The Complete Scientific Guide to COVID-19

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… will be written in about three years from now. Meanwhile …

We labor under a number of falsehoods about how science works. Even scientists do. There are considerable differences among the panoply of scientific disciplines, and these are important enough that I would never trust the practitioners of one scientific discipline to, say, review research procedures or grant proposals from another discipline, by default.

These differences are even more significant outside of science itself. A common example is this one. A lay person evaluating peer reviewed research claims that a certain scientific conclusion can not be supported because there have been no double blind studies. That person may be unaware of the fact that almost no science uses double blind studies. This is a methodology used only in some areas of research. A study of earthquake hazards, genetic phylogeny of chickadees, or how long a particular virus lingers on a surface will not have a double blind methodology.

In some fields of study, a single idea will often be represented by a single major publication (sometimes a book) and will not be seen elsewhere unless it is being criticized. This is not common in the true sciences, per se, but this does happen in the peer reviewed literature. In other fields of study, a single idea may be addressed in hundreds of peer reviewed papers. In some fields of study, if a published peer reviewed paper presents a conclusion that is thought to be wrong, because of some flaw, the scholars in that field are expected to learn of this problem and thereafter avoid citing that paper. In other fields, when this happens, the paper is withdrawn from the literature after the invocation of complex rituals that might or might not involve the sounding of trumpets.

There seems to be two falsehoods affecting some of our thinking about COVID-19. One is the idea that a “study” or “publication” about some detail of the disease tells us something that we can take as fact. Yes, Covid-19 stays on a certain kind of surface for N days, therefore we can’t do X! That sort of thing. However, this research is, firstly, not peer reviewed. There may very well be no peer reviewed papers on COVID-19 at this time. This Pandemic has lasted less time that the typical peer review process takes. Maybe there are a few out there, but mostly, we are dealing with non-reviewed work, or work in review. This is good work, and important work, but it is more like a set of “emergency results” that address specific pressing questions in a provisional way.

It has been important to decide which of a small number of broad categories COVID-19 can be placed in, and the work on persistence on various surfaces has provided that rough and ready guide. There are pathogens that can find their way out of an exam room, go 20 feet down the hall, and infect a person sitting in a different exam room. There are pathogens that are so unlikely to infect another person that you practically have to lick the inside of their mouth five times to catch the disease. COVID-19 is in the in between category, where it sheds into the air and hangs around on surfaces for long enough that surfaces are found to have the virus on them. Is COVID-19 more or less surface-contaminating than, say, norovirus? Rotavirus? Nobody knows, because the research to determine that, and the publication array that would be necessary to lead to policy and recommendations about that, will take time. Someday there will be a study that looks at how much of the virus persists for how long on various surfaces, integrated with the other important question of how can the virus on a given surface actually infect a human, in order to allow for a realistic and useful statement about how to go about keeping a home, and ICU, an examining room, or a school relatively safe. COVID-19 has the potential to be the most studied pathogen in recent history, but not today.

So, that is the first fallacy: that a handful of quick and dirty, rough and ready, studies designed to get a clue about this disease constitute a well tempered and developed peer reviewed literature from which we can glean an accurate characterization of most o fhte important details of this disease. Nope.

One cost of this fallacy is the second fallacy, that we can evaluate models of either COVID-19’s behavior, or the efficacy of our reaction to it, based on a solid knowledge of the disease. That is backwards. We will eventually be able to evaluate ideas like “curve flattening” by understanding a lot about COVID-19, but that will happen after we have actually seen what various curve flattening efforts have done. A recent proposal that certain areas of the world may have seen a prior passage of COVID-19, causing some local immunity. One well meaning expert (not an actual expert) on social media responded that given the way COVID-19 operates, this is simply impossible. But that is backwards. The way we will eventually be able to describe how COVID-19 actually works is by observing it, measuring it, developing good explanations for what we see, strengthening and tempering those explanations by further hypothesis testing, replication, critique in the formal peer review process as well as the less formal but sometimes more important conversations at the conference-bar setting, and time. Time to just think. Then, we will be able to say things like “X is pretty much impossible because this is how COVID-19 works.” Now, we have an expansive void where some good theory and data will eventually reside, and the job of the scientists focused on this problem is to carefully and thoughtfully fill that void with what they come to know. To get a sense of how this works, read up on the literature that came out of the 2013 Ebola epidemic. Many key known things about the pathogen and its effects were not nailed down until months or years after the last patient was identified. These things take time.

I’m not an epidemiologist, but I play one in the classroom. Amanda and I teach a class on the immune system and epidemiology. Had I not gone into palaeoanthropology, I might have gone into this field. Excellent books on the topic include The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett (not current but mind-changing and foundational, includes some important forgotten history), Epidemics and Society: From the Black Death to the Present (Open Yale Courses) by Frank Snowden, and for a good textbook, Gordis Epidemiology.

Have you read the breakthrough novel of the year? When you are done with that, try:

In Search of Sungudogo by Greg Laden, now in Kindle or Paperback
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35 thoughts on “The Complete Scientific Guide to COVID-19

  1. A former colleague of mine at Erewhon University has – with my considerable assistance – put together a course, to be offered this summer to a select few Covid-19 survivors. I’m sorry to report that I accidentally deleted the text that went into this course advertisement poster – otherwise I’d paste it in here.

    I hope you folks derive some reassurance from knowing that it’s not just Greg Laden, but excellent academics like Professor Furrier Ehrlich who also have not yet given up on scientific education for the masses, in the true spirit of one of our mutual heroes, Thomas Henry Huxley!
    _________________________________________________
    PHIL-STAT 666: Aerodynamics of Pandemic Reasoning

    Course description:  Using a pair of dimes borrowed from the fields of epidemiology, immunology, and Cartesian logic, this course emphasizes the application of critical reasoning to various topical and tropical concerns, including acquired immunity from prosecution, infodemics, and recent advances in imaginary-real-numbers theory. Special emphasis will be placed on logical relations (inconsistency and self-defeating statements), misapplication of kin selection theory to authoritarian nepotism, and neo-Orwellian politics in the internet age.
    _________________________________________________
    Here’s the illustrated poster announcement – I hope you can all access it.
    https://drive.google.com/open?id=1zeLhszBwdaVlxcr3Ky2MLYs9Vl8Yp1OK

  2. “Amanda and I teach a class on the immune system and epidemiology.”

    Kudos to you both. I remember reading (more accurately, trying to read), years ago, an article in Scientific American on the human immune system. All I took away from it was that the immune system is horrendously complex.

    1. Thanks, Christopher, for drawing our attention to this outstanding article. Perhaps as important as the astute analysis, well-informed perspective, and valuable links it provides .. is its demonstration that critical thinking about this pandemic, in short supply relative to the general ignorance that swamps us all, is not limited to physicians, scientists, and a few progressive politicians, etc.. Philosophers – real ones, and living ones at that – have a lot to offer. (Although I suspect that they, like many of us – with respect to the American society at large – are communicating in a rather small echo chamber.)

      The author, Jonathan M.S. Pearce, besides contributing to Patheos, has his own YouTube channel, “The Tippling Philosopher,” with some excellent videos. And he is now commenting on the coronavirus daily. This one’s from yesterday:

      So yes, I find it interesting to ponder the insights provided by Patheos* – a highly respected philosophy of religion blog – e.g.,
      https://www.patheos.com/blogs/eidos/2020/03/intended-versus-unintended-consequences-a-helpful-distinction/

      * https://en.wikipedia.org/wiki/Patheos

    2. A VERY IMPORTANT POINT ABOUT COMPARING COVID-19 MORTALITY RATES

      ** HERE’S WHAT WE ALL KNOW and are talking about to death (please excuse the expression):

      • We have a pretty good idea of which countries are under-reporting COVID-19 cases, for whatever reasons

      • We know that COVID-19 testing is inadequate in most places• We know that immunological assays of antibody activity post-exposure and post-recovery are just now getting off the ground

      • We THINK we know that even in states and/or countries with sufficient testing to be somewhat informative, estimating COVID-19 mortality by dividing # COVID-19 deaths by # COVID-19 cases yields an over-estimate of mortality primarily but not exclusively because of error in the denominator. We also know that the varying magnitude of this error makes comparisons between locales only “suggestive” (depending upon your hypothesis-of-interest) – at the absolute best.
      ____________________________
      Let me provide as an example two counties I’ve been paying close attention to, among others, in Colorado: Weld County (Greeley) and El Paso County (Colorado Springs). Every few days, one or the other county in this deadly horse race surges to the lead with 6% or 6.5% mortality (# deaths ÷ # confirmed cases) – depending upon the week of the month and the phase of the moon. There is no other county in Colorado that even comes close.

      Relatives of mine, laypersons, have hypotheses ranging from “Well, the hospital care is better in City X” to “The people are more stupid – flouting social distancing recommendations – in City Y,” and so on. But the likely truth is that El Paso County, with a young (e.g., military) population but a cluster-fuck of testing screw-ups from the get-go, is yielding vastly inflated mortality figures. Meanwhile, Weld County has as its number-one employer J.B. Swift and Company – one of the largest meatpackers in the world – and (hello!) there’s an epidemic of COVID-19 among meatpackers in the United States. Partly as a result of this situation, Weld County is testing far more people than El Paso County. Voilà. (For the sake of comparison, Denver has almost 1/5 of total confirmed COVID-19 cases in Colorado; their mortality rate by the same equation is 4% – likewise unquestionably an overestimate.)
      ____________________________
      ** HERE’S WHAT WE DON’T ALL KNOW and needs to be talked about more. Talked about to death, if you will:

      • Countries differ in their definitions of what constitutes a reportable COVID-19 case – even when you test positive. In some places (U.S.), a confirmed-positive result gets you added to the statistics we’re all keeping track of and some of us input into our mathematical models. In some provinces in China, you must test positive AND have symptoms to warrant reporting; this is one of the reasons China’s numbers have consistently appeared lower than their actual cases.

      • Countries VASTLY differ in what qualifies as “death from COVID-19,” and this creates the biggest skew of all. Weren’t most of assuming that the simple equation # COVID-19 deaths ÷ # COVID-19 cases = Reported COVID-19 Mortality Rate – while clearly over-estimating true mortality in the community as a whole – at the bare minimum had a dependable numerator? That’s what I implied above. But this is not the case –

      – Most people (front-line health providers aside) who die from COVID-19 are older. And most of these patients enter the ICU with comorbidities, some of which – asthma, COPD, diabetes, hypertension, heart disease in general and cardiac arrhythmias in particular, chronic kidney disease, autoimmune disease, coagulopathy – make them pretty much toast from the time they’re put on a ventilator. (I should know, I’ll be one of them.)

      – Okay, so you’re old – and while possibly generally healthy and functional beforehand [forget for the moment nursing home residents] – let’s face it, you’re not the perfect picture of youthful vitality. And while you may only be taking four or five medications, one of these meds might affect ACE2 receptor regulation in a manner that makes SARS-CoV-2 immensely happy (a topic for an entire post).

      – You enter an American hospital via the ED with confirmed COVID-19 and an EMR with a few diagnoses already registered there. But should you, unfortunately, leave the same hospital via the morgue, well … Reportable cause of death? It will be COVID-19 (and sorry, except for bona fide forensic cases, the Autopsy Shops are closed – non-essential businesses, if you will.). After all, COVID-19 was the proximate cause of your death, right?

      In the United Kingdom, on the other hand, it is often the distal cause – your pre-existing condition (co-morbidity) which will be listed as legal cause of death. I mean, them’s the rules there – and as there has been considerable discussion of this topic in the professional and lay media, I don’t know why it’s not more widely known. (One of the ways British epidemiologists are trying to get a decent handle on the “true impact” of COVID-19 in terms of mortality is to subtract the number of expected deaths from other medical problems from the number of observed deaths in COVID-19 patients, over a given time period. This approach has many problems, not least of which is the messy reality that much of the high-risk elderly population has more than one comorbidity: how do you model that?)

      Meanwhile, once again, according to the American medical model, having your heart or kidneys conk out while on a respirator for COVID-19 pneumonia seems like a distal cause of death – after all, it’s the SARS-CoV-2 virus that killed you, even if your ticker wasn’t in the best of shape – however, this is not the way the Brits and many other countries think of it.

      Now of course, “distal” and “proximate” are by definition relative terms – and from some of your perspectives I’ve mixed them up. Never mind. (I could also invoke here the “proximate vs ultimate-causation distinction we use in evolutionary biology – which I actually think would be less confusing – even if medically speaking, non-standard usage. It’s clearer, I think, insofar as (on this small, non-evolutionary scale) your proximate cause of death would be your fatal arrhythmia, but your ultimate cause of death would be COVID-19.)
      ____________________________
      My MAJOR POINT here is simply this: As long as different localities continue to differ in their extent of COVID-19 testing; utilize different official reporting criteria for COVID-19 cases, and still different criteria for COVID-19 mortality – the already problematic product of # COVID-19 deaths / # COVID-19 cases will continue to be, at least for comparative purposes – in and of itself, useless.
      https://www.medpagetoday.com/infectiousdisease/covid19/85925

  3. Ah, the famous pump. I used to drink in the John Snow (the pub in the background) when I worked in Poland Street, long ago.

    Good article, thanks.

    1. Someone should tell Andrew Cuomo who has requested more from the Feds, and President Trump, who asked Modi for an exception to India’s export ban.

    2. Yes, the reliable studies are showing nothing. The “studies” the morons on the right are touting are studies only in the way trump is ethical — which is not at all.

      Raoult’s first stuff from France was not randomized, treatment and control groups were in different hospitals, patients in the treatment group who got worse were removed from the data (with no followup measurements), and there were inconsistencies in how the seriousness of infection was measured. There was also no analysis to see whether the treatment group outcomes were better than the control group outcomes.

      His second “research” was worse: no control, all participants has mild cases, and no end result.

      The Chinese study the ignorati cite has not been published or reviewed, there’s only a preprint.

      The drug was given for 5 days, and they report “promising results” in the treatment group. But — the trial wasn’t blinded, so staff and patients knew what was being done, influencing recording of issues (seriousness of cough, discomfort, and other issues were all self-reported by the patients, only temperature was measured by medical workers). They also used series of t-tests for analyses, with all the problems any sophomore student who has paid attention our statistics courses knows not to do.

      Add to that their initial design called for 300 subjects and they only had 62.

      Lots of other issues as well, but it all adds up to worthless.

      It might work — but a real study is needed. But given the fundamental dishonesty of the modern right wing (witness by the usual right wing science deniers here) the mere fact that some people want to use it will be taken as proof. Such amazing ignorance is on the wide scale we have it here in the US is one of the reasons we have a president who has fucked up this response from the start.

    3. Interesting how the few studies that have been carefully done, the way they are supposed to be, have so far failed to find anything worthwhile, but they are still ignored by the right.

      Interesting only in the sense that it continues to show the dismissal of science by the right in favor of their “our ignorance is just as valid as your science.”

    4. Dean, have you notified Governor Cuomo of the weakness in these studies?
      He would be wasting millions(?) of dollars providing this chloroquine that could be put to better use.

    5. Dean, you write ‘so far failed to find anything worthwhile.’
      That is not the same as a negative finding.
      Can you clarify if the studies did not find an effect, or affirmative found that the proposed treatment is not effective?

      In the former case, what Cuomo is doing is not necessarily a waste, perhaps just a ‘desperate reach’ as you put it. If the latter, then it is definitely a waste, other than to appease a mob.

    6. Someone should tell Andrew Cuomo who has requested more from the Feds, and President Trump, who asked Modi for an exception to India’s export ban.

      Why, because some unreliable agents report that hydroxychloroquine apparently treats coronavirus infection? Because Cuomo is willing to try anything that might help, even if it doesn’t, but can be controlled to minimise negative effects? Or because Trump is a grandstanding imbecile who will convince himself at some point that he invented hydroxychloroquine as a miracle cure-all (and who just happens to have a financial interest in its manufacture…)?

      There’s no reliable evidence of hydroxychloroquine’s efficacy in COVID-19 infection. Anecdotal claims that there is such efficacy are no more than a succumbing to the fallacy post hoc ergo propter hoc.

  4. First, a PERSONAL ANECDOTE, followed by an article in yesterday’s Boston Globe, in which appears this (my favorite) quote:

    “Stephenson likens the condition to sending a thousand ambulances racing down a single highway. Each ambulance might be able to help on its own, but with so many at once “you’ve clogged the entire highway and no one can get there.” At the same time, “ambulances” are headed to places where they’re not needed, like the liver and kidneys, “creating traffic jams everywhere.”
    _________________
    Early Wednesday morning, I developed a rapidly progressing upper respiratory infection – in ordinary times, this would be called a cold. Now the differential is cold-vs-Covid-19.

    Af first, my symptoms were rhinorrhea, sore throat, cough, malaise (a.k.a. general all-around yuckiness). Then a fever, then a sensation of respiratory constriction.

    I call the Brigham and Women’s Hospital Coronavirus Hotline, which takes a while to locate (even though I knew there must be such a thing) because their number doesn’t appear on their COVID-19 Information web page. Brilliance.

    Boston uses a strict triaging protocol to determine who can get tested and who can’t. But given my age and multiple co-morbidities (hell, I was on an ICU ventilator just last June!), I realized it’d be a VERY low bar for me to obtain the requisite permission for COVID-19 testing.

    But, you see, there was a problem. Massachusetts General Hospital will screen your pulmonary symptoms (thanks, but I can ’screen’ myself – I wasn’t THAT sick), but they won’t automatically test you for Covid-19, even if you seem to have it. Plus, it’s a walk-in clinic. If you can still walk. They don’t want you to take public transportation or even The Ride, our disability paratransit system.

    Meanwhile, MGH’s ‘Partners” affiliate, Brigham and Women’s Hospital, won’t examine you (unless you’re much sicker than I was), but conversely, THEY do have a drive-in Covid-19 testing set-up. But “drive-in” means just that – DRIVE in. I don’t own a car, and they won’t let you take a bus or cab. (Poor people, welcome to 2020 America.) “CATCHA-22,” as the old Italian man says in the movie.

    So I bribe a friend to drive me to the Brigham. This was Friday night, a cool drizzly evening.

    Talk about a surreal experience – as in cue the Twilight Zone music, or a scene from Alien. (I’m sure there are far better sci-fi film analogues, but I quickly forget the few movies I see.) But futuristic and dystopian, that’s how it felt.

    The streets of Boston were practically deserted (Just IMAGINE!). Driving from Cambridge, we took the zigzag off Brookline Ave. to 58 Shattuck St., the Ambulance Bay at the back of the hospital. Before we were allowed to turn into the garage, per telephoned protocol we pulled up to the curb with all car windows rolled up. My driver and I were both wearing N-95 masks.

    A young, surgically-masked and latex-gloved security guard approached my passenger-side window, and again – per telephoned instructions – I pressed my driver’s license against the windowpane. He examined it closely. He checked his clipboard. Nope – my name was not on the approved testing list.

    And so we sat … and sat … and sat. The security guard retreated to his patrol car and got an updated Covid-19 Test List from his dispatcher. Waiting in a very short queue – for like I said it was ‘a dark and stormy night’ (well, okay, I didn’t say exactly that) – we were waved into the ambulance garage, spookily devoid of ambulances.

    In one tiny corner of this vast garage stands a crew of perhaps six young medical personnel (I’m guessing prematurely graduated 4th-year HMS students drafted to the cause), clad head-to-toe in surgical caps, face shields, masks, gowns, Nitrile gloves and perhaps even surgical slippers (I couldn’t see that far down). One of them, a chipper young woman, taps on my window. Again the press-my-driver’s-license-up-to-the-inside-window-pane drill. She checks HER clipboard list.

    Finally, per her shouted instructions, I roll the window eight inches down and lower my mask to expose my nose. She sticks a long sterile Q-tip up one naris. Or at least she TRIES to. Repeatedly. Now surely this would get a normal person’s attention, but I never claimed to be normal. And I’m not paying full attention since I’m spaced out marveling at the dim blue fluorescent glow of the place. And besides this, my attention (being a medical-type person) is reflexively diverted to an obligatory perusal of the equipment and gizmos at their itsy-bitsy Covid-19 Testing Command Center in that one tiny corner of the very big garage.

    Suddenly I “come to” with a jerk and realize her Q-tip (of course it’s not a Q-tip, I’m just calling it that) is jammed because of my deviated septum. So I deliberately flare my nostrils – and in a flash, she’s up and in. Ouch, gag, cough, snot flowing out my nose. She’s happy with her sample, I thank her and roll up the window and wave goodbye. Total round trip from home to hospital and back – 45 minutes.

    Yesterday the Brigham and Women’s Hospital Covid-19 Test Results Center calls me: “You tested negative for Covid-19.” I suppose I should be relieved but I’m not. (And it’s not because of the 30% false-negative rate of our current COVID-19 tests.) I will inevitably contract the disease, and NOW is the perfect time to take my chances (= 30%–50%) of surviving in ICU, before we hit our projected peak in the next 7-10 days.

    For you see, my PhD, as the late Jeremy Knowles said at our graduation, makes me “the type of doctor who does nobody any good.” But as a Massachusetts and NREMT-certified EMT, I COULD be doing some good out there on the front lines. But I can’t do shit now (as opposed to sitting on my ass and clogging up all of Greg’s sites) – not so much because I fear “dying in battle” [can’t we please STOP using that metahor?!] –au contraire, I’d prefer dying with my boots on – but because I don’t live alone (and morality dictates that I not increase risks to others. By the same token, I can’t move out – not now, what with shelter-in-place and a state of emergency making it impossible to find another apartment.
    _________________
    Anyway, back to that article I mentioned:

    WHO GETS SICK WITH CORONAVIRUS, WHO DOESN’T, AND WHY?, who doesn’t, and why? – Although data show clear patterns of who is at risk, the occasional outlier points to an enduring mystery

    By Felice J. Freyer and Tonya Alanez (The Boston Globe, April 5, 2020)

    “Kara VanGuilder’s symptoms started one day in early March, with a cough and a vague feeling that she was coming down with something. By a week and a half later, she was running a high fever, soaked in sweat, barely able to tell night from day — shivering, coughing, weeping, praying.

    “‘That’s the closest encounter I’ve had with death in my whole life. I really was convinced that weekend that I was going to die,’ said VanGuilder, who received test results confirming COVID-19 on March 24, just as she was starting to feel better.

    “With cough and fever, VanGuilder had typical symptoms of COVID-19. But there’s one surprising aspect to her story: She is only 25 and was in excellent health, a runner training for a 10-kilometer race.

    “As COVID-19 spreads around the globe, data on those who fell ill have revealed clear patterns. Four out of five people suffer only mild symptoms. Very few children get sick. Most of those who become severely ill are old or have an underlying health condition.

    “But as with any illness, there are outliers — such as young athletes who succumb, or the Connecticut newborn who died of COVID-19 even though infections are exceedingly rare in young children.

    Such experiences point to an enduring mystery: When a virus strikes, why do some otherwise healthy people get clobbered while others skate through?

    “‘You can be perfectly healthy and this virus can kill you. I don’t think anyone has an explanation,’ said Paul F. Bates, professor of microbiology at the University of Pennsylvania’s Perelman School of Medicine.

    “The novel coronavirus arrived only in December. Before then, no one had been infected with it, and the human immune system was not primed to act against it. But some people are able to mount a fast immune response, quickly producing proteins known as antibodies, tailored to block this particular virus from entering a cell.

    “‘In some people, these antibodies develop faster than others,’ Bates said. ‘We believe that will play into whether they can fight off the virus or not. For any virus, we really don’t know why some individuals develop better responses than others.’

    “Bates’s colleague at UPenn, microbiology professor Dr. Ronald G. Collman, is investigating an intriguing possibility that might explain the disparate responses to the virus: differences in the respiratory microbiome — the collection of bacteria and fungi that naturally inhabit the throats and noses of all people. The composition of this microbiome varies from person to person.

    “Collman has started examining samples from COVID-19 patients to see if there are any patterns in their microbiomes that might explain the variability in the virus’s severity.

    “‘We’re interested in the question of whether the microbiome can influence whether people have mild disease or severe disease,’ he said. Collman is also looking at whether the microbes that get into the lungs when people are sick affect how severe their illness becomes.

    ‘Researchers also speculate that the quantity of virus particles that a person takes in all at once may also play a role in how sick that person becomes. This notion of ‘viral load’ has been posited to explain the death of 31-year-old Li Wenliang, the Chinese doctor who first recognized that a new virus had emerged, and it’s a reason why health care workers, faced with inadequate protective equipment, are especially worried.

    “But no firm data yet support this or other explanations, cautions Dr. Kathryn Stephenson, who directs clinical trials at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. ‘Almost everything is speculation right now,’ Stephenson said. ‘It’s just our best thinking with the data we have.’

    “Stephenson has a hunch that it will come down to genes: Some people may have a genetic predisposition to mount the overactive immune response that has been the hallmark of severe COVID-19 disease.

    “‘At the end of the day we usually figure out that it’s genetic,’ Stephenson said. ‘We’re born with little different variations.’

    Such speculation, though, provides no help for someone like VanGuilder, an administrative assistant at Brigham and Women’s Hospital, who has no contact with patients.

    “VanGuilder said she first started feeling poorly March 9, before COVID-19 was dominating the news reports. Two days later, she visited an urgent care center, which diagnosed an upper respiratory infection. That same day, the World Health Organization declared COVID-19 a pandemic.

    “Her fever rose to 101 and her muscles ached, she said. She started to feel a little better for a few days but on March 17 suddenly found herself shaking with fever and wracked with pain.

    “Another trip to urgent care yielded a diagnosis of pneumonia and an appointment for a COVID-19 test.

    ‘Driving to the Brigham for the test on March 20, VanGuilder could barely see through the sweat dripping from her forehead. For the next few days, she stayed alone in her Medford home, bed-bound, too weak to even sit up, speaking frequently with her primary care doctor. She had no appetite and had lost her sense of smell — an occasional symptom of COVID-19.

    “‘Water and prayer, that’s all I had,’ she said. ‘On the night of the 22nd, that Sunday night, I literally got on my knees. I don’t consider myself a very religious person, but I got on my knees and I asked whoever was out there, God, would he just help me.’

    “Whether or not through divine intervention, VanGuilder did not advance to the most scary stage of the illness.

    “When COVID-19 progresses, the lungs start to give out, unable to take in enough oxygen. The patient will feel pain or pressure on the chest, and most worrisome, shortness of breath. That’s when it’s time to go to the hospital. (The CDC recently added to its list of emergency warning signs a newly recognized and puzzling neurological symptom: new confusion or inability to arouse.)

    ‘With the flu, a secondary bacterial pneumonia is often what leads to hospitalization and death. But COVID-19 is different from the flu. The lungs start to fail because the patient’s own immune system goes haywire, leading to what is known as acute respiratory distress syndrome.

    “Stephenson calls it “an enormous inflammatory response.” The body starts “sending red alert messages everywhere” — routing attack cells to the lungs, the muscles, the organs.

    “This phenomenon, known as a “cytokine storm,” can happen in response to other infections but seems to be a key feature in COVID-19?s lethality, including among the young.

    “Stephenson likens the condition to sending a thousand ambulances racing down a single highway. Each ambulance might be able to help on its own, but with so many at once “you’ve clogged the entire highway and no one can get there.” At the same time, “ambulances” are headed to places where they’re not needed, like the liver and kidneys, “creating traffic jams everywhere.”

    “As their lungs weaken, about 10 percent of hospitalized people need a ventilator to breathe for them, Stephenson said. This buys them time to build strength and fight off the infection. Many do recover; those who don’t usually die from multiple organ failure, she said.

    “The vast majority of people who die of COVID-19 are elderly or have serious underlying illnesses. Same goes for the majority of those hospitalized. The estimated rates of hospitalization ramp up with age, more steeply as you get older: 1 percent for people in their 20s, 8.1 percent for people in their 50s, 18.4 percent for those over 80.

    “The data so far show that about three-quarters of hospitalized people have an underlying condition. Coronavirus is especially dangerous for people with diabetes, chronic lung disease or asthma, serious heart conditions, conditions that weaken the immune system such as cancer treatment or smoking, severe obesity, and kidney disease.

    “Even among those without such conditions, the risk of severe illness increases with age, because the immune system works less effectively as we get older.

    “But the news reports are replete with stories of younger people falling victim. Most young people survive, but a significant proportion need hospital care, enough to potentially strain resources.

    “A recent review of cases in the United States found that among 508 people hospitalized with COVID-19, one in five were between the ages of 20 to 44.

    “So younger people can get sick, sometimes severely, even though they are less likely to die.

    “Data from Massachusetts show that COVID-19 strikes adults of all ages, but death comes primarily for the old.

    “At least 90 percent of Massachusetts COVID-19 deaths were in people age 60 or older. Only three who died were in their 30s, and all were known to have had pre-existing conditions. No COVID-19 patient younger than 30 has died in this state, as of Sunday.

    “But despite these stark age differences among those who die, adults of any age are clearly at risk of getting sick. The number of people in the state who have tested positive for COVID-19 is almost evenly distributed among age groups over 20. For example, as of Sunday, 14 percent of positive tests were in people in their 20s and 17 percent were in people over 70. (Only 2 percent of people younger than 20 have tested positive so far.)

    “‘I think a lot of young people aren’t really taking this seriously,’ VanGuilder said.

    “Never admitted to the hospital, VanGuilder might be counted as a ‘mild’ case. It didn’t feel mild to her, but she said Friday that she’s on the mend.

    The fatigue lingered even after her fever broke; she wanted to sleep all day. Recovery typically takes one to six weeks from onset of symptoms, depending on how sick the person was. But when she awoke on Thursday, nearly a month after her first symptoms, VanGuilder sensed a hint of vigor.

    “‘I’m not feeling the most amazing I ever felt,” she said, “but I feel good enough to do my laundry.’”
    https://www.bostonglobe.com/2020/04/05/metro/who-gets-sick-with-covid-19-who-doesnt-why/

    1. Coronavirus is especially dangerous for people with … serious heart conditions … and kidney disease.

      Well that is myself in trouble should it come my way as well as being a septuagenarian.

      With younger people I ponder on the possibility of diet being a factor. Say poorly managed vegan or vegetarian diets which could lack the input of some of the essential amino acids, ones required such that the body can produce the other amino acids required for creating proteins so the body can fight the infection.

    2. “Dean, have you notified Governor Cuomo of the weakness in these studies?
      He would be wasting millions(?) of dollars providing this chloroquine that could be put to better use.”

      MikeN, I realize things done the correct way are foreign to you, but neither the facts nor I, nor doctors and others who have looked at these “studies”, give a rat’s butt what you think. Your lack of understanding doesn’t matter: none of these “studies” so far are worth the paper they’re printed on, and that’s not just my opinion.

      So yes, Cuomo is wasting a shit-ton of money on something that’s unproven. Perhaps if the shit-stain in the White House hadn’t ignored the problem from the start, had provided the support a real leader would have provided when it was needed, and weren’t still screwing with shipments to states (the feds have been intercepting shipments of equipment to different states and reselling them), Cuomo wouldn’t have to waste money like this. (Even so, it’s an asinine decision on his part.)

      The vermin you support has a big dose of responsibility for the massive clusterfuck that passes as the “response” here. I get that you don’t like facts, and don’t like responsibility, and don’t like that being pointed out. Too bad.

    3. Dean, your reply makes no sense. Why does Cuomo have to waste money?
      It’s not like he’s spending more than he needs to on this treatment because of Trump.
      You are saying the treatment itself is a waste, at any cost.
      Have you made attempts to notify Cuomo or others in his administration of this?
      As anti-Trump folks, they are likely to be receptive to such information, while the Trump administration would not listen.

    4. “Dean, your reply makes no sense. Why does Cuomo have to waste money?
      It’s not like he’s spending more than he needs to on this treatment because of Trump.
      You are saying the treatment itself is a waste, at any cost.
      Have you made attempts to notify Cuomo or others in his administration of this?
      As anti-Trump folks, they are likely to be receptive to such information, while the Trump administration would not listen.”

      Sometimes I think you are incapable of getting the point, sometimes I think it is intentional.

      “Have you made attempts to notify Cuomo or others in his administration of this?”

      Do you think Cuomo hasn’t been told by medical folks there that it is a waste? Do you think he hasn’t seen Fauci in trump’s campaign ads/virus “updates” correcting trump’s lies?

      Sometime you’ll have to explain what problem you have with facts — since you never accept them, there must be something.

      It is not a ‘treatment’ as there is no real evidence it helps. It’s a desparate reach. And yes, it is a waste of money.

    5. So in your opinion Cuomo has been told it’s a waste, but is doing it anyways as a desperate reach? Fauci has been a little circumspect, perhaps because he needs to avoid upsetting Trump. He has said there is no hard data, then he comes back and says they could do it, then there needs to be double blind testing, then that he doesn’t want to endorse.
      He has never said it’s a waste.

    6. “perhaps because he needs to avoid upsetting Trump”

      Perhaps? Haven’t you noticed trump’s habit of firing capable people when they annoy him and replacing them with his brand of dishonest butt-licking moron?

      “That is not the same as a negative finding.
      Can you clarify if the studies did not find an effect, or affirmative found that the proposed treatment is not effective?”

      thanks for verifying your ignorance. The studies that trump touts as showing this has promise did no such thing: as described, they were so bad they are worthless (if you care about things being done correctly which you and other republicans have shown you don’t).

      From people involved of a study of it in Sweden:

      Chloroquine has been given to covid-19 in several hospitals in Sweden. But last week, all hospitals in the Västra Götaland region stopped using it.

      “There were reports of suspected more serious side effects than we first thought. We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. In addition, we have no strong evidence that chloroquine has an effect at covid-19,” says Magnus Gisslén, professor and chief physician at the infection clinic at Sahlgrenska University Hospital, to the Gothenburg Post.

      He continues

      “We might have made another assessment if covid-19 was a disease with very high mortality, for example 80 per cent dead, but now we can manage most people who are intensive care anyway,” says Magnus Gisslén.

      He is self-critical that he let himself be drawn into the chloroquine.

      “In retrospect, I can regret that we did. We were a bit naive and thought the side effect profile was much better. I have changed my mind and hope that the rest of the country does too.”

      And, again, the work from France was worthless because of their lack of design and internal irregularities (remember, one of the French bits was able to claim 100% recovery because they didn’t include 4 deaths in their treatment group). Same for China.

      So yes mikeN, in spite of your steadfast refusal to try to understand why there is no evidence that it works, there isn’t any. Cuomo is wasting money.

      The fact that you are hung up on this and not on trump’s monumental series of fuckups and lies over this whole thing tells us a lot: you’re just trying to distract from how badly your people have acted and continue to act.

    7. I misunderstood your claims about the studies.
      I thought there were studies that Trump touted, and then a separate set of studies that you were talking about that found no such thing.
      Instead, is it just that the studies Trump touted were flawed, and there are no contrary studies(except Sweden in practice)?

  5. Oh fear not, Lionel … while just a (very few) years younger, I’m in the same leaky boat, medically speaking. And so, I promise, I’ll be right behind you – propping you up – until it’s my turn to drop. Just promise you’ll do the same for me.
    __________________-
    Also:

    COMING TO A HOSPITAL NEAR YOU: Rationing ICU Beds and Ventilators

    Oh fuck. It’s Italy all over again, only this time around it’s the U.S.A.

    Foreseeing this is exactly why I devoted so much effort, one month ago, attempting to translate the original Italian version of this SIAARTI document before successive online English translations appeared … followed eventually by the official English-language version released by SIAARTI itself http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf

    Why in today’s Boston Globe article are they crediting Pittsburgh as opposed to Italy, where these ethical minefields were first navigated?https://www.bostonglobe.com/2020/04/07/metro/massachusetts-officials-release-plan-ration-ventilators-icu-beds-if-need-arises/?s_campaign=breakingnews:newsletter

    I TOLD everyone this would happen here … and my biomedically knowledgeable acquaintances unblinkingly concurred. (Others – friends and relatives – accused me of alarmism and worse, said it couldn’t happen here, and looked at me like so many prefrontally leucotomized sheep.) Yet everything seems to be sugar-coated in the reality-challenged United States. Truth is rationed out, dollop by dollop, in the same way that some inoculations are administered one tiny injection at a time.

    Maybe, psychologically speaking, Trump et al. know exactly what they’re doing and why they’re doing it.

    But speaking as a grown-up citizen who would prefer that my public officials be grounded in reality and tell me the truth – for whereas they might be children, I am not – their strategy (if it even is one) is insulting and it sucks.

    1. Yeah, our leaders are neither grounded in reality nor telling the truth (nor are they ethical, moral, or competant). They are doing their damndest to screw states and the population and enrich themselve.

      @GovPritzker confirms that the federal ‘Air Bridge’ flights from China, organized by the White House taskforce, are bringing PPE back from China which are then turned over to private companies. The states then have to bid against each other to purchase from those companies.

      https://www.politico.com/news/2020/04/07/trump-removes-independent-watchdog-for-coronavirus-funds-upending-oversight-panel-171943?utm_source=fark&utm_medium=website&utm_content=link&ICID=ref_fark

      And still the right-wing lowlifes who post here will defend him

  6. “I misunderstood your claims about the studies.
    I thought there were studies that Trump touted, and then a separate set of studies that you were talking about that found no such thing.
    Instead, is it just that the studies Trump touted were flawed, and there are no contrary studies(except Sweden in practice)?”

    There is no valid evidence it helps mikeN. None. Anecdotes are worthless, but since you seem to value them, why ignore the anecdotes that it has killed people in these trials?

    And why no blame for the massive fuckup your president has made of this?

  7. I’m not an epidemiologist either, but James Annan is currently playing one and so am I.

    Here’s our joint scientific and behavioural Covid-19 perspective from (currently locked down!) sunny South West England:

    http://GreatWhiteCon.info/2020/04/covid-19-in-south-west-england/

    As a “silver surfer” myself I cannot help but wonder if all these surfers at Fistral Beach earlier today are:

    a) Resident in Cornwall, and
    b) If so only getting wet once per day, and
    c) Always over 2 meters apart

    1. … or at least cause conditions like the cytokine storms which in turn damage those organs.

      Which is how these viruses can become so deadly for those with a robust immune system — fit young people. Influenza can cause similar as happened with the 1918 influenza pandemic.

      I once read that influenza had broken out in waves, especially in the US, in the build up to the 1918 – 1920 event. I thought my source for this was ‘Catching Cold: 1918’s Forgotten Tragedy and the Scientific Hunt for the Virus That Caused It’ by Pete Davies but having revisited this is not the case. Maybe it was in the book ‘The Hot Zone’ by Richard Preston, mostly about Ebola and other haemorrhagic fevers, which I no longer have to check.

      An informative book I am reading at present is :

      ‘The Great Influenza: The Epic Story of the Deadliest Plague in History’ by John M. Barry

      The large scale farming of fowl and hogs even back in the early twentieth century was considered as a mixing ground which could accelerate the mutation of the virus.

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