chain of food distribution (it does): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529092

And this is the New England Journal of Medicine letter that introduced the experiments I refer to on viability of the virus on surfaces (it was also the first high-quality study to show that the virus maintains infectiousness in the air for HOURS -- unfortunately it didn't let the testing time run long enough, so all we knew was it was *at least* three hours. But at the time, when a lot of people still didn't believe it was airborne at all, that was newly verified information.): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121658

2020.12.24

WHAT YOU NEED TO KNOW RIGHT NOW  ABOUT THE VACCINES


***THIS RIGHT HERE is the thing you need to know about covid-19 today BECAUSE IT REALLY REALLY MATTERS.*** 

Even if -- ESPECIALLY if -- you're sick of hearing about it and you're ready for things to go back to normal. 

You already (I hope) know that coronaviruses are viruses that people catch over and over again, and that immunity to them is only temporary after infection. People can, and do, get re-infected with covid-19. Plenty of evidence on that.

BUT HERE'S SOMETHING YOU PROBABLY DIDN'T KNOW, AND EVERYONE NEEDS TO BE AWARE OF THIS: 

There's a thing called "sterilizing immunity" and it's the thing most of us think all vaccines do -- prevent vaccinated people from getting infected with the target disease and therefore prevent them from transmitting said disease. 

(The measles vaccine is like that. Vaccinated? Great! That means you can't get infected with measles because essentially your body knows how to neutralize the virus and therefore you can't infect anyone else with it either. Huzzah!) 

But there's a different kind of "immunity" vaccines can confer instead, in which one is effectively immune from (or, at least, at MUCH lower risk of) severe disease, but can STILL BE INFECTED by the virus -- and even be passing it along -- without showing any signs of being infected. 

So there's sterilizing immunity (like the measles vaccine), and then there's infection-permissive immunity. The former means we can get rid of a disease entirely if we vaccinate enough people ("herd immunity"); the latter means we're still spreading the disease around, it's just not killing us at so high a rate because being vaccinated has made our bodies more ready to handle it. 

The latter is what we're getting from the current covid-19 vaccines.

Data from covid-19 vaccine trials suggest the current vaccines confer at best partial sterilizing immunity.

That is, the vaccine doesn't teach our bodies how to completely neutralize the virus such that it doesn't infect us and we can't infect others. Instead, it helps our bodies recognize the virus and learn how to respond so we're much less likely to get a severe infection.

And that's totally excellent and super helpful -- but it's not the thing most people think these vaccines are doing. 

Asymptomatic infections are not necessarily prevented by the covid-19 vaccines: Covid-19 infection was detected AT THE SAME RATE among standard-dosage recipients of the Astra Zeneca/Oxford vaccine as in the placebo group, and at more than 40% the rate of the placebo group among those receiving the lower dosage. Presumably that means they'll go with the lower dosage -- because it resulted in fewer infections -- but the core problem remains: a significant number of the people who get the vaccine will still be able to get infected with covid-19, and potentially pass it along. 

I want to be super clear about this -- the vaccines are VITALLY IMPORTANT because the data show that they very effectively reduce the risk of serious (hospitalization-level/deadly) infection, which is a great leap forward. And make no mistake: Sky-high rates of vaccination across the whole population (not just the most vulnerable, but all of us) are extremely necessary to help ensure our hospitals don't overflow AGAIN next winter. (Hopefully.) 

But the trial data indicate -- as was predicted this summer by plenty of well-informed scientists -- that many people who get the vaccine (including people who were previously infected with covid-19 sometime prior to getting the vaccine) will still get infected and likely be able to transmit the virus. 

And we need to be very mindful of that fact, NO MATTER HOW TIRED OF COVID-19 WE ARE. 

This means that just because you got the vaccine doesn't mean you can't transmit the virus, and just because your friend got the vaccine doesn't mean she can't give the virus to you.

So get vaccinated as soon as you can, and encourage everyone you know to do the same, and be sure to get your second dose exactly as directed, exactly the right number of days later. But keep wearing the mask and distancing because the unvaccinated will still be at significant risk of severe illness and death.

And since we don't have longitudinal data yet to say exactly how long the vaccine protects us from severe disease (hopefully a very long time, but we don't know that yet), we need to keep up the safety precautions for the foreseeable future. 

Here's an excellent overview of the data I'm referring to and a very accessible explanation of why this point about sterilizing immunity really really really matters:

https://dalewharrison.substack.com/p/results-from-the-astrazenecaoxford

2020.12.20

Facebook, for better and worse, part 1

I posted in a private group (that shall remain unnamed) the fact that 1 in every 1000 people in America in 2020 has so far died of covid. Here's one of the exchanges that followed, with names changed to protect the dickish.

The entire exchange, verbatim, follows. To be clear, I have not changed, nor added, nor removed a single word; this exchange really happened exactly as reproduced here.
 

 

Dick: I like those odds.


Me: 1 in 1000 aren't the odds that you'll die. They're not odds at all. 

That's the number of people WHO HAVE ALREADY DIED at this point in time at which fewer than half of Americans have ever been infected even once (and you can be infected over and over again).

The odds that you'll die battling covid once you've been infected range from about 1 in 6,000 (under age 25) to about 1 in 5 (at my grandmother's age, 88). From one's mid-30s to mid-60s the odds range from about 1 in 1,000 to 1 in 50 respectively and depending on various factors. 

You know what else has odds of 1 in 50? [Meeting the standard to get into the organization we in this group are all part of, because members of said organization are the only people permitted in this Facebook group.]

...and that's BEFORE the knock-on effects: damage to heart, lungs, and other internal organs and systems that we're still learning about that for many people with take months, years, possibly decades off their lives. 

That's not just for people who get severe infection and survive, btw; MRIs and chest x-rays have shown covid heart and lung damage in patients with asymptomatic and mild-symptom covid. So odds of an earlier death overall (during infection or later down the line) than would have happened without covid are even higher than the aforementioned odds of dying from covid acutely.
 

Dick: I like those odds still! 
 

Me:  Do your parents and grandparents like those odds? 

Imagine saying this to a 75-year-old person you love: 

Pick A or B. 

A) You choose to have a 1 in 7 chance of dying in the next two months AND no matter what you will die earlier (maybe by a few weeks, maybe by several years) than you otherwise would have. 

OR 

B) You choose NOT A. 
 

Dick: Yeah Grandma is over this shit.
 

Me: Do any of you care about anyone but yourselves? 
 

Dick: No, not really. 
 

Me: Well, there it is then. You're bringing the rest of us down with you. 

There are a lot of adjectives for that, but I won't use any of them here because everyone reading this exchange is already thinking them. 

You could be making the world a better place (or at least not a worse place) and yet dragging everything down is the choice you are making. What a shame.


Dick: No, I'm bringing you up. I am absolutely sure you feel very virtuous about yourself right now.

You're welcome.


Me: That's so cynical, man. I feel deeply sad right now because your attitude is exactly what's keeping us in this situation where LITERALLY THOUSANDS of people, including our own loved ones, are dying EVERY SINGLE DAY in America.

You could EASILY make a different choice, and yet you choose to poison the world instead of plant seeds that grow into a better world for everyone.

I feel deeply sad for you, because you clearly need love and understanding that you're not getting, and are not likely to get if you continue putting out so much negativity and behaving so selfishly. And I feel even more terribly sad for America, because people with attitudes like yours are making things worse and harder for all of us.

It is my great hope that something will change for you that helps you grow into a person who cares for others and acts accordingly.

If it helps, fyi, caring for others benefits everyone, very much including yourself.

 

I've said it before and I'll say it again, you can choose whether to be a dick or, you know, not do that.

You can choose to make positive change rather than bring about death and destruction.

You can choose thoughtfulness over ignorance.

Choose wisely.

2020.12.17

1 in every 1,000 Americans has died of covid-19.

Since March.

Ten months, and we're already at more than 1 in 1,000 Americans having lost their lives to this highly contagious disease.

More than 3,500 Americans died YESTERDAY from covid-19.

And those numbers are going to keep going up for the next month at least. BECAUSE A BUNCH OF STUPID FUCKS DIDN'T TAKE THIS SHIT SERIOUSLY.

DON'T BE A STUPID FUCK.

2020.12.16

Update on those implausible P&I-but-supposedly-not-covid deaths numbers

Two months ago I looked at the CDC's weekly P&I numbers and covid numbers and was blown away by the fact that there were 121,313 deaths where P&I was listed as a factor but covid was not. Checking back today, it is still clear, and indeed even more pronounced: the number of deaths attributed to P&I but not covid (second from right column) is implausibly huge.

As explained in the post from 2020.10.14 ("A Bunch of Important Shit I Noticed from Diving into the CDC Mortality Stats"): The most reasonable explanation for the not-remotely-believable number of P&I-but-not-covid deaths (subtract the number of covid deaths {second-from-left column} from the number of P&I&covid deaths {second-from-right column}) is that many -- most -- of those deaths were in fact unattributed covid deaths.

Let's do the math, because math rules:

423,212 total P&I&covid deaths -- these are deaths that listed any or all of those three conditions (pneumonia, influenza, covid-19) as contributing factors in the death, possibly among multiple factors.

276,061 total covid deaths -- these are deaths in which covid was listed as a contributing factor, possibly among multiple factors.

Simple subtraction tells us that there have now been at least 147,151 deaths so far in 2020 in which pneumonia and/or influenza was listed as a contributing factor on the death certificate but covid was not.

{I've been up 36 hours -- will check this math when I wake up: And that estimate of deaths involving P&I but not covid is a minimum because "all deaths involving covid" (X) would include many deaths with pneumonia but not flu (P), and  some with flu but not pneumonia (F), and some with both flu and pneumonia (U), and many with neither (N). "All deaths with covid" is not a subset of P&I&covid deaths (Y); rather the two sets form a venn diagram. So the number of P&I deaths without covid is greater than (not equal to) X - Y. Specifically, the number of P&I-without-covid deaths = Y - (X  - ((X-P)+(X-F)+(X-U))) or, in other words, P&I-without-covid deaths = Y - (X-N).}

To determine how plausible that number is, compare that to the total number of deaths in the US in which P&I was listed as a contributing factor in recent years.

In 2018, 59,120 deaths included pneumonia and/or influenza as a contributing factor. In 2017, that number was 54,936. These were both bad flu years -- in 2017, the word "pandemic" was used to describe the level of influenza infections among Americans. Even imagining this year's flu is 10% worse than 2018's -- likely a significant overestimate (though this is a year that seems to like to pile on, so not ruling out an epically terrible flu season on top of covid) -- that would still only account for about 66,000 deaths legitimately related to P&I. That means the other 81,000+ deaths are deaths that were were very likely covid related in which covid was not listed as a contributing factor. If influenza is less deadly than average this year, that could mean at least 100,000 deaths so far this year have been misattributed to pneumonia and influenza.

The smallest estimate I can offer of the underreporting is by taking the total number of P&I&covid deaths -- 423,212 -- and subtracting 60,000 or so, the number of confirmed-on-death-certificate P&I deaths we'd expect to have seen by mid-December in a pretty bad flu year. That leaves about 363,000 unaccounted-for deaths. The most recent numbers (which are not what CDC has on its weekly page because death certificate data takes time to process) suggest between 308,000 and 315,000 Americans have died of covid officially, suggesting an underreporting of about 50,000 deaths.

And that doesn't even get into deaths attributed to cardiovascular disease, alzheimers, diabetes, and "unknown" that did not list covid as a contributing factor, and keep in mind that all those causes of death are up by 11%-144% this year over an average year.

It is not even remotely plausible that we have had nearly 150,000 non-covid influenza/pneumonia deaths this year. That would be the worst flu in CDC records by half (the worst two flu years in CDC records showed about 100,000 deaths, and those two flu years were more than half a century ago when modern medicine wasn't at nearly the level it is today.) The CDC knows this -- but they obviously can't make guesses and go changing what's on the death certificates, so we have to follow the excess deaths (50,000 to 100,000 more P&I deaths in 2020 than in a typical year) to get an idea of just how many covid-related deaths are going unreported.

If in fact at least 80,000-90,000 deaths are covid deaths that haven't been counted as such -- which looks pretty indisputable, since the 50k-100k number is only looking at deaths misattributed to one set of causes -- that means we are actually likely around 400,000 covid deaths in the United States so far -- or about 1 in every 800 Americans having been killed by covid. And even if we aren't there yet, we will be -- even officially. And much sooner than you think.

Officially, by the data from the death certificates, that number is still under 1 in 1,000, but it won't be for much longer -- the number of daily deaths is very much on the rise and is likely to remain high for at least the next month or two.

Source: CDC weekly data at https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm (screencap below), plus CDC wonder database query for P&I deaths as any of multiple causes of death (so even if P&I wasn't the primary cause, it was listed as a cause -- same standard as officially counted covid deaths) for full years of 2017 and 2018.

*Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction and cause of death.