Leiter Reports: A Philosophy Blog

The authority to lockdown business and quarantine people rests with the states, not the federal government...

...so the decision-maker who matters in the U.S. is your Governor not the monster-child.   See the comments on Twitter from law professor Bobby Chesney (Texas).

Timeline for various COVID-19 experimental drugs

Here.  If we're lucky, it looks like we may know more in April or May about some of them, and if we're VERY lucky it will turn out some of them actually work.

Khalidi from York U/Toronto to CUNY Graduate Center

Muhammad Ali Khalidi (philosophy of science and cognitive science, medieval Islamic philosophy), Professor of Philosophy at York University, Toronto, has accepted appointment as Presidential Professor of Philosophy at the City University of New York Graduate Center, effective July 1.    Those of you who have not read his Natural Categories and Human Kinds:  Classification in the Natural and Social Sciences (Cambridge, 2013) should:  it's an important book, one that will be recognized as such quite generally once the current metaphysical fad that has dominated discussion of "natural kinds" for more than a half-century passes, as it should!

How coronavirus progresses, day by day: mild, moderate, severe, critical, fatal

This video is circulating via Tech Insider and is quite informative:

 

Natural selection and coronavirus

A concise primer from philosopher Alex Rosenberg (Duke).

The best anti-Trump joke yet

Donald Trump, Boris Johnson, Angela Merkel, Pope Francis and a ten-year-old schoolboy are on a plane, that is going down.  There are only four parachutes.

Trump declares, "I'm the smartest person in the U.S.A., the country needs me."  He grabs one and jumps.

Johnson declares, "Britain can't survive Brexit without me," as he grabs one and jumps.

The Pope declares, "More than a billion Catholics needs me," as he grabs one and jumps.

Merkel looks at the boy and says, "You take the last one, you have a whole life ahead of you."

The boys replies, "It's OK, there's two parachutes left, the smartest man in the U.S.A. took my backpack."

Italian death toll declining

Let's hope this optimism based on somewhat less life-altering grief in the last couple of days is warranted.

"Respiratory disease" increases the risk of severe illness and death from the coronavirus...

MOVING TO FRONT FROM MARCH 13:  UPDATED

...but what counts as "respitatory disease"?   Clearly something like emphysema or Chronic Obstructive Pulmonary Disease, but what about asthma (or different kinds of asthma)?   On that, I've heard different opinions.   Does anyone know?  Links welcome.

UPDATE:  Some time in the last week, it appears, the CDC added "moderate to severe asthma" as a risk factor for "serious illness" from COVID-19.  That's obviously unhappy news for many people, but all the more reason for those with moderate or severe asthma to take extra precautions.   I note that the CDC also lists extremel obesity (BMI greater than 40) as a risk factor, probably because of the pressure weight places on the lungs, but I don't know if that's the reason.

The chart below the fold explains the meaning of terms like "moderate" and "severe":

A public health message about the coronavirus "shitshow" and dangerous "dumbfuckery"

Courtesy of Australians:

 

Journalistic report: many of those infected with COVID-19 lose their sense of smell and taste

This is curious:

Anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, have emerged as peculiar telltale signs of Covid-19, the disease caused by the coronavirus, and possible markers of infection.

On Friday, British ear, nose and throat doctors, citing reports from colleagues around the world, called on adults who lose their senses of smell to isolate themselves for seven days, even if they have no other symptoms, to slow the disease’s spread. The published data is limited, but doctors are concerned enough to raise warnings....

The British physicians cited reports from other countries indicating that significant numbers of coronavirus patients experienced anosmia, saying that in South Korea, where testing has been widespread, 30 percent of 2,000 patients who tested positive experienced anosmia as their major presenting symptom (these were mild cases)....

“Almost everybody who is hospitalized has this same story,” said Dr. Marco Metra, chief of the cardiology department at the main hospital in Brescia, where 700 of 1,200 inpatients have the coronavirus. “You ask about the patient’s wife or husband. And the patient says, ‘My wife has just lost her smell and taste but otherwise she is well.’ So she is likely infected, and she is spreading it with a very mild form.”

Most readers do not yet know anyone with COVID-19

That's one takeaway from the poll tacked on to a post yesterday (Sunday):  68% (of about 350 respondents) report that they know of no friends or acquaintances who have COVID-19, while 22% know 1 or 2 people, 9% know 3 to 7, and 1% know ten or more.   Sadly, these numbers are likely to change dramatically over the next few weeks.

A list and description of treatments and vaccines in development

An informative description of what's being worked on.

Visa problems for foreigners teaching or studying in the U.S.?

A young philosopher writes:

I hope you’re staying safe. I want to thank you for your coverage of the pandemic, which has been immensely helpful to us all.

I also wanted to bring attention to a related issue. The pandemic is creating additional problems for foreign faculty and students on visas. Many visas have residency requirements, and some of these have not been updated or had exceptions made for them in light of the pandemic. Because of this, some are finding that in traveling to safer places, or failing to travel back to more dangerous ones, they are at risk of losing their visas and therefore their employment.

If it helps, let me illustrate this issue with my own example. I am a [non-US] citizen who is (was?) a lecturer in the philosophy department at [U.S. research university] on a J1 visa (for short-term, international scholars). Because of the pandemic, I found it advisable to return to [my home country]. I informed the university and department of my intention to return to [my home country], which I did. A day later the university terminated my employment for ‘voluntarily violating my visa’, in particular the residency requirement. I will no longer be getting paid this term, and my courses and students are now in jeopardy (the university has still not informed them of the change, as evidenced by their continued emails to me, and online lectures are slated to start Monday morning).

In discussing this with other international faculty, at [my former U.S. university] and elsewhere, it has become clear that many are deciding to withhold certain information from both the administration and the department. This so as not to jeopardize their visas and employment. I am hoping that you might be able to bring attention to this issue and prevent others from jeopardizing their own employment or studies.

This the first I've heard of this, but my guess is others are in similar binds or having similar problems.  IF any of my law readers know more about the visa rules, please weigh in.  Links and advice from those with relevant experience are welcome.

Three senior hires for Wash U/St. Louis: Copenhaver, McGrath, Watson

The Department of Philosophy at Washington University, St. Louis has made three senior hires:   Becko Copenhaver (early modern philosophy, philosophy of mind) from Lewis & Clark College; Matthew McGrath (epistemology, metaphysics, philosophy of perception) from Rutgers University, New Brunswick; and Lori Watson (political and legal philosophy, feminist philosophy) from the University of San Diego.   After last year's senior losses (John Doris, Julia Driver, Roy Sorensen), these new hires should preserve Wash U's place in the U.S. overall top 25-30.

(Thanks to Jon Kvanvig for the information.)

I'm falling behind on e-mails, but thanks to all who have written

I am glad so many have found my attempt to sort through the news and information related to the coronavirus useful (traffic has been very high--up 40% since February, and while traffic usually goes up in March, not by this proportion--and thanks especially to all those who have written, I'm trying to acknowledge all those e-mails slowly--one philosopher said I was the only source of "unbiased" news he had found [at best, I'm a source of reasonably objective and sensible news moderation and aggregation, and I'm openign comments a lot for corrections]).  I probably won't be able to keep this up, but will try to share the most helpful items going forward.  Good wishes to you all!

Don't go to the hospital, unless you must: a warning from Italian doctors

Doctors need to read this, but so do possible patients; an excerpt:

“Western health care systems have been built around the concept of patient-centered care,” physicians Mirco Nacoti, Luca Longhi, and their colleagues at Papa Giovanni XXIII Hospital in Bergamo urge in a paper published on Saturday in NEJM Catalyst, a new peer-reviewed journal from the New England Journal of Medicine. But a pandemic requires “community-centered care"....

“We are far beyond the tipping point,” Nacoti and his colleagues write. With 70% of ICU beds reserved for critically ill Covid-19 patients, those beds are being allocated only to those “with a reasonable chance to survive,” as physicians make wrenching triage choices to try to keep alive those who have a chance. “Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact,” they report....

To have any hope of avoiding that disaster in the U.S., the health care system needs to decentralize and make the community a focus of interventions on a par with patients, said Cereda, a graduate of the medical school at the University of Milan who has been in touch with colleagues in Italy....

One such step reflects the finding that hospitals might be “the main” source of Covid-19 transmission, the Bergamo doctors warned. The related coronavirus illness MERS also has high transmission rates within hospitals, as did SARS during its 2003 epidemic....

Although doctor house calls seem as prehistoric as rotary phones, home-based care for Covid-19 patients may be necessary in order to protect the community even if, to an individual patient, hospital care might be more effective....

Things "get real" (i.e., personal)--plus get an oximeter if you can

In just the last 24 hours, I've heard from a colleague in Boston whose wife (also an academic) has COVID-19 (he does not have any symptoms yet), and from an academic couple in New York City, both of whom have it.  One of the latter made a good suggestion on Facebook:  it's helpful to have an oximeter at home:  you put your finger in, and it gives you your pulse and, more importantly, the oxygen saturation in your blood.  Normal results are 95 or higher, but you should figure out your own baselines once you get one.  We bought the Zacurate Pro Series 500DL Pulse Oximeter from Amazon a couple of weeks ago for about $27 or $28 dollars.  (My father, who has COPD, has had a Choicemmeter one for a long time, and that has also been fine.)  If one feels short of breath, it's hard to tell how short of breath you really are, and this gives you a useful metric to share with your doctor.   According to the Mayo Clinic, readings under 90 on an oximeter are low, but normal levels can vary depending on one's general pulmonary health.  (Medicare authorizes supplemental oxygen for most patients with blood oxygen consistently below 88 on a pulse oximeter.)  Links to other sources and comments from knowledgeable readers welcome.

UPDATE:  A reader, below, notes that Amazon can't deliver the Zacuarate Oximeter until late May.  There are many others on the market fortunately, google should be able to help you figure out whether they're legitimate.

ADDENDUM:  Here's a poll, to get a sense of how many others now know people with COVID-19.  Maybe I'll run this again in a few weeks for comparison.

The COVID-19 disaster in Italy, in perspective

Italy now has 53,578 confirmed cases (they are not testing everyone), and 4,825 deaths.   China reports 81,397 confirmed cases (they are also not testing everyone), and 3,265 deaths.   But China's population is nearly 1.4 billion people, while Italy's is about 60 million.   If China's statistics were as grim as Italy's, China would have more than 1.2 million confirmed cases, and more than 100,000 deaths.

Daily updates from the head of surgery at Columbia Presbyterian Hospital in New York City...

...are being posted on this Twitter account.  Since this hospital is in the "thick of things" in the hardest hit spot in the U.S., it's a window into what's going on. 

Philosopher of physics Tim Maudlin explains in simple but stark terms why "social distancing" works

 

Spreadsheet of recorded philosophy lectures with links

You can add to it as well.

(Thanks to Tyron Goldschmidt for the pointer.)

Support independent bookshops during the pandemic

A suggestion from philosopher David Velleman:

If people are worried about their local independent bookstores during the crisis — or even under normal conditions — they should consider buying their books from https://bookshop.org. This site enables independent bookstores to set up their own sites within the bookshop.org domain, with all fulfillment functions performed by a third party; and in addition to the returns the bookstores earn from their bookshop.org sites, they share in a pool of returns earned by sales from the central bookstore.org site. If your book its not yet available on bookstore.org, you can become an affiliate and list the book on your own sales site. You will then earn a share of the sales, but if you already link to your books on Amazon from your personal home page, you can switch those links to bookshop.org and format them in such a way that the earnings will go to your local independent bookstore instead, if they are also affiliates. (The format is https://bookshop.org/a/xxxx/yyyyyyyyyyyyy where xxxx is the bookshop.org affiliate number of the store and yyyyyyyyyyyyy is the ISBN-13 number of the book.)

Great moments in obscure rock 'n' roll: Blodwyn Pig, "Dear Jill," 1969

Another nice number from the debut album of ex-Jethro Tull guitarist Mick Abrahams' band:

 

Good speech by Dr. Emily Landon (U of Chicago) explaining why Illinois Governor was correct to require a "lockdown" for at least two weeks

The "lockdown" begins at 5 pm today.   To put this in a bit of context, Cook County, where Chicago is and with 5.2 million people, has 548 confirmed cases as of today (the caseload did not quite double in the last two days); New York City, with 8.5 million people, has about 7500 confirmed cases today.  New York's "lockdown" started just the other day.   New York hospitals are already in crisis, as each day's New York Times reveals.   By starting earlier in Illinois, Governor Pritzker will undoubtedly save lives and alleviate a lot of suffering.  If your locality hasn't acted, send this speech to your local officials.

 

Survey of infectious disease experts

Here; an excerpt (but see the charts in the article for much more detail, including degrees of confidence):

The most recent survey, taken on March 16 and 17, found that, as a group, the experts think that as of March 15, only 12 percent of infections in the U.S. had been reported by the Centers for Disease Control and Prevention. They think there’s a 73 percent chance of a second wave of hospitalizations this fall. And they expect approximately 200,000 deaths in the U.S. by the end of the year....

The expert consensus is to expect about 200,000 deaths in the U.S. from COVID-19 this year, but the uncertainty around that number is also huge: There’s an 80 percent chance the final number will be between 19,000 and 1.2 million, according to these estimates.

According to the CDC, there were a bit more than 2,800,000 deaths in the U.S. in 2017.  So coronavirus, on the average estimate, would increase deaths in the United States by about 7%, but might increase it by as much as 40%!

Twitter threads by Yale's Christakis related to COVID-19...

...collected here.  (We've noted a couple of them previously.)

More on hydroxychloroquine (the anti-malaria drug) as a *possible" treatment for COVID-19

A mixed verdict so far, with skeptics, but also some hopeful assessments.  What might the mechanism be by which it could work?

In the UK, Robin May, Professor of Infectious Disease at the University of Birmingham, explained that there is a scientific rationale for the use of hydroxychloroquine in the treatment of COVID-19, based on its mode of action in malaria.

In a statement through the Science Media Centre, he explained that, as chloroquine is a "weak base" and so helps to neutralise acids, it makes the environment "less suitable" for the malaria parasite to live in when it diffuses into red blood cells.

While the mode of action against COVID-19 is not established, Prof May said, he pointed out that many viruses enter host cells via endocytosis, as a result of which they are initially taken up into an intracellular 'compartment that is "typically fairly acidic”.

Chloroquine would alter the acidity of this compartment, which can interfere with the ability of viruses to escape into the host cell and start replicating.”

He continued: "Another possibility is that chloroquine may alter the ability of the virus to bind to the outside of a host cell in the first place,” adding that the drug "has subtle effects on a wide variety of immune cells…and it may be that one of these effects helps stimulate the body’s ability to fight off COVID-19.”

Crucially, the drug is also "cheap and relatively easy to manufacture" and so could easily be put into clinical trials and, eventually, treatment, May underlined.

(Thanks to Dr. David Ozonoff for the pointer.)

The challenges of fine-tuning a vaccine against the coronavirus

A lucid explanation from a Cambridge scientist.

(Thanks to Joe Hatfield for the pointer.)

Leiter v. Trump

A funny message, from longtime reader Larry Franz:

Thank you for your COVID-19 posts. The public needs reliable information like you've been providing. We also need TV networks to stop giving the president free access to misinform the public. He's a risk to public health.

Alas, I can only address one of these issues!

Tory government to pay up to 80% of wages (up to 2500 GBP per month) of those unable to work due to pandemic

That's a far more serious response than the proposal to send out some $1,000 checks now and then.   Will it inspire the Republicans here?

Is there any bioethical consensus on whose lives to save first in a triage situation? (UPDATED)

Professor Terry Myers (English, William & Mary) writes:

The Johns Hopkins piece notes that "Unless patients can be transferred, we would then enter the uncharted territory of having to ration life-saving care in order to save the most lives—something we have never done before in an organized way.”

Is there a consensus among ethicists as to the best criteria for choosing to save one patient’s life instead of another’s?

I don't know the answer to this.  New York prepared a report in 2015 about criteria for rationing ventilators, but I don't know whether this reflects any kind of "consensus" outside this particular committee, which included philosophers but, thankfully, non-philosophers too.  From page 4 of the Executive Summary:

The primary goal of the Guidelines is to save the most lives in an influenza pandemic where there are a limited number of available ventilators. To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized. The Guidelines define survival by examining a patient’s short-term likelihood of surviving the acute medical episode and not by focusing on whether the patient may survive a given illness or disease in the long-term (e.g., years after the pandemic). Patients with the highest probability of mortality with medical intervention, along with patients with the smallest probability of mortality with medical intervention, have the lowest level of access to ventilator therapy. Thus, patients who are most likely to survive without the ventilator, together with patients who will most likely survive with ventilator therapy, increase the overall number of survivors.

This article suggests a similar kind of consensus among the bioethicists consulted (those with best chance of surviving get priority for treatment).   Links and comments from more knowledgeable readers welcome.

UPDATE:   Thomas Cunnigham, the Bioethics Director at KP West Los Angeles and a faculty member at the Loyola Marymount Bioethics Institute, writes:

The "new normal" is going to last

A propos this earlier thread, this analysis is relevant albeit partly speculative:

What counts as “social distancing”? The researchers define it as “All households reduce contact outside household, school or workplace by 75%.” That doesn’t mean you get to go out with your friends once a week instead of four times. It means everyone does everything they can to minimize social contact, and overall, the number of contacts falls by 75%.

Under this model, the researchers conclude, social distancing and school closures would need to be in force some two-thirds of the time—roughly two months on and one month off—until a vaccine is available, which will take at least 18 months (if it works at all). They note that the results are “qualitatively similar for the US"....

Ultimately, however, I predict that we’ll restore the ability to socialize safely by developing more sophisticated ways to identify who is a disease risk and who isn’t, and discriminating—legally—against those who are.

If you get COVID-19, are you then immune?

Another very informative thread from Professor Christakis at Yale. The short answer is:  probably for awhile, but not forever.

What are the *early*symptoms of COVID-19?

We know something about the "mature" symptoms based on the Chinese study noted before, but since some infection (perhaps a lot) is taking place because of people in the early stages of infection, what do those symptoms look like?   This article offers some pointers, but I'd welcome other sources in the comments:

It is known that some people infected have no symptoms or ones so mild that they’re not noticed.  Daniel Mueller, an infectious diseases doctor at Temple University Hospital, said infected people might feel “just slightly under the weather for a few days.… They might just feel a little tired or a little achy." It’s the sort of feeling you’d have if you thought you were coming down with something, but nothing very worrisome.

Then they might start having a dry cough. Later, in some people, shortness of breath comes on. “They don’t always happen together,” Mueller said....

Unlike the flu, which announces itself suddenly with fever and muscle aches, the early stages of COVID-19 can go on for a few days.

Reynold A. Panettieri Jr., vice chancellor for clinical and translational science at Rutgers University, said some mild cases last just three to four days. Others who are not sick enough for hospitalization still may have symptoms for two weeks. Presentation of the disease is, he said, “very individualistic and very heterogeneous." Some people are barely affected and some have “shaking chills” and muscle aches, he said....

[Dr.] Meyer [Penn Medicine] would add sore throat to the list of early symptoms. She said most patients will eventually have a fever, but it “may not be in the first five days.”

"Why travelling changes us"

Philosopher Emily Thomas (Durham) comments.  (The timing, alas, is a bit ironic here, but it's still worth a read.)

Another perspective from England...

...from a reader who works in the healthcare sector, about an hour or so from London:

As per other commenters, life is very sombre indeed. Patience is thin. Nerves are frayed. Cynicism is gone. The time for worry is well upon us. We have many patients but fewer staff. Everything is being cancelled. Many of our temporary clinical staff are simply not coming in because they 'heard' there is coronavirus in the hospital. Or the bar for self isolation is (understandably) so low that we are losing many hands. And there are no extra hands office side to help with all this.

I work office side, not on wards. We have been asked if anyone has previous medical training of any kind. They want to know if anyone will go on a refresher course and go to the wards. It is an enormous logisitcal challenge. As well, of course, as the obvious fight for clinical staff and patients of all kinds. When schools close Friday I am not sure what will happen for coworkers who are parents.

Some offices are to be changed into wards.

On the *possible* connection between blood type and coronavirus infection

An appropriately cautious assessment:

"Meta-analyses on the pooled data showed that blood group A had a significantly higher risk for COVID-19 compared with non-A blood groups," the researchers write in their paper.

"Whereas blood group O had a significantly lower risk for the infectious disease compared with non-O blood groups."

But the paper also clearly states that although the results were significant, it's not an all-or-nothing result.

As per the study, the normal population in Wuhan has a blood type distribution of 31 percent type A, 24 percent type B, 9 percent type AB, and 34 percent type O.

Those with the virus, by comparison, were distributed as follows: 38 percent type A, 26 percent type B, 10 percent type AB, and 25 percent type O. Similar differences were observed in Shenzhen.

As you can see, the percentages between the normal population and those with the virus have some differences - but it doesn't mean that people with type O blood type are immune; and not everyone who gets the virus is going to be type A. Far from it....

The authors of the blood group paper uploaded to medRxiv aren't sure [what explains the differential rate of symptomatic infections], but they suggest that maybe it has to do with the anti-A antibodies that both type B and type O have.

That's just a hypothesis for now, and until we find out more, don't take it as gospel.

The cover of "Abbey Road" redesigned for the era of social distancing

New study of CFR for COVID-19 in Wuhan

The experts I follow on Twitter think this study is the best yet.   They suggest a case fatality ratio of 1.4% for symptomatic cases.   If there are many asymptomatic cases (there are clearly a non-trivial number, but we don't yet know how many), then the mortality rate for all infections even in Wuhan would be lower.  (This journalistic account of two studies suggests roughly 15-30% of cases may be asymptomatic.)  To put this in perspective:  even if the mortality rate ends up as low as 0.5%, it would still be five times worse than seasonal flu.  And that isn't counting the much higher rates for hospitalization associated with COVID-19 compared to flu.

Anti-malaria drug shows promise for treating COVID-19

This is a circulating copy of an accepted paper:   Download Gautret P et al. hydroxychloroquine COVID-ACCEPTED.  The only bad news here is that the drug is hard to come by in the U.S. and probably in other countries not regularly afflicted by malaria (not entirely surprising, but it better get rectified!).   Drug manufacturer Bayer is "donating" some (all?) of its stockpile to the U.S. government.   Here's yet another reason to "flatten the curve" short-term:   more treatments (if not cures) are likely to become available as we learn more over time.

(Thanks to David Ozonoff for the pointer.)

 

A substantive interview with Dr. Anthony Fauci, conducted by the editor of the Journal of the American Medical Association

The real substance starts around 6:30 in.   He discusses a number of issues, clearly and matter-of-factly.   He doesn't, for example, seem to think that the virus that remains on surfaces is likely to have clinical significance.   More significantly, and news to me, is his worry that ACE-inhibitors, a common kind of blood pressure medicine, may be increasing the ability of the virus to infiltrate cells (he emphasizes that this is purely a "may," but he thinks it needs investigation):  apparently the mechanism by which ACE-inhibitors work is compatible with this possibility, and he points in particular to the fact, recently noted, that 75% of those who died in Italy had hypertension--but as he points out, surely they were mostly being treated for it, and he considers those with hypertension under control with medicine to be essentially healthy individuals.   Again, this is correlation not causation, as he himself is clear, but it's plain he's worried about it.

(Thanks to David Ozonoff for the pointer.)

UPDATE:  Please see the comment by Dr. Ozonoff below.

 

Temperature, humidity, and seasonality of COVID-19?

Is this just correlation or causation?    Comments welcome.  An excerpt:

To date, Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has established significant community spread in cities and regions along a narrow east west distribution roughly along the 30-50o N’ corridor at consistently similar weather patterns consisting of average temperatures of 5-11oC, combined with low specific (3-6 g/kg) and absolute humidity (4-7 g/m3). There has been a lack of significant community establishment in expected locations that are based only on population proximity and extensive population interaction through travel.

Interpretation: The distribution of significant community outbreaks along restricted latitude, temperature, and humidity are consistent with the behavior of a seasonal respiratory virus.

It would be nice if these researchers are right.   But do we have enough data points for generalization?  The climate similarities between the most effected regions--from the Pacific Northwester to Wuhan to Japan to Iran and Northern Italy--is striking.

(Thanks to Edward Johnson for the pointer.)

Gloria Gaynor's "I Will Survive"...for teachers

(Thanks to John Tilley for the pointer.)

"The Legal Problem with Diversity Statements," Berkeley's in particular

I believe this is an open access version of my essay at CHE. 

UPDATE:  Alas, this appears to be paywalled, I'll repost when there's a public version.

Biosecurity news from Johns Hopkins: what a Wuhan-like explosion of cases would do in the US

Very straightforward and to the point:

The bottom line is that demand would far exceed capacity, and some people in need of critical care would not be able to get it. But it is not just Wuhan; Italy is currently in the midst of a similar outbreak, and critical care services are overwhelmed there, too.

The encouraging news, however, is that it seems that community mitigation strategies—such as isolating the sick, home quarantining the exposed, canceling mass gatherings, and social distancing—have worked to tamp down the height of the epidemic wave and therefore have kept the healthcare systems functional in other parts of China, Hong Kong, Singapore, South Korea, and Japan. But to be effective, these measures need to be vigorously implemented several weeks before hospitals become overwhelmed....

To make this very clear, let’s do a thought experiment and look at some simple calculations based on data from our recent research. On the peak day of the outbreak in late February, there were slightly more than 2,000 COVID-19 patients in critical condition in Wuhan. Based on the estimated remaining adult population in Wuhan at that time, we can calculate the per capita fraction requiring critical care = 259 per million.

A Title IX horror story

This isn't typical, of course, but it does illustrate how any system, including one that was supposed to serve a constructive purpose, can be hijacked by malevolent actors.  And now that the story has appeared, there will no doubt be others looking to exploit the system this way.  Title IX administrators are going to need to be vigilant against this abuse of the system (far worse than the abuse of the system we saw in the Kipnis case at Northwestern several years ago).

(Thanks to Gregory Mayer for the pointer.)

More than 99% of those who died in the COVID-19 outbreak in Italy had familiar co-morbidities...

...but there's little solace in that for the living (there is no solace for the dead), as they are extremely common:

Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions.   More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease....

The average age of those who’ve died from the virus in Italy is 79.5. As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions.

Demand for hospital beds compared to supply by region of the country based on various scenarios of the spread of the virus

There are some notable differences even among major metropolitan areas.  This also makes clear why "flattening the curve" is crucial:  most areas can cope with 20% getting infected over the next 12 months, none can cope with 60% getting infected during that time.

The situation in Oxford

From a philosopher there:

News from Oxford probably rather similar to that from elsewhere in the UK and the US. The university and colleges are closing, and students are being asked to go home, if they can. If they can’t, they are allowed to stay in college, and I think catering and other services will be available for most of them (though they will have to eat pre-packed meals in their rooms – unlike at Harvard, where my nephew tells me he can eat in hall with others at a distance of 3 metres minimum!). We’re being asked by the govt. to avoid unnecessary social interaction, and to work from home. The university and colleges are following that advice, and my own college will be closing at 12 noon today. I will be able to gain access to my office after that time to collect books, etc, but I’ll need to do it via the porters and we’ve been told that there is no good reason for anyone except core staff to be working in college at present. All teaching and assessment next term will be online. I suspect Teams and Canvas will be the most widely used platforms for the former, but we don’t yet know about how final exams will work. My guess would be open-book exams via WebLearn. Decisions will need to be taken soon, as many students are understandably very anxious. I think what your London contributor said is right – the mood is becoming more sombre. But there are also signs that people are taking positive steps to keep up social contacts remotely. Things will probably continue to change quickly from now on, if the common view that we are about three weeks behind Italy is correct. We have significantly fewer hospital beds per person than them, and at present far too few ventilators (under 6000, though the govt. is frantically trying to produce more).

Another hopeful bit of news: Japanese drug favipiravir helps COVID-19 patients without severe symptoms

Details here; an excerpt:

Zhang Xinmin, an official at China’s science and technology ministry, said favipiravir, developed by a subsidiary of Fujifilm, had produced encouraging outcomes in clinical trials in Wuhan and Shenzhen involving 340 patients.

“It has a high degree of safety and is clearly effective in treatment,” Zhang told reporters on Tuesday.

Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug, public broadcaster NHK said.

In addition, X-rays confirmed improvements in lung condition in about 91% of the patients who were treated with favipiravir, compared to 62% or those without the drug....

But a Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people, but it doesn’t seem to work that well when the virus has already multiplied,” the source told the Mainichi Shimbun....

Favipiravir would need government approval for full-scale use on Covid-19 patients, since it was originally intended to treat flu.