What We Don’t Know About COVID-19
Two new studies bring more questions than answers.
Dave Schuler has been a fair-minded analyst of public policy surrounding COVID-19 internationally, nationally, and in his own Illinois. Two of his most recent posts are especially interesting.
He points us to Elaine He’s report at Bloomberg titled “The Results of Europe’s Lockdown Experiment Are In.” She looks at “the relative severity of Europe’s restrictions based on work done by the University of Oxford‘s Blavatnik School of Government, which tracks a range of measures and scores how stringent they’ve been each step of the way.” The findings are rather confounding.
While not a gauge of whether the decisions taken were the right ones, nor of how strictly they were followed, the analysis gives a clear sense of each government’s strategy for containing the virus. Some — above all Italy and Spain — enforced prolonged and strict lockdowns after infections took off. Others — especially Sweden — preferred a much more relaxed approach. Portugal and Greece chose to close down while cases were relatively low. France and the U.K. took longer before deciding to impose the most restrictive measures.
But, as our next chart shows, there’s little correlation between the severity of a nation’s restrictions and whether it managed to curb excess fatalities — a measure that looks at the overall number of deaths compared with normal trends.
In Europe, roughly three groups of countries emerge in terms of fatalities. One group, including the U.K., the Netherlands and Spain, experienced extremely high excess mortality. Another, encompassing Sweden and Switzerland, suffered many more deaths than usual, but significantly less than the first group. Finally, there were countries where deaths remained within a normal range such as Greece and Germany.
Yet the data show that the relative strictness of a country’s containment measures had little bearing on its membership in any of the three groups above. While Germany had milder restrictions than Italy, it has been much more successful in containing the virus.
The overall impression is that while restrictions on movement were seen as a necessary tool to halt the spread of the virus, when and how they were wielded was more important than their severity. Early preparation, and plentiful health-care resources, were enough for several countries to avoid draconian lockdowns. Germany, with better testing and contact tracing and more intensive care units than its neighbors, could afford to keep the economy a bit more open. Greece, by acting quickly and surely, appears to have avoided the worst, so far.
Emphasis mine.
Lockdowns as such are not an effective method of reducing mortality but they are an effective method of reducing economic activity. It doesn’t matter much how early they were imposed or how strict they were.
1. Lockdown measures as such do not reduce excess mortality. Despite imposing lockdown measures as early as February, Italy still suffered considerable excess mortality.
2. Confounding factors are probably more significant in reducing excess mortality than testing or contact tracing. Confounding factors include demographics, the level of health of the populace, the robustness of the health care system, who knows how many other factors, and, probably dumb luck.
I continue to believe that we should be looking more closely at Portugal’s example. They imposed their lockdown measures later than most and, initially, rather lightly, they’re opening up earlier than many, and their excess mortality has been relatively low. Maybe Portugal’s success is just a matter of being small, comparatively isolated, and having high social cohesion.
As we’ve seen from the case of Sweden, the fear created by the pandemic seems to be enough to shutter the economy with or without a lockdown.
But I agree that the severity of the lockdowns doesn’t seem to matter all that much. Possibly, it’s just because it’s next to impossible to make apples-to-apples comparisons. Portugal’s population is roughly that of the New York City metropolitan area and its largest city, Lisbon, has fewer residents than Sacramento.
Dave also points us to a report from Rachel Rettner in LiveScience titled “Antibody that inhibits the new coronavirus discovered in patient who had SARS 17 years ago.”
A person who had severe acute respiratory syndrome (SARS) 17 years ago could help scientists in the search for therapies to fight the new coronavirus, SARS-CoV-2, according to a new study from a biotech company.
The study researchers found that blood samples from this patient, who had SARS in 2003, contained an antibody that also appears to inhibit SARS-CoV-2.
Antibodies form part of the body’s immune response to pathogens. This particular antibody, which the researchers call S309, showed a strong ability to bind to and disable the “spike protein” on SARS-CoV-2 that allows the virus to enter cells, according to a statement from the University of Washington School of Medicine, which was involved in the research. Multiple authors on the study work for Vir Biotechnology, and the company is developing a therapeutic based on the study findings.
Dave’s takeaway strikes me as right:
We have a pretty good idea of which countries saw the greatest prevalence of SARS cases (China, Hong Kong, Taiwan, South Korea, et al.)
I would like to suggest that we should be prepared for the possibility that the reduction of severity in the outbreaks of COVID-19 in Hong Kong, Taiwan, and South Korea may be a result of more widespread distribution of SARS antibodies in those place than has been commonly recognized as well as the actions those places have taken in response to SARS-CoV-2. I don’t even know how you’d go about disaggregating those two factors.
We and the Europeans haven’t been willing to implement the measures that the countries mentioned above have taken to combat the virus but it’s not beyond the realm of possibility that even were we to do so we still wouldn’t get the same results.
The bottom line is that we’re stumbling through this crisis without much to go on.
That virtually every country on earth decided that some form of lockdown and social distancing were a reasonable response would seem to indicate that these were reasonable responses. And common sense would tell us that it’s less likely that a disease spread from human-to-human contact will spread if there’s less human contact.
But the fact that the severity of the lockdowns doesn’t correlate with the increased mortality numbers would seem to demonstrate that it’s just one variable in a complex equation. And we’re still discovering new variables, like prior exposure to other SARS variants.
Social cohesion looks like a key factor, which is fascinating in its own right.
I don’t agree with this statement:
Every country had *some* form of lockdown, even Sweden, which banned large gatherings and encouraged social distancing. You’d have to look at a country that completely ignored any suggested measures in order to determine what unfettered mortality would be.
Hari Seldon: I’m considering my own ignorance.
Chetter Hummin: A useful task. Quadrillions could profitably join you.
I don’t think this study tells us much of anything. The data is all over the map – reporting standards are different, testing accuracy varies, and we have no measurement of how compliant populations were with restrictions. A government ‘suggestion’ in obedient Germany may have wildly different effects than a government ‘order’ in more anarchic Italy. (Watch Germans waiting for a light at a crosswalk. Then watch Italians.) Apples and oranges doesn’t begin to describe it.
There is policy and there is what people actually do. I believe the cited study looked at policy. The level of compliance, and the kind of measures that aren’t mandated but are practiced anyway, is going to matter quite a bit.
By the way, Denmark did a serious lockdown, and Sweden did not. Denmark’s GDP lost 28% and Sweden’s lost 24%. Which suggests that the difference due to policy differences is small, and it’s the existence of the coronavirus which gives the economy the big hit, not the policy response.
Of course, the report doesn’t track compliance, lighter measured imposed in Germany and obeyed by the population vs strict measured ignored in Italy might be the reason for the observed differences.
If only one of your own readers had brought this up a week ago ;P
@Jen:
In the real world you’ll never get a perfect counter-factual. However, Japan, South Korea, and Taiwan never imposed mandatory lockdowns. They did, however, have nationwide and localized recommendations. Their excess mortality during the pandemic has been negligible. IMO that’s enough evidence to support the conclusion that lockdowns as such are insufficient. Other factors, e.g. high social cohesion, willingness and ability to do contact tracing, etc. are necessary.
But you fight a pandemic with the population you have not the population you might want.
The situation strikes me as analogous to the Great Depression. Nobody knew what to do. Keynes didn’t publish until 1936 and took some time to be accepted. FDR took us off the gold standard in ‘33. Nobody knew that would work, but in retrospect the timing and extent of recovery around the world largely depended on when each country abandoned gold.
A boss of mine once taught me a valuable lesson in project management. That if you can’t come up with a good plan, start moving in the right direction and see what develops. FDR didn’t know what would work, but he kept doing stuff. I hope we’re not going to engage in a binge of second guessing the Cuomos and Newsoms who took the best advice available at the time and acted. But that’s exactly what Trump is planning to campaign on.
Let’s assume that many, if not most, people can weather a SARS-CoV2 infection asymptomatically or with very mild symptoms (more like the common cold). If that is the case, then perhaps there are way more infections than we know. And if that is so, then people in lock down who had a mild or asymptomatic case, were not spreading it around for others to get.
We don’t know this, of course. We might, if reliable and cheap antibody testing i carried out on a wide scale. But even then, we won’t know if the mild cases were a result of a different strain of virus, or innate factors, or environmental factors, or even things like the initial viral load that infected them.
We also know that science journalism in the non-specialized news media, even when done seriously, is usually not done well. That is, regular journalists lack the background to evaluate and convey the information given them by scientists. We’re seeing this lack right now.
you’ve undoubtedly heard to exhaustion that correlation is not causation. Perfectly true. but there are degrees of correlation, and there is relevance. A lot of scientific inquiry comes form observed correlations. Therefore these are reported, when warranted. These are not even preliminary findings. They’re more like possible avenues of research. The problem is they get reported all the time in the media.
So if there is a correlation between, say, taking hydroxychloroquine and recovering from COVID-19, all this warrants is further study, eventually a double-blind controlled study, to gauge efficacy as well as the severity of side effects. It does not warrant a run on Plaquenil.
@Kathy:
There is not. In fact, there is a correlation that hydroxychloroquine makes things worse. But there are a lot of people right now trying their hardest to fool you about this, so don’t fall for the con.
@gVOR08:
Well, the big issue here would be…how do you knows you’re moving in the right direction? At least initially?
I’m not being facetious. There’s a reason the saying “the road to hell is paved with good intentions” has been popular for so long. Sometimes what seems, at first, like the right thing to do turns out to have been the worst thing–in retrospect.
Tomorrow will make 11 weeks that Katherine and I have voluntarily isolated. Since then there have been a total of three trips to CVS and one to a bank, all gloved, masked and followed up by cleaning.
The only possible disease vectors are deliveries, and we have a number of ways of dealing with that.
So, for lockdowns to make no sense at all you’d have to posit that we would be exactly as safe from infection if instead of staying home we hung out at the mall, took in a comedy show and had drinks at a crowded bar. Does that make any sense? Obviously not.
@Dave Schuler: True, but those countries were also at the forefront of the SARS epidemic years ago (so some degree of institutional memory), are fairly homogeneous populations, and were better at testing and isolation.
We’ll never have a pure comparison, so I’m wary of drawing a conclusion that lockdowns don’t matter. They may well be necessary for less-compliant and more diverse populations.
@Stormy Dragon:
I know.
That’s another problem with correlations. if the initial sample size is small, you can’t tell how strong the correlation is. This is also why anecdotal evidence is not taken very seriously. Say a person with cancer drinks cinnamon tea every day, in addition to following conventional treatments like Chemotherapy. They get better, the cancer goes into remission, and years alter they are still well and still drinking a cup of cinnamon tea every day.
Can you say whether:
1) the tea cured them
2) the tea made the chemotherapy more effective
3) the tea had no effect
4) the tea made the patient feel better and that helped the immune response
5) the tea helped the patient sleep well and that helped the immune response
6) the tea inhibited the chemotherapy but not enough to effectively treat the cancer
7) the tea inhibited the immune response but not enough to effectively treat the cancer
8) the tea actually made things worse, so the patient took longer to recover
And who knows what other possibilities, most of them not mutually exclusive with others.
So that’s not even a correlation.
If it had been ten patients, maybe there’s something. As cinnamon tea is harmless, you may try to get other cancer patients to drink it and record their progress. Then you may find a correlation.
One question I have is that (for example) Italy imposed the first lockdown, precisely *because* they were the first European country hit, and they were hit hard. By the time that they imposed the lockdown I believe that that disease was already widespread.
I also think that it was similar in Spain.
@Jen:
Yes. It’s also a favorite observation of Dave’s over the years. What works in Sweden won’t likely work in the United States, because we’re not Swedes. But it might work in Minnesota!
@Michael Reynolds:
Absolutely. But the takeaway is the same: the lockdowns per see aren’t the key variable.
@Jay L Gischer:
Agreed—and noted in the post.
@Stormy Dragon:
I try to scan the Open Forum comments but don’t always get to all of them. Especially when Steven or Doug posts them and I don’t get them emailed to me.
@Mu:
Yes—and the report acknowledges as much. But, if we’re studying policy rather than behavior, that doesn’t much matter.
@gVOR08:
Oh, we agree. As noted in the OP, “That virtually every country on earth decided that some form of lockdown and social distancing were a reasonable response would seem to indicate that these were reasonable responses.” Muddling through is the only option when we don’t know that much.
@Michael Reynolds:
Sure. But that would always be true. And you’re doing those things of your own accord, not because of a lockdown.
Again, my takeaway isn’t that lockdowns, social distancing, and all the rest weren’t good ideas. Rather, I’m interested in why they’re not having similar results across the board.
Look, there were two options: stay home, or the have the government tell you to stay home. There was never any third choice, like a secret trick to keep the economy growing at 3.5% ALL while stopping the spread of Corona. In certain cases–NYC, for example–the two options happened way too late, and in other cases–Germany–the choices happened in a place that had good health care and a reasonable attitude to handing out money to those at home.
All of this hand-waving is pointless, and basically an admission that nobody against lockdowns has any idea of what to do other than Trump’s option, which is simply to play on the resentments of white people and lie, lie, lie.
@James Joyner:
Unfortunately this study doesn’t tell us anything actionable. We’re comparing apples and oranges, lockdown in country A may not be at all similar to lockdown in country B. All we really can be sure of right now is that it remains inescapably true that minimizing exposure minimizes infection. Whether that minimization of exposure is via individual common sense or government fiat, it is impossible to argue that isolation has no effect. And whether the lockdown is purely voluntary or imposed, we have no reason at this point to conclude that the economic effects are any different.
Before this study it made sense to isolate. After this study it makes sense to isolate. How we best achieve isolation is the issue.
Another factor to consider is how many people per country reduced their time outside, stopped going to bars and theaters and restaurants, started working from home, etc. before any lock down was adopted or even any schools closed.
I noted before that traffic in Mexico City started going down weeks before the official lock down, for instance.
I wonder, too, how diligent people are about washing their hands. My assumption is that 99% of the time, all you’re doing is drying out your skin and washing away harmless dirt and common bacteria. Maybe it’s even 99.999% of the time. Few people complain about this or refuse to do it.
Is hand washing ineffective? Does it help at all? it should help that 0.001% to 1% of the time.
@Stormy Dragon:
Funny, a search of clinicaltrials.gov for “hydroxychloroquine” returns 441 results. That is 441 clinical trials investigating the use hydroxychloroquine. Only 199 of them list Covid-19 as the condition being investigated. One Belgian study is looking into the impact of hydroxychloroquine on appetite suppressant in overweight women.
Apparently, the global medical community does not see this “danger” of hydroxychloroquine the media are hyping as they are investigating it for use in many non-life threatening conditions.
The VA study often touted, was not a study, but a records review and provide few details like dosage used or course of treatment in the patients used. It did focus on patients in extremis and does indicate that hydroxychloroquine is not a “Miracle Max” drug, i.e., can’t bring back those mostly dead. Likely because at that stage provoked immune response/pneumonia is the threat not the virus. The records review offered nothing as to the efficacy of hydroxychloroquine before a patient is in near-death ICU critical condition.
The esteemed Mr. Schumer wrote:
SARS1 is really deadly, and doesn’t have a lot of people without symptoms. And there are few mechanisms to transfer antibodies from one person to another — mother’s milk may do so, but to the best of my knowledge the adults in these countries are not regularly drinking mothers’ milk.
There aren’t so many SARS1 survivors to make a large difference in antibodies at a national scale.
It’s far more likely that government and society experience with SARS1 made them much more likely to respond effectively (at both a government and individual level). They wear masks when sick. Thy don’t consider masks to be a violation of their “I got rights!”, etc.
@Kathy:
I do 20 seconds, dry with paper towel, then do hand sanitizer. I’m reasonably confident that this dramatically reduces the presence of any virus. But washing is only the second line of defense, the first is to avoid exposure.
@JKB:
You are so right. You know what else is approved for a wide variety of uses? Bleach?
Have you had a cup, yet?
@JKB:
Quinine was first used to treat malaria in the 1800’s, and is on record as being used as early as the 1600’s in Rome. When I lived in Indonesia as a kid, I took quinine weekly as a preventative. Chloroquine is a synthetic derivative and has been around for decades. The risks are very well known, along with drug interactions. This isn’t a new thing at all. Here’s drug interaction information, including 60 with serious reactions:
https://www.drugs.com/drug-interactions/hydroxychloroquine,plaquenil.html
@Michael Reynolds:
Moreover, Korea isolated/quarantined and provided food to those in quarantine so they didn’t have to figure it out themselves or leave to get it. In the US: miles-long lines at food banks (and polling sites). It’s not even apples and oranges: it’s apples and chunks of bauxite.
@JKB: “Results from two new studies, including the first randomized controlled trial, are providing further evidence that the antimalaria drug hydroxychloroquine may not help COVID-19 patients.
The two studies, published yesterday in BMJ, found that, when compared with standard treatment, the use of hydroxychloroquine did not increase the likelihood of virus elimination in Chinese patients with mild-to-moderate COVID-19, nor did it have any effect on reducing admissions to intensive care or death in French patients with more severe illness. Both studies also found a higher rate of adverse events in patients treated with the drug.
The authors of both papers conclude that the results do not support the continued use hydroxychloroquine in these patients.” ETA: URL https://www.cidrap.umn.edu/news-perspective/2020/05/studies-find-further-lack-covid-benefit-hydroxychloroquine
@CSK:
That is indeed an issue. I talked of FDR and the gold standard. Hoover thought maintaining fiscal integrity was the right direction.
This is basically the common criticism of Utilitarianism, that you can’t know what’s best for the greatest number. But in practice, this doesn’t seem to be much of a problem. Obamacare is far from an ideal health insurance scheme. But it’s clearly an improvement, and it’s more or less as good as we can realistically get. So move ahead.
I’ve characterized conservatism as the philosophy of “but”. “Obviously we need expanded unemployment insurance due to the pandemic, BUT we can’t have a few working people make more on UI than if they were working.” Note that “for the greatest number” is an inherently liberal framing.
In a work setting, if I know we need more testing capacity, but I don’t have the budget, I can still look for my next non-lab hire to have a little lab and design-of-experiments experience.
I recall someone in these threads saying teleological ethics can’t work because unlike deontology, it doesn’t give you a set of rules. I didn’t, but should have, replied that maybe that’s just the way the world is. It doesn’t offer certainty. You make your best estimate, then you pays your money and takes your chances.
Now, people with evil intent apply the same project management rule. If you can’t declare dictatorship, you keep appointing sycophants and Federalist judges and hope for the worst. So politically, the moral is, vote blue, no matter who.
@Gustopher:
Antibodies can be transferred from person to person using blood plasma. This si being done as treatment for COVID-19 patients, with plasma from recovered patients. I don’t know how effective it is.
Antibodies are proteins, shaped to fit over parts of invading pathogens. This renders such parts ineffective, so viruses can’t use them to enter cells or to reproduce if they do. These proteins can be cloned/produced in a lab, and administered to other people. Some drug companies are doing this kind of work.
Antibodies are not the whole of the immune response. there are cells that consume pathogens, cells that kill infected cells, and a great deal more (it’s a work in progress, over 3 billion years in the making), including cells that remember how to make antibodies or what kind of cells to kill.
@Gustopher:
That’s certainly possible, too. I don’t know how to quantify that.
@Blue Galangal:
JKB isn’t aguing for the efficacy of hydroxychloroquine, his goal is to prove to the credulous that his cult leader isn’t a blabbering idiot.
He is using science (badly) when it suits his agenda and disregards it when it doesn’t.
But since he has no shame, it doesn’t matter when you point that out.
Instead of showing some intellectual integrity, he’s just a servile, little man seeking to please the object of his affection, no matter the circumstances. In a sense, he is the ultimate cuck (as the uncool kids say these days).
He calls that freedom, I believe.
DS does not appear to be the sharpest tool in the tool shed. The article says that “lockdowns” didn’t impact mortality rates but early awareness and preparation did. And what did early awareness and preparation consist of? Effective de facto lockdowns. To be sure, because of the nature of the disease, it is truly hard to compare countries or even regions; but once thing is clear: whether you get sick or not depends a lot on virus load and SD serves to reduce exposure to viral load. The more stupid thing DS said, without any shred of actual evidence is that maybe Sars spread more than we realized. Maybe it did and maybe all these pig and bat and pangolin viruses floating around created some type of herd immunity in China or maybe it didn’t. And that’s the point-blind speculation can only take you so far which is not far at all. To say a disease with an estimated 15% CFR has spread all over China without any empirical evidence is actually very ignorant.
@JKB: Thanks. Now tell us why it’s a good idea to drink bleach!
@Kathy:
I meant as a normal thing that just happens in society and would provide a pre-existing layer of protection.
As far as I know, there are no popular blood cults in Korea, Thailand or Hong Kong.
@Gustopher:
This may all come down to the prevalence of vampires.
@JKB:
Do me a favor. Go look up the words “contraindicated” and “drug interaction” then come back to try again.
Since you won’t and we may have readers/lurkers unfamiliar with the terms, contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient. A drug interaction is a change in the action or side effects of a drug caused by concomitant administration with a food, beverage, supplement, or another drug. In other words, just because something works for one thing doesn’t mean it will work in every case or is a good idea to use in every case.
People complaining about the warnings of Hydroxychloroquine being dangerous are deliberately missing the point that it appears to be dangerous to those affected by COVID-19. Yes, it treats specific things and is safe for things it’s approved to treat. Yes, it can be theoretically used to treat things we’ve never tried to use it to treat before so medicine will try if they suspect a chance of success. *NO*, all available data shows it makes COVID-19 symptoms and mortality rates *worse*. The anecdotal evidence of it working is just that, anecdotal. It’s not been reliably reproduced or it would be common knowledge EVERYWHERE. Meanwhile, you rack up a ton of negative side effects that aren’t worth it.
The only reason this is still getting pushed as a miracle drug is due to Trump. He’s trying to make money off it and will push, push, push a bad product regardless of facts. The entire world is affected by this disease so if this drug could really help, there’s a major reason to get it going. Where’s the proof 3 months in that it works? It doesn’t. It really doesn’t, no matter what His Orangeness tells you.
@Dave Schuler:
We can quantify the effects of that though, if not the motivation — date of monitoring for new symptomatic people, and days from first detected case to routing testing. Maturity and effectiveness of contact tracing should also be considered.
And you will see that the SARS1 countries tended to respond to the threat faster, recognizing it as a real threat. While Europe assumed it just couldn’t happen there, and it was a few isolated cases that would remain isolated without any actions.
Curiously, the Ebola countries ramped up their existing contact tracing systems, and haven’t been the disaster that we would have expected (yet). And we know that’s not a matter of temperature, as Brazil is a mess.
Does everyone understand the depths of Trump’s cynicism? He will continue doing as little as he can get away with because doing anything means bearing responsibility. And he’s running on claiming success AND on doing nothing. He’ll declare victory whatever the numbers and and take credit for any good thing that manages to happen. In October he’ll announce that Warp Speed has delivered a wonderful vaccine, the best vaccine, which we’ll all see tomorrow. Or maybe just after the election. And whatever shape the economy is in, he’ll claim victory. Against fierce opposition from the Deep State and Blue state governors he singlehandedly restored prosperity and freedumb by not making you wear those socialist masks, which he provided by the billions and if you can’t find one it’s Obama’s fault.
And the base will eat it up.
@KM:
At this point, Trump believes it.
I think Trump is just looking for an easy solution, and not looking very hard. He’s looking for an easy solution for looking for an easy solution…
@Gustopher: Agreed.
I have pushed back hard on friends who said that Trump was likely profiting in some way by pushing hydroxychloroquine. It didn’t–and still doesn’t–make any sense to me because it’s been off-patent for decades. It’s readily available and inexpensive. I think he just wants a magic bullet to take care of things.
@JKB:
Same site lists 3,489 studies involving morphine. That doesn’t mean it’s safe for us all to start injecting heroin.
I have no doubt that many of the things done to control the spread of the virus are going to be found to be ineffective. Closing schools seems like something obvious, but Kevin Drum cited a study that closing schools actually results in more cases rather than fewer. It’s one study, but if that holds up then do we open schools?
I personally doubt the effectiveness of masks, especially the way I see a lot of people using them (covered mouth, exposed nose). But I wear one (covering nose and mouth) because I don’t know that they don’t work. They might, so wearing one seems sensible.
What I take from Schuler’s article is that reduced social contact is equally effective whether achieved through government mandate or through individual action. Which specific behavior changes have caused the greatest reductions is still a question for examination.
Edit: Link to Kevin Drum’s post https://www.motherjones.com/kevin-drum/2020/05/school-closure-vs-restaurant-closure-which-is-most-effective/
@Jen:
Actually, Trump wants more than anything else to prove the experts who said hydroxychloroquine is bad for you wrong. He always has to be right.
My last three comments on the Open Forum have gone into moderation. Could someone address this?
@Jay L Gischer:
Interestingly, Japan has fallen into a recession despite not having locked down, instead depending on masks and other less-severe measures to achieve an astonishingly low death rate. So, even with no lockdown and a low death rate, they got screwed.
However, Japan’s economy was troubled pre-COVID.
@Stormy Dragon: Fun Fact: Heroin was developed by Bayer as a morphine safe enough for children.
It was named Heroin because it made children feel like heroes.
@KM:
Yes and no. Patients taking this drug for lupus, RA, et al. have to get periodic exams and tests to ensure it’s not blowing out their internal organs.
The same thing goes for a drug I take called letrozole. It prevents breast cancer recurrence and is generally considered safe for that purpose. However, I need to get regular blood tests to ensure it’s not blowing out my internal organs or screwing up my blood cholesterol too badly.
I don’t care if morons pop hydroxychloroquine and fall over dead as a result; they’re not hurting anyone but themselves. I am angry that patients who actually need this drug for lupus and RA are having difficulty finding it because the feds are hoarding it.
@Jen:
I agree. This drug is dirt-cheap. He’s pushing it because he wants everyone to think there’s a silver bullet to cure COVID.
Hell, if enough can be manufactured that lupus & RA patients don’t have trouble getting their scripts filled, we can sell this crap OTC for all I care. Let the Branch Covidians pop these pills like candy and kill themselves. At least suicide by pill doesn’t involve taking anyone else with you.
I still agree with what was said on the other thread; at some point, you choose to be this stupid and ignorant. If you truly think this drug is harmless, there’s no hope for you. Just make enough for everyone and sell it OTC. I don’t have to buy it, and I won’t, because I don’t take medical advice from newsreaders.
@Gustopher:
Breast milk, as you noted, may do so. Blood transfusions for sure. perhaps blood product transfusions, like platelets or plasma, perhaps bone marrow transplants. I don’t know whether drinking blood would. Proteins do survive their trip through stomach acids and absorption through the intestine (otherwise why consume protein at all, yes?), but I’ve no idea if then they’d go where they should.
All that is very limited.
But this gives rise to a thought, though not a relevant one to this thread. Look in the open forum.
When I post a link, I get tossed into moderation, so I’m just going to say that Will Sommer has an interesting piece in The Daily Beast about the lengths Cult45 is going to in order to get its hands on hydroxychloroquine. Apparently there’s an appetite for homemade hydroxy: QAnon recommends steeping fruit rinds.
@Kathy:
This is only the first part of it.
Scientist explains via simplified language and/or analogy/metaphor.
Audience uses pedagogical tools designed to explain complex subjects to non-specialists as accurately descriptive of the subject itself.
Audience extends the teaching tool beyond it’s purpose; those extensions are often invalid.
See: widespread misunderstanding of Dawkins’s concept of the selfish gene.
@Kari Q:
The Reynolds response to Schuler is appropriate, and likely correct.
Comparing Germany and the East Asian countries cited by Schuler to Italy or the US is inappropriate, because the cultures have much different attitudes toward authority and responsibility to each other.
@CSK: Oh for heaven’s sake.
They’d be better off drinking tonic water, if they can find a high-end brand that still uses quinine. At least they are getting some vitamin C? Seriously, what in fruit rinds are they trying to isolate, the tannins?
I wonder: Are the Trumpkins who are rushing to obtain hydroxychloroquine and ingest it doing this because they think it will protect them against the disease, or because they want to demonstrate solidarity with and love for Trump, their cult leader?
Dave Schuler doesn’t seem to understand statistics. He’s comparing apples and oranges. About the only thing we can (cautiously) state is that it may not really matter what sort of lockdown you have, but that you really should have one. If Schuler really thinks that lockdown has no effect, he should take a look at what is going on in Brazil, where we have a real kook of a president, no lockdown, no equivalent of lockdown, and COVID-19 wildly uncontrolled. (I suspect that by July Brazil will have had more deaths from COVID-19 than the US–if the statistics ever get out.)
(By the way, some of the QAnon loonies are squawking about drinking tonic water in order to get “quinine against the virus.” Snopes several years ago pointed out that in order to get the recommended dose against malaria from tonic water you’d have to drink 25 liters per day. Which means over 8000 calories from the tonic water alone. Drink up, guys!)
@Stormy Dragon: I don’t think that Kathy’s comment represents “falling for it” as much as it represents frustration that her relative is having problems finding enough Plaquenil to treat the condition it’s prescribed for because Mexican versions of MAGAots are binge buying.
Relative to conclusions on lock-downs and effectiveness, it seems to me one must compare Like to Like and not abstract away from socio-demographic.
For example, in the case of the Nordic countries, comparing Sweden to UK does not help a great deal given large differences (never mind Sweden with France or Spain).
However, if one compares Sweden to fellow Nordics with highly similar culture, democragrphics, socio-economics in general, one has a comparison point that makes sense on impact of measures or not, as you have in these cases about as good “control” for socio-economic factors as one is going to ever get in the real world.
Secondly it is rather nonsense (although typical of the dear interlocutor as I recall him from the wonderful blogging days) to engage in airy abstraction from real effective implementations
This is silly. Italy as a whole did not in fact impose lockdown in February and it’s more than amply documented the incomplete and very poorly observed half-meeasures early on were observed in a typically Italian fashion (as in not). It is only much later as deaths exploded that real proper measures were taken.
As in looking at the underlying report, and living in a country which is coded high-strictness (on paper yes, in daily life as I am able to actually observe it, very dubious) drawing conclusions here is unwise relative to impact on death unless one is comparing a like to like – that is a culturally similar country where theoretical paper regs are likely to be implemented in a similar fashion (France to Italy seems fair – Spain to Italy – Spain, France and Italy for example).
@Jen:
Beats me, but one of the rinds is grapefruit, and, as you and everyone who’s not a halfwit are aware, if you’re taking some statins, grapefruit can do you serious harm.
The people I’ve read who actually take hydroxy for indicated issues (Lupus, etc) all say that even though it’s indicated and the benefits outweigh the costs, the side effects are nasty (especially gastric).
Also, this:
https://www.wisn.com/article/woman-with-lupus-took-hydroxychloroquine-for-19-years-still-got-covid-19/32605139#
@grumpy realist:
Or, at least, the equivalent of a lockdown. People staying away from other people as much as possible clearly helps. Government policy per se, less so.
But I tend to agree with Dave that, if the policy per se isn’t the biggest driver of excess deaths, other factors are likely more important. Demography would seem to be the biggest explainer but there are also cultural considerations. And the natural proximity of people obviously matters. NYC and London didn’t get slammed because they’re run by idiots but because they have massive populations packed in small spaces.
@CSK: Crazy. And yeah, I went and read the article (and noted that they referenced the tonic water idea too, heh).
@Jen:
Apparently you’d have to guzzle 25 liters of Schweppes per day for a week to get a proper dose. Again: Why are these fools doing this? To prevent disease (which it won’t) or to show their support for their disgusting cult leader, who’s probably not even taking this?
@Jen:
Fruit rinds, when soft and easily edible, are rich in fiber. I never peel apples or pears. Citrus rinds are a great source (the only source, really) for citrus zest 😉
My favorite recipe for lemonade is to quarter some limes, put them in a blender (rinds, insides, seeds and all) with cold water and sweetener, and blend away. Then strain the whole thing with a fine mesh strainer, and pour in a pitcher with ice.
I haven’t made it in years, but now I wonder how it would taste with coconut water, vodka, and some pineapple.
@Blue Galangal: The BMJ also has an article about Covid-19 leading to anti-microbial resistence. And a big reason why: people are using azithromycin (Zpak) prophylactically, since among Trump’s followers, they insist that Zpak is a necessity to accompany hydroxychloroquine.
@Michael Reynolds: @wr:
Well, given that bleach is recommended at 6-16 drops per gallon of water, I would have to drink a lot of water with the proper chlorine ppm to get a gallon of bleach. Are you saying the EPA is trying to kill people?
But neither have I used other virucides, i.e., disinfectants, such as Interferon, which is only taken internally. I did once do a course of fungicide.
Your, and the MSM’s, ignorance of the definition of a disinfectant, ie., that which kills/deactivates an infectious agent, doesn’t make your snark funny, just revealing. And quite frankly, since there is a study showing that ethanol down to 30%, i.e., 60 proof, deactivated SARS-Cov-2, I would take a drink if I thought I had gotten virus intra-orally or in my throat. Couldn’t hurt. Might need more than one, just to make sure I get enough contact time.
@Stormy Dragon:
Diamorphine, as heroin is known, is twice the strength of morphine. But that said, even morphine should only be taken as directed by a doctor. Similarly with diamorphine. Hydroxychloroquine is also a medicine that should be taken only as directed by a doctor, until such time it is approved for OTC dispensing.
No, actually they’re just telling you to drop dead…
Keep trying to spin away Trump’s idiocy…know, though, that your spin isn’t working, well, except for the rubes like you that believe such claptrap…
@JKB:
We aren’t such groveling toadies that we’ve forgotten Trump was explicitly referring to injecting bleach and isopropyl alcohol.
Despite all your self-abasement, he won’t love you back, you know.
When we compared the first half of pts we admitted vs the second half (study size 700) we found that mortality in the second (later group) was significantly reduced. I expect to see the same thing at other hospitals. So it turns out that lockdowns do have the potential to save lives. Probably strokes, kidney disease and long term respiratory complications also.
Steve
Well, given the lockdowns did not achieve the the government’s legitimate public health goals, either minimally or as opposed to not being imposed, they are an unconstitutional infringement upon the constitutional rights of the People. By definition.
That the government “experts” erred in the heat of the moment is perhaps justifiable, but the continuance of the restrictions is unconstitutional. As would any future impositions. The great failure is that the “experts” have done nothing to refine the restrictions to ones that are both effective and minimal.
@Kathy: Yes–of course. And one of my favorite lemon tart recipes uses the whole lemon, whizzed in a blender with sugar and eggs–no waste, and there’s an extra punch of lemon flavor from using the peel, which has a bunch of citrus oil in it. When combined with the fat that is in an egg yolk, it makes a very tasty dessert. Also, when you combine citrus juice with proteins (such as egg yolks, or dairy in cream) it “sets” as the acids denature the proteins (this is what happens to raw fish in ceviche).
I geek out on food chemistry, and that’s why I’m perplexed by what, exactly, home-brewers of hydroxychloroquine think they are coming up with by boiling grapefruit peels. It isn’t so much that they are devoid of nutrition, it’s that I’m not seeing the chemical similarities. Usually when you are attempting a knock-off, there’s at least some common theme/logic that goes into it.
Actually, he wasn’t explicitly referring to either bleach or alcohol of any kind. He was broaching the disinfectant topic, with a lab director who had just reported on surface and in-air disinfection results. In addition, President Trump specifically mentioned they have to bring in medical people for such research.
@JKB:
The number one goal of the lockdowns was to keep hospitals from getting overwhelmed by preventing a sudden surge of patients. With a handful of exceptions in a few parts of the country (New York, New Orleans, Gallup NM), that goal was very successful.
@JKB:
It seems you missed the memo that Trump has walked back his idiotic bleach remark by claiming it was “a very sarcastic question.”
Oh no! Humiliated again! Are you getting off on this?
Maybe you should tug that forelock some more.
@KM:
Agree with your larger point but want to make something you discussed clearer: it is safe for those things in those people who don’t get negative side effects.” I’ve taken chloroquine myself as a malarial prophylaxis and know that many people have negative reactions to it. Some of them are worth it (a night full of nightmares is better than a night full of malarial fever) and some are not (severe tachychardia requiring hospitalization and sometimes resulting in death).
@Stormy Dragon: I’m glad you responded to him. You are more patient than me. I read that and thought, “This is the quintessential Republican response. Using random facts to confuse and muddy the issue and tear down those working on the problem without offering any solution of their own. And all delivered in a tone of anger and contempt.”
@JKB:
Except that is not the conclusion. You don’t read very well, do you?
@drj:
Have some pity for @JKB, how is he to know which Trump lie is the currently operative Trump lie?
The cynic in me views Dave’s whole thesis as typical Republicanism. It is ungenerous but I’m so tired of decades of “We really can’t know what is happening and so we can’t act until we do more studies”, whether it is cigarette smoking or DDT or lead in gasoline or global warming or whatever. I’m not saying Dave is a professional Republican but the excerpt James publishes has the trappings: find out what the billionaires want (in this case, tell everyone that isolation doesn’t help so we can get the deaths out of the way quickly, before it costs them (the billionaires) too much), use your college degrees to hack together a bunch of studies and citations so as to create confusion, and then use that confusion to advocate no action. The serious, professional Republicans never come up with anything of use. They just let others do the work and try to pull them down.
@Michael Reynolds:
Well, a good servant knows the unspoken wish of their master.
So I was kind of expecting a bit more of him.
There is at least one study ongoing regarding hydroxychloroquine as a prophylactic against the Covid-19 virus that includes hundreds of front line health care workers. Unfortunately, I’ve misplaced the link. The description read like exactly the kind of serious study needed: large enough sample population, long enough time base, control vs treatment (don’t recall if it was double-blind or not). It sounds like exactly the sort of thing I would have liked to hear the president announce CDC is funding some weeks back, rather than “I’ve been taking it for 10 days now and I’m doing great!”
In an article I read today, Trump’s former employee Barbara Res was quoting as saying flatly that there would be no way Trump would take hydroxychloroquine, because he’d be too terrified of the possible deadly side effects. Res would know, since she worked closely with Trump for 18 years, first as executive v.p. and then senior v.p. of the Trump Organization.
@JKB:
Dude, we *SAW* it. We all saw it. He was stupidly musing aloud about injecting disinfectant into a human being like a drunk speculating out loud about the latest brain fart they’ve had. He was directly addressing the medical personnel on stage – even turned to address it to them! – and was serious. He wasn’t joking, he wasn’t “posing a question” as an intellectual challenge, he wasn’t trying to spark new research. He’s a moron who had a moronic thought and decided to air it on live TV. The faces of everyone around him on stage tells you what they thought about it.
His own words:
You don’t need a “medical doctor” to tell you how $^#%&%^*#$&$ stupid an idea that is and how badly it will go for you. It is *extremely* telling that bleach and other disinfectant companies *immediately* issued disclaimers because the people who make this crap are very aware how fatal that idea was. They understood what Trump said was stupid and dangerous….. why can’t you?
@MarkedMan: Ring Ding! A WINNER!
@Jen:
I’m not sure whether it’s sympathetic magic or cargo cult science.
See, quinine is derived from tree bark, fruits grow on trees, therefore you can make cinnamon tea by boiling grapefruit rinds.
Link
@KM:
Did Cult45 actually buy the sarcasm excuse?
@Monala: Dr. Hotez is giving Trump way to much credit. Trump doesn’t think or care if it’s a manufacturing problem, or a testing problem, or an alignment of the planets problem. Politically he needs to say there’s a fix coming soon, somebody told him a thing called a “vaccine” would be a fix, so he’s promising a vaccine. If somebody said a left handed deneuralizer would fix the problem, Trump would be promising us a left handed deneuralizer.
I really wish people would stop normalizing Trump by pretending he thinks or acts in any approximation of a functioning adult.
@Kathy: Thanks. I laughed out loud at that one. It’s been a long day and I needed it…
@MarkedMan:
Bingo.
@KM:
Because JKB won’t get sued by someone who ingests Lysol or Clorox but the manufacturers will?
@Kathy: Was that the first ever 3-dimensional non sequitur?
So they’re making their own kool-aid….(rubs hands together in evil genius fashion)….exxxxcccelllent. 😉
@CSK: Don’t overcomplicate it. If the sarcasm excuse upset Trump’s enemies, it met the needs of Cult45.
(ETA: But, yeah, they probably did. 🙁 )
@MarkedMan:
Unless something has changed that I’ve missed, Dave is a lifelong Democrat. You’re confusing an engineer’s effort to understand a problem in another field for a political agenda.
@Kurtz:
There are also cultural differences about personal space and physical contact. It may be my imagination, but it seems to me that countries that fall to the left end of the “bow>>handshake>>kiss-on-the-cheek” continuum have higher transmission rates.
@rachel: Ooops! Right end, not left end.
@James Joyner:
Oh, baloney. Dave’s party registration isn’t the issue. Since Trump was elected he’s been all three little monkeys: see no evil, hear no evil, speak no evil. Unless it involves speaking evil of Hillary Clinton, he’s always got time for that. Dave Schuler is just a Good German.