George Rebane

Those words from Speaker Pelosi summarized her three most important aspects of the pandemic legislation now going through Congress.  But once more I believe that the lady misses the point here.  Testing will do demonstrably little to stop or even slow down the inevitable and incipient explosion of Covid19 infections in the land.  The emphasis of governments at all levels now should be to facilitate manufacture and distribution of life’s necessaries and healthcare equipment/supplies to treat the daily growing cohort of the infected requiring medical treatment.

A couple of useful definitions for discussing the pandemic – ‘asymptomatic’ means “showing no evidence of disease”, and ‘pre-symptomatic’ means having been infected but not yet showing symptoms.

The pandemic will stop only after 1) all have been infected (meaning it never stopped), or 2) it dies out since no more infections and the lucky infected have survived and are no longer infectious.  The best and fastest way to achieve the latter without inevitably overstressing our healthcare system is to self-quarantine and STAY AT HOME.  The head fed expert on infectious diseases, Dr Anthony Fauci, reinforced this prescription again today when he advised everyone to maximize the time they can “stay at home” (here).

A lot of bullcrap about how the virus is transmitted still pollutes the media channels.  Dr Michael Osterholm, director of University of Minnesota’s Center for Infectious Disease Research and Policy, gives some extremely important and cogent advice about Covid19 transmission (here) the main takeaways from which are –

1. The virus survives for several days on surfaces, depending on the material and its environment.
2. The virus is readily transmitted via the aerosols (exhalations, sneezes, coughs, …) from infected people. And the scariest part is that in the air the virus can survive for a matter of hours.
3. Pre-symptomatic people can infect others. Just because you are asymptomatic does not guarantee that you are not pre-symptomatic.
4. Available masks do little to nothing to stop your breathing the viral aerosol.
5. No anti-Covid19 vaccine will be available in time to stop the coming national spike in infections.
6. The only way to stop the spread is maximum social distancing, i.e. self-quarantine yourself, stay at home.
7. Our medical infrastructure is woefully inadequate to cope with what is coming; the spike in infections will overwhelm it. We will wind up triaging like the Italians and others are doing now.

So getting back to testing, and how that affects each of us.  I’ve prepared a little flowchart that most people (most certainly the astute RR readers) can understand.  It shows clearly how your being tested for the virus is essentially immaterial as to what you should really do in any event.

In the meantime, our Democrats and lamestream media along with international news outlets like the leftwing Economist, continue to lambast President Trump.  They blame everything from starting the pandemic, through not having the country’s healthcare system prepared and waiting (no nation has achieved this even now), to securing America’s borders as evidence of his “mismanaging” this national emergency.  In the mean time all the EU countries are sealing their own borders and many have already shut down all walk-in businesses and imposed national quarantines.  Any idiot should know that one obvious way the infections will continue to increase is through infectious people uncontrollably crossing borders.  But apparently not.

And finally, I want to make the point that this pandemic may turn into a large-scale emergency for all of us (recall that’s an emergency when 911 calls are not answered).  But however it ends, we will have a national dialogue that will result in new policies calling for major changes in our preparedness for such future catastrophes which will surely pay us another visit.  A discussion of what these may be, I will reserve for a future commentary and comment stream.

[16mar20 update]  It’s worth continuing to pay attention to the Dems’ Big Lie programs.  Most noteworthy now is the continuing lie that we would have done a better job fighting the coronavirus had we already implemented a nationalized healthcare system like Bernie’s ‘Medicare for All’.  If anyone cares to look at how the countries with nationalized healthcare are doing in this pandemic, they would quickly be disabused of any such thing.

The other part of last night’s comedy debate was Bumblebrain’s ongoing claims that somehow he was in the crucial heart of policy making and implementation in the Obama administration.  Listening to him talk, ol’ Bumble was right in the middle of all that was happening.  If anyone cares to check the record, they quickly discover that the man was one watering short of a potted plant during the entire eight years.  VP Biden was trotted out to stand behind Obama during photo ops, dignitary dinners, and other ceremonial occasions, mostly to allay rumors of his early demise.  Oh yes, he was allowed to attend certain meetings as long as he kept his mouth shut.  So you know Bernie has to bite his tongue when, like last night, Bumblebrain claimed to be the “steady hand” that quashed the ebola epidemic and kept it from our shores.

Now, as with Trump’s bravado, I would not count as ‘lies’ these outlandish claims of accomplishment.  But it would be refreshing to hear a progressive see such a common thread that knits together all politicians.

And also, do you note that like socialists, they don’t want to call attention to China’s autocratic mismanagement of when the Wuhan virus epidemic started?  No mention is made of its genesis in China or Wuhan because such attributions would be “racist”.  The lamestream, of course, fell into line immediately.  For them and theirs, President Trump is a much more believable cause of all that’s bad about the Covid19 pandemic.

[17mar20 update]  Sierra Nevada Memorial Hospital sent out a notice to their foundation members (of which Jo Ann and I are) regarding their new drive-through testing program.  They also direct you to the county’s coronavirus information website is here.

 Drive-through Covid-19 testing now at SNMH

Sierra Nevada Memorial Hospital will begin drive-through Covid-19 testing from 3:00-6:00 p.m. on Tuesday and Wednesday (3/17 & 3/18).

If you are symptomatic and meet criteria for testing, Nevada County residents should call their primary care doctor. If the doctor agrees that an individual needs to be tested, the doctor can fax an order to the hospital.

Sierra Nevada Memorial Hospital will call the patient to set up an appointment drive-through time. Please do not attempt to go to the testing drive-through without a previously set-up appointment. 

[18mar20 update]  New epidemic model revealed.  It turns out that the epidemic spread model that’s currently most trusted and used by policy makers in various countries is from the epidemic modeling group at Imperial College. (here, here, and here)  Note the (lack of) emphasis put on testing as a policy tool to affect infection and mortality rates.

Common malaria drug prevents and fights Covid19.  That is claimed in a report announced on Anthony Watts website (here) that was authored in league with Stanford University School of Medicine, National Academy of Sciences, among others, and published in several respected journals.  This, of course, would be the best news yet to salve the pandemic until a vaccine arrives.  In the meantime, Dr Rebane advises that you reconsider a gin and tonic as your afternoon preventative; after all, it is made with tonic water.  (H/T to reader)  The summary of the report follows –

Recent guidelines from South Korea and China report that chloroquine is an effective antiviral therapeutic treatment against Coronavirus Disease 2019.  Use of chloroquine (tablets) is showing favorable outcomes in humans infected with Coronavirus including faster time to recovery and shorter hospital stay.  US CDC research shows that chloroquine also has strong potential as a prophylactic (preventative) measure against coronavirus in the lab, while we wait for a vaccine to be developed.  Chloroquine is an inexpensive, globally available drug that has been in widespread human use since 1945 against malaria, autoimmune and various other conditions. 

[23mar20 update]  The reliability of Covid19 tests now reported should give most of us pause.  We are told that existing tests catch about 60% of people infected with the virus, and they test positive from 3% to 50% of those who are not infected.  So what’s the utility of giving a test to an asymptomatic walk-in American?  Well, the good Rev Bayes can help us out (more here).

[Trigger warning: some mild-mannered math ahead.]

We start with the prior probability that the asymptomatic walk-in has the virus which computes to about P(V) = 100K/330M = 0.0003 assuming generously that today about 100K Americans have been infected as opposed to today’s reported number of 42K.  The test’s likelihood ratio L(TP|V) = P(TP|V)/ P(TP|¬V) where V stands for virus present, ¬V means virus absent, and TP indicates Test Positive.  So the ratio is simply the two probabilities of a positive test given that the virus is present and the virus is absent – i.e. ¬V.  What we want to calculate is the updated or posterior probability that a person has the virus given that the test came back positive.  The Bayes formula for that is P(V|TP) = L(TP|V)P(V)/[L(TP|V)P(V) + 1 – P(V)].  Using the published numbers P(TP|V) = 0.60, and P(TP|¬V) = 0.25 (rough average of quoted range), we get L = 2.40.  Plugging this into the Bayes formula gives us

P(V|TP) = (2.4)*(0.0003)/[ (2.4)*(0.0003) + 1 – 0.0003] = 0.00072.

This tells us that an asymptomatic walk-in testing positive more than doubles his probability of having been infected, but his overall probability of actually being infected is still ridiculously low.  So what are you as a medical professional going to do with that information?  The answer is nothing much, because his probability of being uninfected, even with testing positive, is still P(¬V|TP) = 1 – P(V|TP) = 1 – 0.00072 = 0.9993, almost certainly virus free.

This little exercise allows us to evaluate the utility of such medical tests as to how much their results will move the needle one way or the other given what the test reports.  If the reported reliability numbers are accurate, then the test’s detection rate is way too low, and its false alarm rate is much too high for such a test to be very useful.  I’m sure that new tests are going to push the detection rates well above 0.9 and false alarm rates below 0.1.  Those interested can plug in different numbers and decide for themselves how reliable Covid19 testing should be before its results become a gold standard for use in making public response policies.  As a reference, here and here are a couple of websites that reports on the reliability of Covid19 tests so you can get a feel about how these tests are considered.