Leiter Reports: A Philosophy Blog

How the coronavirus spreads through a room, a bar, a classroom

Nice visuals.

Meanwhile the COVID disaster rolls on

Over 9,000 new confirmed cases in Chicago over the last week, the highest recorded number ever (the previous high, last Spring, was over 7,000, but that surely wildly undercounted, as Chicago was doing about 25% of the daily testing that's being done now).   On the other hand, Cook County, where Chicago is, is averaging about 30 cases per 100,000, well below other parts of Illinois which are closer to the neighboring disaster areas, especially Wisconsin, but also Iowa and Missouri.

What a fiasco the Trump Virus has been.  Apart from Bolsonaro, we couldn't have had a worse national leader during this world-historic event.

Another university succeeding despite COVID

This time Cornell University--but, in typical journalistic hysteria-mongering, the article treats this as "rare" rather than the norm.

Coronavirus infection: it's not just the nose, it's also importantly the mouth!

This is interesting.

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

Hospitals in Utah preparing to ration care...

...due to surge of COVID patients.   Utah has a 7-day rolling average of about 1,400 cases per day in a population of a bit more than 3 million.  By way of comparison, Illinois has a 7-day rolling overage of about 4,100 cases per day, but with a population four times the size; Illinois is, not yet, facing such a crisis, but Illinois also has a fairly good ratio of beds to persons compared to many other states.  (Illinois has 2.8 ICU beds per 10,000 people, while Utah has 2.2.)

As COVID cases surge, one bit of good news is that doctors are now much better at averting death

A useful overview of the changes:

Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness....

The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.

That's a big improvement, but 7.6% is still a high risk compared with other diseases....

 

Horwitz and her colleagues looked at more than 5,000 hospitalizations in the NYU Langone Health system between March and August. They adjusted for factors including age and other diseases, such as diabetes, to rule out the possibility that the numbers had dropped only because younger, healthier people were getting diagnosed. They found that death rates dropped for all groups, even older patients by 18 percentage points on average....

COVID on campus: an update

Philosopher Gregory Pence (Alabama/Birmingham) kindly shared this list of universities with the biggest outbreaks of COVID on campus.  What they have in common is that they are all large, mostly state schools, most of which have big fraternity/sorority scenes.  (One surprise on the list is BYU, which is large, but is an alcohol-free campus, which one would have expected to contribute to more sensible behavior by students.)   But these schools are the outliers, as even the NYT data reveals, despite their best journalistic effort to emphasize the negative:

More than 35,000 cases [COVID] cases have been identified since early October.

Though some colleges moved all their fall classes online, many campuses remained open even as positive tests accumulated by the hundreds or thousands. Of more than 1,700 institutions surveyed by The Times, more than 50 reported at least 1,000 cases over the course of the pandemic. More than 375 colleges have reported at least 100 cases.

Translated into non-hysterical English:  3% of universities account for about a third of all the cases on campuses, and one-quarter of the schools account for almost all the cases--meaning about 70% of colleges and universities are doing quite well.  Considering that COVID is spreading out of control in huge parts of the country, colleges are performing admirably overall.

STAT News runs a very useful COVID-19 "tracker" of drugs and vaccines in development...

...here.

The Swedish COVID disaster

The chart here certainly sums it up:  Sweden has had 59.3 deaths per 100,000 people, compared to 11.8 per 100,000 for Denmark, 6.3 for Finland, 5.2 for Norway, and 11.7 for Germany, all proximate countries that were far more proactive in managing it.  Sweden is up there with other countries whose response everyone knows has been disastrously incompetent, including the U.S. (66.3 death per 100,000) and the U.K. (64.5 deaths per 100,000).

Good news about air travel and the risk of contracting COVID...

...although it does  require that passengers wear masks!  A question for anyone who has flown recently:  are airlines enforcing mask wearing?

Some striking COVID graphics...

...which document vividly the differential impact of the pandemic across the United States at different times.

(Thanks to Tushar Irani for the pointer.)

Reinfection with the coronavirus? Possible, but quite rare

An informative discussion of what we know, and why it's not a cause for concern.

On COVID and aerosol transmission

This is informative.  It's pretty clear by now that aerosol transmission (i.e., not just droplets when someone sneezes!) is important, more so than fomites for example.  Links to other sources on this issue welcome in the comments.

New study estimates 20% of Chicago residents have antibodies to the new coronavirus

Not wholly surprising, given that there have been more than 83,000 confirmed cases in a population of not quite 2.9 million in the city proper.  So 20% having been exposed would mean not quite 500,000 people with either symptomatic or asymptomatic cases over the last 8 months or so.  I've talked to some students who had COVID-like symptoms in the Spring who could not then get tested, and I suspect that phenomenon was widespread.  We're still far from "herd immunity," as the surging cases this past week illustrate:  more than 2,900 confirmed COVID cases this past week in Chicago, the highest total since last May (Chicago has been running a bit over 2,000 confirmed cases per week for a couple of months now, but it ticked up noticeably this week unfortunately).

This New England Journal of Medicine editorial would make a good opening statement at the "war crimes" trial for those politicians who failed us in the "war on COVID"

An excerpt:

Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.² Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.

When COVID joins the family gathering

Not a happy event:  a 13-year-old with very mild symptoms (stuffy nose) nonetheless infected 11 others!

Notre Dame President Rev. John Jenkins should resign

As multiple news outlets are reporting, Rev. Jenkins tested positive for the coronavirus after attending last week's announcement of the nomination of former Notre Dame law professor (now Judge) Amy Coney Barrett to the Supreme Court.  Rev. Jenkins violated all the public health protocols that faculty and students at Notre Dame are expected to observe, most particularly, by not wearing a mask.  (By contrast, the Dean of Notre Dame's law school did wear a mask, while sitting right next to the President!)   You cannot demand compliance with public health protocols by your faculty, staff and students, and then flout those protocols yourself in such public fashion.  What an embarrassment; he should apologize and resign the Presidency and return to his role as a faculty member in the philosophy department.

UPDATE (October 4):  Some students are also calling for his resignation; they're correct.

A poll about COVID-related restrictions

UPDATE:  Moving to front from earlier today--vote!

Philosopher Peter Godfrey-Smith (Sydney) suggested I run this poll.  It asks whether you think the level of Covid-related behavioral and economic restrictions in your own local community has been "excesssive," "about right," or "not stringent enough."  Please take it.

ADDENDUM:  Be forewarned some odd ads pop up after you've taken the poll.  I got one for Dr. Phil and "how to lose 31 pounds in a month" (that would be good!), and some gossip about the Royal Family.  Others are, I'm told, more provocative.   Unfortunately, the poll service provider controls those.

ANOTHER (October 2, 6 pm CST):  Here are the results (with about 400 votes), albeit before most of the Asian, Australasian, and European readers weigh in:  about 14% find the restrictions "excessive," 49% "about right," and 38% "not stringent enough."

OCTOBER 3, 10 AM CST:   Now with about 700 votes (including many in the last 12 hours from Australasia, Asia, and Europe), the results have shifted a bit:  33% deem them "excessive," 38% "about right," and 29% "not stringer enough."   Of course, there's always a risk that the "Covid isn't a big deal" nuts may have linked to this somewhere, I don't know.  But certainly restrictions have been more dramatic in Australasia than many parts of America, which might explain the difference.

Finally, a news story about colleges *successfully* managing COVID

In the NYT.  But you heard it here first!

Trump's COVID diagnosis

Trump is 74 and obese, two facts we do know about him, and that puts him at higher risk for complications and even death from COVID.  But counting in his favor is that he will presumably be able to get access to newer treatments, like antibody plasma from recovered patients.   Since he is purportedly asymptomatic today, it seems unlikely he would have been infectious at Tuesday's debate with Biden, since people with COVID are, from what I've read, only infectious in the 48-72 hours prior to the onset of symptoms.  But Biden is being tested as well, of course.

If a candidate for President becomes incapacitated (e.g., on a ventilator) or dies, what happens?  It can get quite messy, but here's an extended and informed discussion by election law experts.

It's hard for those of us living through this nightmare not to experience some Schadenfreude.  As a philosopher elsewhere wrote me this morning:  "The arc of the pandemic bends towards justice."   Given Trump's gross mismanagement of the pandemic, which has cost tens of thousands of people their lives, and millions of others suffering and misery, there is a kind of "justice" that it has now come back to bite him.  If he becomes seriously ill, it may give him a face-saving way to withdraw before his likely defeat.  But it may also plunge this dysfunctional country into further turmoil in ways none of us can yet anticipate.

UPDATE:  The latest this morning (9:30 am CST) is that Trump does have "mild symptoms" now, meaning that he may have been infectious on Tuesday.  What a mess.

ANOTHER:   So as of 11:30 am CST, roughly, the Bidens have tested negative.  Of course, false negatives are not uncommon, so we'll see.

New study estimates 10% of Americans have antibodies to COVID

Study here.  Of course, we know that antibody levels wane fairly quickly, and that the key to immunity are T-cells.  Is there any way to estimate from this study how many people have T-cells that recognize COVID, even though they no longer have antibodies?

Four immunity scenarios for COVID

This is informative.

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!