Leiter Reports: A Philosophy Blog

COVID risks while flying

Interesting, case study of ten-hour flight with one symptomatic passenger in business class:

We traced 217 passengers and crew to their final destinations and interviewed, tested, and quarantined them. Among the 16 persons in whom SARS-CoV-2 infection was detected, 12 (75%) were passengers seated in business class along with the only symptomatic person (attack rate 62%). Seating proximity was strongly associated with increased infection risk (risk ratio 7.3, 95% CI 1.2–46.2). We found no strong evidence supporting alternative transmission scenarios.

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

The colleges that are succeeding, despite COVID

After the "bad news" stories about college openings that journalists love, the real story now is the number of schools that seem to be making this work.  Notre Dame, with 12,000 students and a rocky start, imposed a two-week lockdown; now they have a positivity rate of 1.2% and only about five dozen active cases on campus.  As we noted before, Duke University is doing quite well, with aggressive testing and good student compliance with behavioral expectations.  Bates College, with nearly 1,800 students in the boondocks of Maine, has had only 2 cases after several weeks of class.  Amherst College, far less isolated than Bates, has had a total of 3.  No doubt this will be disappointing to those invested in the idea that it was obviously nuts to open a school during a pandemic.  But it is good news for students and their families.

ADDENDUM:   Someone on Twitter points out that Brandeis, near Boston, is also doing quite well.  I'm opening comments for readers to add links to evidence of other schools that are faring well.

Most states are doing badly on COVID benchmarks

No state meets all four benchmarks; I'm lucky that Illinois is one of a handful that meets three of the benchmarks.  I doubt this would be happening if we hadn't thrown the Republican plutocrat bum out of the Governor's office in the last election.   The Democratic plutocrat now in office is at least competent on basic matters.

Possible new antibody-based treatment for COVID

Interesting, and hopeful.

Penn will not admit PhD students this coming year in any humanities/science fields

This is remarkable; we noted a couple of philosophy departments that were not admitting PhD students this year, but this is the first school-wide suspension of PhD admissions in the humanities and sciences.  Comments are open if readers know of other schools following a similar path; please include links.

Characteristics of young adults (ages 18-34) hospitalized with COVID

This is informative.  Of 63,103 hospitalized patients (April through June of this year), only 5% (3,222) were in the 18-34 age bracket (median age of 28.3).   36.8% were obese, and 24.5% were morbidly obese!  2.7% of the young adults died.  41% of those patients who died or needed mechanical ventilation were morbidly obese. From the discussion:

Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse events. Young adults with more than 1 of these conditions faced risks comparable with those observed in middle-aged adults without them. More than half of these patients requiring hospitalization were Black or Hispanic, consistent with prior findings of disproportionate illness severity in these demographic groups.

ADDENDUM:  Comments making factual claims must include sources, or they will not appear.

Bad news for restaurants (but not a surprise)

CDC reports that in a sample of those recently diagnosed with COVID, having dined in a restaurant in the two weeks prior emerged as an important risk factor.  With colder weather approaching in large parts of the United States, this is bad news for restaurants and diners.  When this world-historic catastrophe is over, will there be any restaurants left in New York or Chicago or Minneapolis?

New study finds Vitamin D deficiency raises risk of COVID infection substantially

News item here.  Vitamin D deficiencies are easy to have, since not a lot of foods have substantial amounts of it--most people need to take supplements (most multivitamins include it).

(Thanks to Joshua Selby for the pointer.)

Duke University doing rather well with COVID to date

And better than neighbors at UNC/Chapel Hill and North Carolina State.  Extensive testing plus better student behavior seem to be key factors.

"Herd immunity": what it is and isn't

This is an informative interview.

All about a COVID-19 vaccine

Informative discussion with Dr. Paul Offit (Penn), a vaccine expert.  He thinks there will be a vaccine by the "first quarter" of 2021; he explains why we are able to produce this vaccine so quickly (basically, government is assuming all the risks); and other topics.   One interesting data point:  if a vaccine is 75% effective, then you would need to vaccinate about two-thirds of the population to stop spread of the virus; but if the vaccine is only 50% effective (like the flu vaccine), then to stop spread  you'd need to vaccinate the entire population (which you can't do, since some people can't take vaccines for health reasons).  As Dr. Offit emphasizes, the arrival of a vaccine will not eliminate the need for hygienic measures to control the virus.

(Thanks to Michael Weisberg for the pointer.)

More than 1/3rd of those on a 1 1/2 hour bus ride with a person with COVID...

...later tested positive.  Proximity to the index case wasn't decisive for risk either, suggesting, of course, aerosol transmission facilitated by air circulation.

Another university handling COVID effectively: U of Illinois/Urbana-Champaign

They're testing students twice per week, using saliva-based tests the university itself developed.  Impressive, let's hope it does the trick.

COVID cases at Arizona State University

Many years ago, my father quipped that, "Farmers hope for rain, journalists hope for floods," because disaster is more newsworthy.  So too with some of the COVID reporting, as in this piece from Phoenix.  It's headline reports that cases have "tripled" in a matter of days ("flood"!), but if you read the article, you see the positivity rate on tests is only a bit over 1% (very low, especially compared to the nearly 7% rate in Arizona)) and you also find this:

Officials said there were 452 positive cases out of the approximately 74,500-person student body in addition to 28 positive cases out of the 12,400 faculty and staff members. 

More than half of the positive cases reside off-campus within the Phoenix area. Officials said 205 of the approximately 9,600 students living on the Tempe campus were in isolation on Friday.

Given the prevalence of COVID in Arizona this summer, these are remarkably good statistics:  a bit more than half of one percent of students have tested positive (most of whom live off campus), and the rate is even lower for faculty and staff.   Of course, if growth is exponential then maybe this will turn into a disaster.  But so far these numbers are quite moderate, although you wouldn't know it from the emphasis in the headline.

(Thanks to Robert McGarvey for the pointer.)

Northwestern University makes the wrong COVID choice

Colleges should certainly reduce the number of students in campus dorms, but they shouldn't exclude freshmen, who are new to the college experience:  they should prioritize those new to college life, and those who have to be on campus for their work (e.g., labs).  

U of Arizona nips COVID outbreak in the bud by testing wastewater from dorms

Interesting,  I hope other schools take note!

The case for aersol transmission of COVID (with a useful analogy to cigarette smoke)

Here.  I guess I'm persuaded it's clearly a factor (much more than fomites), but it's not that easy, as the author explains via helpful analogy:

[I]t is useful to use cigarette or vaping smoke (which is also an aerosol) as an analog. Imagine sharing a home with a smoker: if you stood close to the smoker while talking, you would inhale a great deal of smoke. Replace the smoke with virus-containing aerosols, which behave very similarly, and the impact is similar: the closer you are to someone releasing virus-carrying aerosols, the more likely you are to breathe in larger amounts of virus....

"COVID immune responses explained"

This is informative; an excerpt:

Our immune system consists of two different layers. The first layer is the innate immune system, which acts within minutes of infection to provide kind of a rapid response. This doesn't require any specificity; it is engaged after any kind of infection. But this innate activation is important to triggering the second layer of the immune system, which is the adaptive immune system. In the adaptive immune system, the key players are B cells and T cells; they eventually acquire specificity and memory, which are the basis of the vaccinations. Having those T- and B lymphocytes that are specific to a particular pathogen and provide a memory response in the long term is very important....

If you follow COVID-infected patients over time, their antibody levels do seem to wane to some degree within 2-3 months. But that is not a cause for alarm because that's what happens when you get infected or when you become immunized for the first time. The antibody levels peak within the first couple of weeks and then eventually come down over a few months. That's okay because you still have memory B cells specific to that antigen as well as a T-cell immune response to the viral antigen. So the second time you're exposed to the same virus, you can mount a rapid, specific, and robust immune response. It's likely that you won't feel anything the second time you're infected. It will be a pretty mild or asymptomatic infection....

Does old tuberculosis vaccine really limit spread/severity of COVID?

That's what these Israeli researchers claim.    Is this just a correlation/causation confusion, or is there some plausible mechanism at work?   Links to other commentary welcome.

 

Alabama Governor spearheads a serious public health effort aimed at opening universities

Interesting.  I hope it works!  

An aside:  some academics on social media seem to mainly hope these efforts fail, so they can then say, "I told you so!"   Grocery stores and hospitals, among other facilities, have been operating without massive outbreaks; universities present more challenges in some respects, less [than hospitals] in others.  What's disappointing about faculty hostility to efforts to reopen universities is the complete indifference to the fact that students overwhelmingly want to be able to come back to campus.  Apparently some faculty don't care and I suppose faculty indifference to students shouldn't be news, but it's still discouraging to see.  If campuses can't open, it's a tragedy, not an occasion for glee (or armchair idiocy like this from academics with no relevant competence acting like they have deep insight--this guy is sufficiently confused that he thinks [correctly] that Baumol's cost disease applies to higher education, but then claims [falsely] that none of the increase in tuition goes to faculty salaries). 

(Thanks to philosopher Gregory Pence [UAB] for the pointer to the NYT article.)

ADDENDUM:  Professor Pence writes:

Not the Governor’s idea, but she is taking some credit. We created our own rapid test (before FDA allowed it, to safeguard our patients and docs), partnered with Apple and Google to create our own ap, and used CARES to fund testing of students BEFORE they return. Yeah, two week window is not perfect, but better than not testing them at all . We are also doing sentinel testing of random faculty and students. So far, that rate is less than half of 1%.But high school football in BAMA starts tonight = amplification systems. We shall see.

The key to COVID immunity: T-cells

And they appear to work.  Let's hope these research findings hold up.  Informed comment on this research, including links, welcome.

What we do and don't know about COVID after 7 months

A  useful review (compare an earlier amateur discussion back in June).

Which masks are best and worst?

Biologist Jerry Coyne (Chicago) has an overview of a recent article on the subject.

Do your classrooms have HEPA filters in the ventilation system?

That's what's needed in the COVID era.

"The Trump Pandemic"

A useful documentation of the blood on the monster-child's hands.

COVID and Sweden: what can be learned?

This ER doctor in Stockholm has a very optimistic take, although he omits that Sweden's death rate was much worse than that of its neighbors.  But the preceding article does confirm the former's point about the crucial role of T cells for immunity:

[A] study by the Karolinska Institute and Karolinska University Hospital recently found that about 30% of people with mild or asymptomatic COVID showed T-cell-mediated immunity to the virus, even though they tested negative for antibodies.

This figure is [more than] twice as high as the previous antibody tests, meaning that the public immunity to COVID-19 is probably much higher than what antibody studies have suggested," Ding told MedPage Today. "This is of course very good news from a public health perspective, as it shows that people with negative antibody test results could still be immune to the virus at a cellular level."

Indeed, T-cell immunity is coming into focus as a potentially important factor in COVID infection. A paper published in Nature in mid-July found that among 37 healthy people who had no history of either the first or current SARS virus, more than half had T cells that recognized one or more of the SARS-CoV-2 proteins.

Another 36 people who had mild-to-severe COVID-19 were all found to have T-cell responses to several SARS-CoV-2 proteins, and another 23 people who had SARS-CoV-1 (the virus responsible for the SARS outbreak in 2003) all had lasting memory T cells -- even 17 years later -- that also recognized parts of SARS-CoV-2.

As the article also notes, the decline in COVID in Sweden could also be due to the mild weather, in  which Swedes spend much more time outdoors.  We'll see how things look in three or four months.

"Designer" antibodies against COVID before a vaccine?

Interesting, I have not heard much about this.  Any readers have additional information, links etc?

Why the current COVID testing regimen is useless from a public health standpoint...

...and why we need different, cheaper, less accurate tests.  Interesting, and not as strange as it sounds!

Ten more commandments found!

This is pretty funny.

Jail time for Jared?

One can hope so after these revelations, assuming they are confirmed in subsequent legal proceedings.  This version cuts to the chase.

COVID and higher education...

...with a particular focus on Boston University, from philosopher Daniel Star at BU.  BU has not been covering itself in glory with its approach to faculty and graduate students during the crisis.

Things "we" now know that we didn't know about COVID a few months ago

I first started posting about COVID in February, and created a separate "coronavirus" category in early March.  Reviewing these posts, here are a few things that lept out at me:

1.  When the CDC said wearing masks wasn't needed, that was false:  it would have made a difference then, as it does now.  It defies belief that there are some states in this benighted country not requiring that masks be worn in public places that are indoors.

2.  The anxiety about ventilator supply in the U.S. was mostly misplaced.   There was stress in New York City in particular, due to the massive surge in cases, but even there I gather they met the demand.  More importantly, we discovered that avoiding ventilators in favor of high-flow oxygen canulas and masks led to better outcomes for patients.

3.   The question of heat and the novel coronavirus looks to have been settled:  heat doesn't have much or any effect, as the surging cases in Arizona, Florida, Texas, and Southern California, among other places, attest.

4.   People rarely get COVID from contaminated surfaces or from passing someone outdoors who has it (are there any confirmed cases of such transmission?).  The primary transmission occurs indoors with prolonged exposure (10-15 minutes or more).   The worse the ventilation, the more likely transmission is, and the more people are talking, singing, sneezing, or coughing, the more likely transmission is.

It's stunning, though, what we still don't know.  We don't know why some people get very sick, while others have no symptoms or mild illness, even when controlling for known variables like age, pre-existing conditions, obesity, and the like.  We also don't know why this virus ends up doing damage to so many different organs. 

Feel free to offer links to correct any of the preceding claims.

Another COVID Dr. Doom, Israel's Anthony Fauci (as it were)

Like the earlier one, he may be right (he's focused, naturally, on Israel, but one can extrapolate to other places).  Short version:  if you're under 50, you should be fine; if you're over 70, you're in trouble; between 50-70, mixed prospects.

Modelling COVID spread on campus

This is sobering.

More evidence for the "war crimes" trials for the failed U.S. war on COVID

Here; an excerpt:

Had American leaders taken the decisive, early measures that several other nations took when they had exactly the same information the U.S. did, at exactly the same time in their experience of the novel coronavirus, how many of these Covid-19 deaths could have been prevented?

That isn’t a hypothetical question. And the answer that emerges from a direct comparison of the fatalities in and policies of the U.S. and other countries — South Korea, Australia, Germany, and Singapore — indicates that between 70% and 99% of the Americans who died from this pandemic might have been saved by measures demonstrated by others to have been feasible.

Certainly if there had been adequate testing available, the incidence of asymptomtic staff infecting residents in nursing homes and assisted living facilities would have been far less frequent.

The obstacles to ethical vaccine challenge studies

Bioethicist Carl Elliott (Minnesota) comments.

(Thanks to Mark Pavlick for the pointer.)

COVID-19 planning for higher education

A detailed set of recommendations from the Johns Hopkins Center for Health Security.

Can U.S. faculty be forced to come back to campus in the fall?

This is useful, from a law professor.  The short answer seems to be: yes, unless you have a claim for accomodation (i.e., being permitted to work remotely) under the Americans with Disabilities Act:

For those who have not previously requested accommodations, they first must prove they are eligible. The Equal Employment Opportunity Commission has suggested that if employees have conditions that make them more susceptible to Covid-19, employers should take steps to eliminate the direct threat posed by Covid-19.

Faculty members who seek accommodations under the ADA must show that that they will be able to perform the essential functions of their job at home. When most colleges thrust faculty members into online teaching in March and continued to pay them, the colleges essentially agreed that faculty members are able to perform the essential functions of their jobs from home, at least during this pandemic. Colleges would be hard pressed to now argue that working from home is not a reasonable accommodation. Moreover, they have resisted tuition refunds for students this spring on the grounds that online education is not inferior to in-person classes....

And now some thoughts from Dr. Doom...

...but he's a serious and informed virologist.  Let's hope he's too pessimistic, but that's only a hope.

Cheap and widely available steroid drug cuts mortality in patients seriously ill with COVID

A welcome bit of news:

For patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%.

Chief investigator Prof Peter Horby said: "This is the only drug so far that has been shown to reduce mortality - and it reduces it significantly. It's a major breakthrough."

Young children do not appear to be transmitting the new coronavirus to adults

From a recent news story:

[T]here has not been a single [documented] case of a child under 10 transmitting COVID-19, even through contact tracing carried out by the World Health Organisation (WHO).

Let's hope this doesn't just reflect a gap in the evidence!

UPDATE:  See the first comment below, the news account, above, is not quite accurate.

COVID reproduction number, by state

This is a useful resource.

The risks of COVID transmission from indoor teaching

A useful thread of sources and evidence (some noted here in the past) compiled by philosopher Michael Otsuka (LSE).

More on Sweden's failed COVID strategy: a mea culpa from the architect

Here; as the article notes:

At 43 deaths per 100,000, Sweden’s mortality rate is among the highest globally and far exceeds that of neighboring Denmark and Norway, which imposed much tougher lockdowns at the onset of the pandemic.

Legal issues facing colleges planning on reopening this fall--plus the difference social distancing can make

This is useful and the opinions quoted sensible; this is really the most important bit:

"Institutions will have a number of strong defenses available, including, among others, that their adherence to CDC and other guidance demonstrates that they have met the applicable standard of care and that, given the nature of the virus, it will be very difficult … to demonstrate what caused a particular individual to contract the virus," Warner said. "Institutions will also be informing their students and employees of the risks inherent in returning to campus given the very nature of the virus."

Any institution in  compliance with federal and state health guidelines will be in good shape legally, regardless of how much illness there is on campus.

Small Belgian study of 154 elderly patients finds benefits from use of statins...

...and possible benefits from use of blood pressure meds (ARBs and ACEIs).  Particularly striking (but too small a sample to inspire confidence) was that 6 of the 8 elderly patients taking both statins and blood pressure medications were asymptomatic despite testing positive for COVID (and only 1 of the 8 got seriously ill)--much lower than the rate of asymptomatic patients generally.

Incompetent COVID reporting, NY Times edition

This from yesterday:

In the weeks since America began reopening on a large scale, the coronavirus has persisted on a stubborn but uneven path, with meaningful progress in some cities and alarming new outbreaks in others.

A snapshot of the country on a single day last week revealed sharply divergent realities. As the United States marked the tragic milestone of 100,000 deaths from the coronavirus on Wednesday, the contrasting picture was unmistakable — a murky, jumbled outlook depending on one’s location.

Around Chicago, Wednesday was one of the most lethal days of the pandemic, with more than 100 deaths....In the Boston area, where an alarming crisis of a month ago has given way to cautious optimism, businesses were reopening that day and new cases numbered in the dozens, no longer the hundreds.

COVID peaked in Chicago three-four weeks ago, so of course deaths are still occurring.  In fact, yesterday saw the lowest number of new cases reported since early April (and last week saw about 3,000 new cases the entire week, less than half the number three weeks ago).  No doubt there are places where the pandemic is gaining steam, rather than losing it, but the example chosen is in fact irrelevant.

Public health measures and "freedom"

Les Green (Oxford & Queen's U) comments (amusingly and aptly); an excerpt:

Admittedly, there are disagreements about freedom.  Some philosophers say these turn on people having different ‘concepts’ of freedom; others say that we have various ‘conceptions of the concept’ of freedom. (It can only be a matter of time before someone says that we have different ‘concepts of a conception of a concept’ of freedom.)  My own view is parsimonious.  I think we are free to do what we can actually do, and not free to do what we cannot do because we are prevented from doing it or because the action has been made infeasible.  What we disagree about is why freedom and unfreedom matter.

Some people hate restrictions just because they hate anyone making them do things they don’t want to do. (Teenagers, and some libertarians, tend to fall into this class.)  For others, unfreedom is of concern only if it also limits their autonomy, the power to shape their lives to fit their needs and character, as JS Mill put it.  Being forced to wear a mask while shopping may outrage the first group, but not the second because (save in special cases) wearing a mask does not limit any further activities.  A third group have still narrower concerns.  They only chafe under unfreedoms they judge to be imposed arbitrarily or unreasonably, in which cases they think they are being ‘dominated’.  These are all real disagreements, but they are fundamentally disagreements about the value of particular freedoms, not about freedom’s nature.

More antibody testing results: 3% of people in Indiana have been exposed to the new coronavirus...

...and 45% had no symptoms from it.  As the article notes based on Indiana and other antibody studies, the infection fatality rate seems to be between .5 and 1%, which is still pretty awful, but not as awful as some of the very early figures tossed around.

How Vietnam avoided a COVID catastrophe

Pretty remarkable, given the size of the country and the proximity (and ties) to China.  Nothing like competent political leadership during a catastrophe.