Leiter Reports: A Philosophy Blog

Is age an independent variable in severe cases of COVID-19 or is it just that known co-morbidities increase with age?

News studies regularly report that the risk of serious illness and death from COVID-19 increases with age.  (This study finds a marked increase begins at age 50, although the highest fatality rates are for those over age 80.)  We also know that certain co-morbidities--cardiovascular disease, chronic lung diseases (like emphysema, chronic bronchitis, and "moderate to severe" asthma), and diabetes--increase the risk of serious illness and death from COVID-19.   Yet most of these co-morbidities also increase with age (chronic bronchitis and asthma may be the exceptions).   Has there been any study that has disentangled age and the co-morbidities?  This article explains that as people get older, their immune systems get weaker, but is that the primary explanation for the higher fatality rate among older patients, or is it the combination of weaker immune systems and co-morbidities?   Links to studies or articles related to this question welcome.

UPDATE:  Here's the latest report on co-morbidities:  no real surprises and consistent with the comments above.

From the frontlines of the pandemic in NYC

As noted before, Dr. Craig Smith, head of surgery at Columbia-Presbyterian Hospital, sends out a daily missive, that, in addition to being nicely written, gives some insight into how things look to the care providers on the front line.   Yesterday's (March 31) is worth a read, some encouraging news, but also appropriately apprehensive about what's coming.  (You may need to scroll down to get to the March 31 missive, although I tried to link to it directly.)

More evidence that social distancing is working: Kinsa thermometers recording fewer fevers

The NYT ran a story on this today, and the Kinsa map is here.  From the NYT story:

The company, Kinsa Health, which produces internet-connected thermometers, first created a national map of fever levels on March 22 and was able to spot the trend within a day. Since then, data from the health departments of New York State and Washington State have buttressed the finding, making it clear that social distancing is saving lives....

Kinsa’s thermometers upload the user’s temperature readings to a centralized database; the data enable the company to track fevers across the United States....

Kinsa has more than one million thermometers in circulation and has been getting up to 162,000 daily temperature readings since Covid-19 began spreading in the country....

To identify clusters of coronavirus infections, Kinsa recently adapted its software to detect spikes of “atypical fever” that do not correlate with historical flu patterns and are likely attributable to the coronavirus.

As of noon Wednesday, the company’s live map showed fevers holding steady or dropping almost universally across the country, with two prominent exceptions [in New Mexico and Louisiana].

Have any universities discussed plans for next fall?

I broached this topic a couple of weeks ago, but I'm wondering whether any readers have heard about any contingency plans or discussions at their institutions related to the question of, "What happens in the fall?"   No need to use your name, but please include a valid e-mail address in case I need to follow up with questions (your e-mail and identity will not be disclosed).

I am guessing John Ioannidas will come to regret his essay from last week

Professor Ioannidas, a Stanford epidemiologist and statistician (most famous for first calling attention to the problem with the standard use of p-values in medical research), obviously has a contrarian instinct, but sometimes those instincts are dangerous.   I had been ignoring this piece, which seemed obviously unsound even to a layperson like me, but since it continues to circulate, I thought I would mention it and one of the decisive replies.  (The comments on the Ioannidas piece also point out some of the obvious omissions from his analysis.)  There is a longer interview with him here, where he sounds somewhat more reasonable.

Support doctors and nurses (and really all of us)

Everyone should share and sign this.  Now!

UPDATE:  My apologies:  as Peter Klein pointed out to me, the petition is only seeking  signatures from medical and legal professionals.   I'm sorry to those who wasted time trying to sign.   I failed to scroll through the list of professions, and so didn't realize the limitation.

As usual, religious zealots are a threat to human well-being

Unbelievable.  And some of these morons think that the First Amendment protects their right to endanger public health:   it doesn't.

UPDATE:  Good news, one of the pastors breaking the law has been arrested.  A few civil suits down the line for reckless indifference to human life would be appropriate too!

National survey of those charged with preventing infections in healthcare facilities

Here, with an article summarizing the findings here.  An excerpt from the latter:

Overall, 1140 (9.6%) infection preventionists responded. Almost 70% of respondents represented a healthcare system rather than a single facility, and facilities ranged from hospitals (42.7%) to ambulatory care (17.4%) and dialysis (2.7%). The centers, from all 50 states and Washington DC, ranged in size from those with 1 to 50 beds to those with more than 300 beds.

Of the respondents, 233 (20.4%) reported their facilities have no protective respirators and 317 (27.8%) said they were almost out of the devices, which are needed to protect healthcare workers managing patients with COVID-19 and different infectious diseases....

Other findings from the survey include:

• Nearly half of respondents (49.2%) said their centers lack sufficient enough face shields, with 36.5% reporting being almost out and 12.6% reporting being completely out.

• Approximately one third (31.7%) of respondents reported being completely or nearly out of face masks.

• Even simple hand sanitizer is in short supply at more than 1 in 4 facilities surveyed; 25.6% of respondents said they are almost out and 2.6% are completely out.

• Nearly 30% of respondents reported accessing supplemental PPE through state or local resources, while 24.6% said they accepted private donations of supplies.

• Fewer than one third (31.5%) said they had sufficient gowns.

• About 28% said they were almost out of protective respirators, while 20.5% said they have none.

• Only 12.3% said they have received supplies from federal resources, including the Strategic National Stockpile, which is controlled by the Department of Health and Human Services.

• 17.2% of respondents reported resorting to DIY measures such as sewing their own masks.

I guess I would not have expected dialysis and ambulatory care facilities (which makes up about 20% of the facilities included in the survey) to have respirators.  I haven't had time to look at the report to see whether it breaks down the data more thoroughly.

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

Our future has arrived in Germany...

...which will begin testing people and issuing "immunity certificates" to those who have antibodies for the new coronavirus.

The issue isn't the *total* number of cases, it's the per capita rate of confirmed cases

That's one takeaway from the first chart in this NYT story:

Metro area	Population	cases	Per thousand
Wuhan, China	11.1 mil.	50,821	4.59
Lombardy region, Italy	10 mil.	34,889	3.48
New York	20 mil.	43,016	2.15
Albany, Ga.	153,000	206	1.35
New Orleans	1.3 mil.	1,674	1.32
Seattle	3.9 mil.	2,543	0.65
Bridgeport metro, Conn.	944,000	607	0.64
Mount Vernon-Anacortes, Wash.	128,000	78	0.61
Pittsfield, Mass.	126,000	73	0.58
Detroit	4.3 mil.	2,468	0.57
Kingston, N.Y.	179,000	89	0.50
East Stroudsburg, Pa.	170,000	67	0.40
Show Low, Ariz.	110,000	43	0.39
Albany, N.Y.	883,000	340	0.38
Bellingham, Wash.	226,000	86	0.38

Although Chicago in recent news reports has been deemed a new potential "hotspot," its per capita rate of confirmed case was 0.262, about 1/8th the rate of New York City and half the rate of Detroit, for example.  That rate will go up, but hopefully over a long enough period of time to avoid catastrophe:  that's basically all communities can try to do at this time.  (For details on Chicago and NYC, see this post.)  (By the way, regarding Italy, it's worth noting that Italian officials, by their own admission, are not testing everyone, and that they think there are five to ten times as many actual cases as "confirmed" ones.  As with Wuhan and New York City, the issue is how quickly those cases came.)

 

How to move forward

There seems to be a consensus among some experts:  compare Dr. Scott Gottlieb's report for the American Enterprise Institute with Dr. Ezekiel Emanuel's recent op-ed in the NYT.  Both approaches require widespread testing to permit tracking and isolating of those infected, yet this infectious disease expert tells us that

In three to four weeks, there will be a major shortage of chemical reagents for coronavirus testing, the result of limited production capacity, compounded by the collapse of global supply chains when the epidemic closed down manufacturing in China for weeks.

The second hard truth is that at this stage, any public health response that counts on widespread testing in the United States is doomed to fail. No one planned on the whole world experiencing a health conflagration of this magnitude at once, with the need to test many millions of people at the same time. Political leaders and talking heads should stop proffering the widespread-testing option; it simply won’t be available.

This expert and his colleague propose other ways of tracking the disease, which sound far less reliable, but maybe they will work?

So this is puzzling:  do Drs. Gottlieb and Emanuel not know that widespread testing won't be an option?  Or is it really an option, contrary to the quote above?

UPDATE:  Maybe blood tests for antibodies are the answer?

China excluding asymptomatic cases that are positive for the new coronavirus from its offical counts

Worth noting, if China's numbers seem too good to be true.

Rhode Island police hunting down New Yorkers seeking refuge

Yikes!

UPDATE:  Listening to New York Governor Cuomo's remarks this morning, I learned that the Rhode Island Governor repealed the executive order requiring police to stop cars with NY plates and require the occupants to self-quarantine if they were stopping in the state.

The next worry on the horizon: sick healthcare workers

This is already happening in Europe (and starting to happen here):  because the virus spreads primarily through close contact, healthcare workers are at enormous risk, even more so if they lack adequate protective gear, as is increasingly true in the United States.  And without healtchare workers, having enough ventilators won't matter.

ADDENDUM: Here are the current CDC recommendations for dealing with the  shortage of protective equipment and gear.  (Thanks to David Ozonoff for the pointer.)

Forecasting peak cases and demand for hospital beds, ICU beds, and ventilators by state

MOVING TO FRONT FROM MARCH 26--UPDATED

A new study out of the University of Washington, that makes both U.S. forecasts and state-by-state forecasts.  The charts starting around page 20 digest the key information.  This confirms something we've noted previously, namely, that there is some wide variation by state in terms of capacity to deal adequately with a surge in patients.   These estimates, by the way, assume wide use of social distancing, closures, etc.  Comments welcome from those who have time to digest more of the details.

UPDATE:  See these useful comments on this study from a biologist.

Convalescent plasma to treat COVID-19?

From the editorial in the Journal of the America Medical Association accompanying a newly published research article on this possibility:

Shen et al report findings from a preliminary study of 5 severely ill patients with coronavirus disease 2019 (COVID-19) who were treated in the Shenzhen Third People's Hospital, China, using plasma from recovered individuals.¹ All patients had severe respiratory failure and were receiving mechanical ventilation; 1 needed extracorporeal membrane oxygenation (ECMO) and 2 had bacterial and/or fungal pneumonia. Four patients without coexisting diseases received convalescent plasma around hospital day 20, and a patient with hypertension and mitral valve insufficiency received the plasma transfusion at day 10. The donor plasma had demonstrable IgG and IgM anti–SARS-CoV-19 antibodies and neutralized the virus in in vitro cultures. Although these patients continued to receive antiviral treatment primarily with lopinavir/ritonavir and interferon, the use of convalescent plasma may have contributed to their recovery because the clinical status of all patients had improvement approximately 1 week after transfusion, as evidenced by normalization of body temperature as well as improvements in Sequential Organ Failure Assessment scores and Pao₂/Fio₂ ratio. In addition, the patients’ neutralizing antibody titers increased and respiratory samples tested negative for SARS-CoV-2 between 1 and 12 days after transfusion.

 

A new study of the seasonal variabiltiy of the new coronavirus

Here (not published, not peer-reviewed, but by legitimate researchers).  Short version:  hot weather and humidity will not extinguish the virus, but it may reduce the spread slightly.

Fox, the fascist propaganda network, is now an official threat to public health

 

COVID-19 case tracker...

...by selected cities around the U.S.  (Via the map at this site, you can also find state totals, as well as what each state has done in terms of business closures, school closings, etc..)

Bioethicist Thomas Cunningham to historian Allen Guezlo: cut it out!

(3/27 UPDATE:  Professor Cunningham, happily, tested negative for the new coronavirus.)

Professor Cunningham invited me to share this letter he sent out to many colleagues:

Does anyone know Allen C. Guelzo, a “senior research scholar in Princeton University’s Council of the Humanities?” If so, please tell him to stop it.

In his article on WSJ this morning, referring to  the plans we have been discussing tirelessly for weeks now, he asserts: “…people have become too accustomed to taking the easy way out of dilemmas, and too comfortable with making excuses for killing with the only offense for those we kill the possibility of inconvenience. Americans are better than that. Ventilators are not simple, but neither were Spitfire fighter plans…Improvise, innovate, imagine.”

Someone, please, who can tell him to stop or publicly rebuke him with argumentation, do so. Those of us working long hours in our hospitals do not have time to. While this shoddy reasoning obscures the point and is sloppy, scaremongering editorial writing, it may improve his profile. But there is no time for self-interested slop. He is correct in the sentiment, one can charitably grant him, that these are profound moral problems. But they aren’t manufacturing problems. And they are urgent.

He ignores that everyone wants more ventilators, more hospital beds, more adequately trained health care providers, more PPE, and so on, in the event the situation becomes so dire that we need far more resources than anything we have had in the past. The work that we are doing to plan for crisis conditions and appropriately operationalize triage protocols for making allocation decisions is predicated upon the assumption that this is the way to save the most lives under conditions Guelzo appears to assume, in his unwarranted optimism, are readily preventable. We all hope they are prevented. The question still remains, what if they are not? Then what do we do?

What the evidence shows so far about drugs that might be used to treat COVID-19

This is a helpful overview of the studies and their results (we've noted some of the studies previously).   We'll hopefully have more information in about a month on several of these.

This ad makes clear why Trump is a threat to public health

 

What goes around comes around

Mexicans demand halt to Americans crossing the border.   They could build a wall, maybe?

Lead author of Imperial College London study now more optimstic about UK's prospects

Story here.  Earlier coverage of the ICL report.   Frankly, the about-face in less than ten days seems rather dramatic.  He offers some clarification here.

Epidemics in historical perspective

Philosopher Steve Sverdlik (SMU) called my attention to this interesting podcast with a Yale historian, made before the current pandemic.

Trump's Easter announcement

This is the best impersonation of the monster-child I've ever heard; it's also very funny.  I bet SNL snatches him up! 

UPDATE:  For those who can't see it on Twitter, here it is:

(Thanks to Alan White for the pointer.)

Good news or false hope? Regarding the papers circulating that claim infection with the new coronavirus is very widespread, so that actual fatality rate is much lower

MOVING TO FRONT FROM YESTERDAY--UPDATED

There are two papers (neither peer-reviewed or in print) circulating--by legitimate researchers, I should add--speculating based on various assumptions and models that, in fact, huge numbers are already infected with the new coronavirus, but have no symptoms or such mild symptoms as to never get tested.   (Here's a journalistic account of one of them.) The theory, then, is that we are closer to "herd immunity" than we realize, and the fatality rate is much, much lower than previously claimed, maybe even as low as seasonal flu.  Both papers make some dubious assumptions based on my amateur reading, so I am waiting to see some more expert assesments and analyses before posting links (thanks to those who have sent them, I appreciate being kept abreast of these things).  Still, it is plainly true that the "confirmed" cases just about everywhere represent only some fraction of the number of actual cases, but we don't know what that fraction is:   1/10?   1/5?   1/50?  Even if that is true, it's clear that the proportion of confirmed cases requiring hospitalization and ICU treatment is significant (e.g., 10-20% requiring hospitalization, 3-8% requiring ICU), and that's still enough to generate a healthcare crisis.   In any case, I'll keep my eyes open for better-informed assessments and post more when I learn more.

UPDATE:  This Twitter thread (noted by Professor Gressis in the comments) has some illuminating comments from some actual experts.

MARCH 26 UPDATE:  This is a very helpful analysis and explanation of the Oxford study that made (misleading) headlines.  (Thanks to John Dupre for the pointer.)

Why the states trump Trump in most respects when it comes to the coronavirus response

Here's a very good explanation of the state of the law from a well-known public law expert, Dan Farber (Berkeley).  (We touched briefly on this the other day here.)  As I wrote ten days ago, it's "good news" right now that the U.S. is a "federal system" (at least if you're lucky enough to live in a state with competent leadership).  Trump can talk about "opening up the economy" by Easter (which is insane), but he can't actually do it, only the states can.

(Thanks to Dean Rowan for the pointer.)

What the future holds as we learn to live with the new coronavirus

A propos a question raised in the comments here, this new article is informative.  The article is consistent with what I have read in reliable sources, and seems a good summary of the state of current knowledge with regard to what the next year or so will be like.

Another COVID-19 hotspot in the U.S.: New Orleans

The NYT reports.  Some 800 cases in the city, as of yesterday, a bit less than Chicago, but Chicago has nearly three million people, and New Orleans has less than 400,000.   Good luck to readers there; more details or personal reports welcome in the comments.

Washington State positive test results stable or declining?

MOVING TO FRONT FROM MARCH 20--SEE MARCH 26 UPDATE

The University of Washington has led the way in COVID-19 testing, and in the midst of the country's worst initial outbreak.  Their daily tracker of test results (scroll down to see the chart) suggests positive results are not increasing and may even be declining in just the last couple of days.  Perhaps this is due to strict containtment measures in the last few weeks there, or something else.  Thoughts from  knowledgeable readers?

UPDATE:   Statistician Nate Silver on the Washington data.

MARCH 26 UPDATE:   It looks like the rate of new confirmed infections in Washington has indeed stabilized, a good bit of evidence for the value of social distancing and business closures.

Some advice from Dr. David Price (Cornell Weill Medicine in NYC)

Some useful points from a critical care physician in New York City.   A couple of key takeaways from the first twenty minutes:  (1) his hospital does almost nothing now but care for COVID-19 patients; (2) cases he's seen are overwhelmingly due to "sustained contact" with someone who is sick or one or two days away from getting sick, by which he means 15 to 30 minutes of contact, especially physical contact, with a sick or about-to-be-sick person; and (3) keep your hands clean and don't touch your face (mask are useful to prevent face-touching, but you don't need an N95 mask for that).   Those who listen to more can add additional useful points in the comments.  Point #2 seems to me especially important, and is consistent with points made by the W.H.O. team that visited Wuhan.

 

Anti-malaria drug ineffective in new, small but "controlled" study out of China

Dr. Ozonoff (BU) writes to me about the "[o]nly controlled trial so far of hydroxychloroquine [the anti-malaria drug]," which appears in a paper from Journal of the Zhejiang University...in Chinese...but the Abstract is in English. This is a very small trial (15 subjects per arm) so hard to draw firm conclusions, but there is zero effect of hydroxychloroquine with these endpoints (disappearance of viral nucleic acids in throat swab after a week; time until negative swab; time to become afebrile; 'radiologic progression' in CT [not sure what this means]; clinical improvement)."  Here's the abstract:

[Abstract] Objective: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the treatment of patients with common coronavirus disease-19 (COVID-19). Methods: We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed consent at Shanghai Public Health Clinical Center. The patients were randomized 1:1 to HCQ group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days plus conventional treatments, while those in the control group were given conventional treatment only. The primary endpoint was negative conversion rate of COVID-19 nucleic acid in respiratory pharyngeal swab on days 7 after randomization. This study has been approved by the ethics committee of Shanghai public health clinical center and registered online (NCT04261517). Results: One patient in HCQ group developed to severe during the treatment. On day 7, COVID-19 nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and 14 (93.3%) cases in the control group (P＞0.05). The median duration from hospitalization to virus nucleic acid negative conservation was 4 (1-9) days in HCQ group, which is comparable to that in the control group [2 (1-4) days, (U = 83.5, P ＞ 0.05)]. The median time for body temperature normalization in HCQ group was 1 (0-2) after hospitalization, which was also comparable to that in the control group 1 (0-3). Radiological progression was shown on CT images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all patients showed improvement in follow-up examination. Four cases (26.7%) of the HCQ group and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (P＞ 0.05). Conclusions: The prognosis of common COVID-19 patients is good. Larger sample size study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent research should determine better endpoint and fully consider the feasibility of experiments such as sample size.

Dr. Ozonoff comments:  "Certainly not conclusive but not exactly encouraging, either."  (Some of the problems with the earlier French study, that got so much attention, are discussed here [thanks to Nathan Ballantyne for the pointer].)

Spain will be the new Italy for a COVID-19 disaster

This is horrifying.  See also.   This will, I fear, also be New York City in about two or three weeks, although Governor Cuomo is leading an impressive effort to avert disaster.

Blood pressure meds and coronavirus, again: conflicting evidence

Following up on an earlier post, there is a new analysis of the evidence so far.  Here is how Dr. David Ozonoff (Boston University), who kindly sent me the paper, usefully summarized it:  

[T]here is evidence in animals that would allow one to infer that: (a) ARBs [one kind of blood pressure medication] via ACE2 could improve lung function; (2) ARBs via ACE2 increase the chances of lung injury. So we have contradictory inferences and which require further work to sort them out. In the meantime, hypertension experts (through their societies, which don’t represent every possible judgment about the persuasiveness of one or another inference) are continuing to say we should default to current recommendations on managing hypertension. It is the conservative (not in the political sense) position, which is not surprising.

Italian mayors are fed up and letting their fellow citizens know

This funny video has been making the rounds--it's indicative, of course, of how serious the situation is.  We need more leaders like this!

Why having an incompetent President is a problem during a national emergency

Yesterday I noted that Governors, not the President, have authority to take public health measures like shutting down businesses and requiring individuals to stay home, but this interview makes very clear why having an imbecile as President is a real problem; an excerpt:

What is supposed to happen is the federal government has to activate the Defense Production Act immediately. Now, what Defense Production Act does is it allows the federal government to step in and aggressively force the private sector to produce what we need. And what is so critical in this is timing. Because you can't simply build factories from scratch; what you can do is identify a supply chain in order to make it work.

For example, if New York needs rubber gloves, New York cannot simply build rubber glove factories overnight. However, there might be a rubber glove factory in Ohio that could produce it, but they might not have the latex. So therefore, the Defense Production Act allows the federal government to go to the condom factory in Missouri and say, "Listen, you have barrels of latex we need. We are requisitioning those. We are giving them to the rubber glove factory in Ohio. And then we are transporting the finished rubber gloves to New York." That's how it is supposed to work.

Coronavirus in Chicago (and Illinois): a timeline

MOVING TO FRONT, ORIGINALLY POSTED MARCH 14--VARIOUS UPDATES, BOTH FOR CHICAGO/ILLINOIS AND NEW YORK CITY

Just a snapshot of what's going on in one metropolis, that hasn't (yet!) been hit as bad as NYC or Seattle or parts of Northern California; I'll update this periodically.  Illinois is doing a fair bit of testing, but not nearly enough.  Technically these are the numbers for Illinois, but almost all the cases are in the Chicago metropolitan area (9.5 million people are in the Chicago metro area, Illinois has 12.5 million altogether, Cook County, where Chicago is, has 5.2 million people; the data is broken out starting March 18):

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.

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).

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.

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!