Friday, March 27, 2020

Wuhan Virus - Testing Stigma and Virus Spread

Today I've got two topics to discuss (and zero readers (:-).  The first is a national level testing stigma.  Everyone around the world watches the number of cases in each country.  You can test and accurately report deaths, or you can not test and inaccurately report deaths.  When you don't test, you don't get Wuhan virus deaths reported to WHO and they don't get into the Johns Hopkins COVID19 map.

So the US did its usual world-leading effective testing regime.  One that the press inadvertently forced by continually claiming we weren't testing adequately.  So we now show more cases than any country in the world, including China.  Our death rate is of course lower than countries with limited testing but honest reporting of deaths.  Who knows what the situation is actually around the world.

The increasing number of positives in the US is going to limit travel for our people if the rest of the world 'effectively' shows virus die out.  But that doesn't matter since they don't seem to be limiting shipment of goods.  What will be bad is if the rest of the world stops testing and accurately reporting and we allow them to travel here again.  But then again, they will probably be afraid to travel here.  Maybe its a wash.

More importantly, how is the virus spreading?  I suspected all along that China stopped accurately reporting cases. It makes them look good and it removes any stigma from their people and goods.  What is the benefit of accurately reporting a spreading contagion?

But there is also the chance that China did actually stop the spread.  They took some drastic measures separating out the sick (forced quarantine), locking people down in their apartments, allowing only food delivery (not take out or drive thru), and preventing entry and exit of people from virus breakout areas.  I do not know how they got food and fuel into those regions.  But if they did careful testing and protection of truckers, they would have had a pretty good way to stop virus breakouts from leaking to nearby regions.

Contrast that with the US.  Only in the big cities do people live in large apartment complexes, and that is usually just a small percentage of the population.  Groceries do not have the capability to deliver to their customers.  China did it by requiring large orders where people grouped together to place orders.  US mayors could have done something to work out voluntary delivery assistance (for pay), but they couldn't mandate it.  Instead in US cities, we all mingle in a few large groceries trying to stock up for 'worse to come' where we enhance the spread of the virus by crowding and a stigma against using masks.

Likewise, when someone gets sick in the US, they aren't visited by HAZMAT dressed police or military that drag them to a communal quarantine area.  Instead, they continue living with their family or friends with the serious chance of virus spread.

Perhaps worst of all, there is no limit on travel into or out of breakout areas.  I think NY tried that with the Westchester breakout with a national guard cordon around a one mile radius.  But NY now has about half our national cases.  Their limited trial didn't do them much good.

But take Texas, and our local experience as an example.  We have a Super Walmart and a super HEB within 15 minutes of us in our county.  Their shelves continue to be empty of any kind of disinfectant supplies.  30 minutes away, in Bexar Country (San Antonio) where they have a shelter-in-place order, is our closest Sams Club.  We heard that yesterday they were allowing old folks early access.  We went and stood in a tight line outside for 15 minutes, then shopped in an overly crowded store.  They did have Clorox and Clorox wipes, the first we've seen since the pandemic started.  But if anyone had the virus, there was a good chance it was spread.

My point is that even locals are going to shop a little farther from home to find goods they consider essential.  No locked down city, the way the US does it, is going to stop the slow spread of the virus outside its borders.  And there is nothing stopping a person in a breakout (locked down) area from traveling out into the 'country side.'  If they have the means to do so, they are going to try and reduce their risk of the virus.

So in the US, unless something drastic changes, and I think it may be too late for that, the virus is going to spread outward from each breakout area.  New breakout areas will form.  It will move from the large cities to the smaller ones to the towns throughout the country.

The spread may not be fast, but it is going to happen.  I guess it might disappear for summer weather.  But if not, you are going to see waves spreading out from the big cities and hot spots.  Each wave will have it's own 8 week curve.  And like waves, they can go both ways.  This will not be an 8 week hunker down and it's over.

There are three things that may mitigate the pandemic in the US:  (1) therapeutic drug cocktails like hydro chloroquine and antibiotics may be effective enough to stop people from dying and slow down the spread and allowing the young and healthy to go back to work, (2) summer weather may nearly stop the spread as it does with the flu, and (3) social distancing and self-isolation may slow the spread enough that relatively few elderly and medically-at-risk persons will get sick, at least outside big urban centers.

There is a fourth measure that may help the situation.  If the feds can convince people that the death rate is not much worse than the flu, they have a chance at heading off draconian measures.  Just keep the elderly and sick protected.  Unfortunately, I don't think the media will allow that to happen.  It might help Trump.

Like the President said, I think the economy needs to get back to work.  But if the death rate keeps going up drastically, the US is going to need to rethink its approach.

Thursday, March 26, 2020

China Decoupling

Lots of people online seems to think the US will start bringing back critical item production from China after the Wuhan pandemic is over.  I find it unlikely that companies will return significant pharmaceutical manufacturing to the US.  And I’m using pharmaceuticals as an example.

The driver for decoupling at the moment is that the realization that masks, gowns, and most meds or med components are produced in China.  China stopped exports of some things like N95 masks, and threatened stopping exports of meds if we didn’t stop ‘blaming’ them for the virus.  India just stopped the export of hydro chloroquine from their country.

So yes, decoupling would be the wise, smart and obvious thing to do.  Bring that manufacturing back!  But it’s easy to prophesy decoupling, it’s another to actually execute...

First, companies are out there to make money for their owners.  If they don’t, the owners/investors move their money somewhere else.  Suppose a company wants to bring back a pill production line to the US.  Costs for the pill will go up since the labor costs will be higher.  Plus they will have to invest in the product line in the US and will want to recoup those costs.  Now they are competing with the other Chinese manufactured pill that is still sold at the old price.  Which pill does the hospital or pharmacy buy?

To bring back production, you are either going to have to make it illegal to buy non-US or you need to impose tariffs.  Both require, in most cases, laws being passed by the US Congress.  Have you seen any democratic cooperation with republican initiatives in the last few years?  Remember, this is after the pandemic is over.  My guess is ‘when hell freezes over.’

However, companies also don’t want their supply chains compromised in bad situations.  So they may move production from China to another low labor cost country, e.g. Taiwan, Vietnam or Mexico.   They might even split production and leave half in China.  Maybe they think that will assuage their corporate consciences in case of another pandemic.

But we just saw India stop the export of hydro chloroquine.  Countries are going to do what’s best for them.  If they need the product, it is not going to be exported—back to the US.

There’s another aspect to the problem. Manufacturing anything requires ‘raw’ materials.  I don’t necessarily mean mined rock.  But you usually need piles of stuff that you feed into the machine process to get the output product.  If China is the one that mines or makes that stuff, even a US factory is limited to the pile of stuff on hand in an emergency.

Somehow the US or US companies need to produce that stuff in the US.  Now the manufacturer could fund US production of that stuff, but that’s a bigger investment.  Again, US incentives created by law are going to be needed.  And again, do you think that is going to be a priority for democrat politicians?

I’m not saying Congress won’t take up this kind of law.  But I don’t think it is likely.  I also don’t think pharmaceutical manufacturing will return to the US without those laws.

In my opinion, decoupling is another good idea that will be forgotten the moment the media moves on from this emergency.

Tuesday, March 24, 2020

Wuhan Virus - Statistics and the Economy

I've got two topics I wanted to discuss this morning.  The first is statistics.  What I get out of the Johns Hopkins statistics map is pretty useless.  It shows total US cases of the virus and the total number of deaths, and what appears to be a highly inaccurate tracking of recoveries (almost nil).  The number of deaths initially were by county then went to state for several weeks, and now it's back to counties.

You know how many counties there are in the US?  I don't either, but it's a lot.  By county data may be of use to Dr. Birx on the president's task force, but it's not very useful to me.  It does help to tell me how many got sick in my county (three), but I know where maybe 5 counties, by name, are located in the US.

But the real problem I have with the data is it doesn't tell me a thing about the severity of the cases (except for the small number that have died).  I really want to know how many cases are requiring hospitalization and how many of those are requiring ventilators.  Plus, I want them to tell me how many beds and ventilators are available.  That will tell me whether the hospital system is near to getting overtaxed.  Better yet, they should show that data by state and then for Dr. Birx, by county.

I hate all of 'the sky is falling' about hospitals about to be overwhelmed when nobody is giving me any data that supports the claim.  I want to see a curve showing the progressions of the number of hospital patients, and patients on ventilators, over time. 

And then there's the anxiety people have about their personal risk of dying if they get sick.  People will take risks and go about their lives if the risk is equivalent to the flu.  But who knows with this situation? 

They tell me the average age of people dying in Italy is above 80 and that they have 2.7 underlying conditions.  So what?  What does the curve look like?  Especially here in the US where we have a different situation.  Is the age distribution a  tall thin peak in the 80's or is it spread down into the 60's?  How about the distribution by underlying condition?

In my own family, I'm 64 and my wife is under 60 but has an underlying condition.  Where on the distribution curves do we sit?  I don't have a clue.  And apparently either no one is collecting that information or they don't think the public deserves to get it.  My suspicion is the former.  If it's the latter, I would be even more worried.

Now I will turn to our economy.  If you have read my previous posts, you will see that I was pretty alarmed.  Doing state lock downs or shelter-in-place will kill almost every small business in the region.  If they are down for two weeks, those who sell consumables (restaurants and bars) will have to restock.  If they didn't have a big cash reserve, and most small businesses don't, they probably will require loans to start back up.  Nearly EVERY small business will require loans.  Unless of course, as soon as business fell, they let off all of their employees and stopped paying rents, leases, mortgages, utilities and taxes.

The business community, with some good will and understanding, could probably take 2 weeks without help.  4 weeks would bring it all down.

A couple of days ago, it looked like the Senate would pass a bill that would provide funds to unemployed individuals and families.  Do you want them all going to the unemployment insurance office to file in a lock down?  Do you think those offices dispense cash?  Or do they take a week or more to send checks?

The small business, many of which would still be paying off their initial loans for start up and operation through the growth stage won't want to take on any more debt burden.  And I'm not sure giant (or local) banks would want to take the risk they could handle bigger payments.  But the bill in the Senate looked like it would provide grants rather than loans to get small businesses back on their feet.

But then the democrats balked.  The market tanked yet again.  Now there's talk that they may have resolved their differences.  My guess is the republicans caved to the pork and social justice/abortion/climate change giveaways the democrats wanted to add.

I hope not.  It seems to me that there are two options for the future situation.  In one, after the President's 15 day social distancing period, the feds recommend reopening business for the young and low to moderate risks and further isolating the high risk people.  At 15 days, except for the democrat run state holdouts, that will allow the economy to recover on its own.  The other approach requires or recommends another two weeks of lock downs.  This approach requires a Senate/US bill similar to what I've mentioned above, or the chance of societal and economic breakdown becomes high.

I expect one of those two approaches to work out.  And society won't break down.  But there's still going to be state holdouts.  Three states needed lock downs.  NY is the only one that seems to have quickly rising cases, and that's in NY city.  I have a fear that democratic governors (and mayors) see this not just as a crisis to be overcome, but one where they have an opportunity to damage President Trump.

First, they do the shelter-in-place (lock downs) statewide because that protects people, and when people are worried or panicking, that helps their ratings.  It doesn't matter that it's overkill for the 2/3 or more of the state that is rural and has almost no chance of worst case predictions.  But unless they are bigger idiots than they appear (and that's got to be impossible), they know they are causing serious economic damage.  And that will hurt Trump in the election.  Those rural folks probably weren't going to vote democrat, so what's the down side for a democratic governor?

A democratic mayor is in basically the same position, except that they don't have a rural segment of voters and economy.  If the city is big enough, they are going to do a lock down to prevent loss of life.

During this period, there is another factor.  The feds always come to the rescue in a disaster.  They have to expect a rescue bill for any damage done to the economy.

Now consider the situation after a change.  Either the feds recommend starting up the economy because too much damage is being incurred. Or the numbers show the hospitals in a city, region or state won't be overwhelmed.  As I said in the first part of this blog, the statistics aren't there to allow assessing hospital risk.  All you can get is anecdotal information from local reporters talking to a hospital administrator that is trying to prevent economic business as usual.  They know their limits and they fear what will happen if cases surpass those limits.  They are not going to say everything is good and the hospital can handle whatever comes its way.

But my point is, in either case, there is evidence that the city mayor or state governor should back off on their total shelter-in-place orders.  If their citizens/voters agree, they are probably pretty soon going to allow some relief.  Those whose motives lean towards damaging Trump, and that believe the feds will step in with relief funds, will keep their lock down orders in place longer than others.

Of course, there are still likely to be hot spots, like NY city, where you need to keep a lock down in place.  I would guess any city over 500,000 people, ought to be very careful.

So I'm not as pessimistic now as I was a few days ago about a serious depression.  But I still think state autonomy, combined with democratic governors and mayors that want to damage Trump, is going to make this worse than it should be.  Of course, I'm still for state autonomy!

Saturday, March 21, 2020

Wuhan Virus - A Governor's Crisis Meeting, Somewhere in America

The following transcript was verified as accurate by multiple sources high in state government.  However, the text was provided on the assurance of anonymity, not just for the sources, but also for the state.

Governor (G): Thanks for your quick response in joining today's video teleconference.  My chief of staff (COS) would like us to consider taking further, strong action in this ongoing crisis.  And I would like your input.

Chief of Staff/Political Adviser (COS): Thanks Mr. G.  Our focus groups have provided new results.  The voters will strongly support leaders that provide strong action against the Wuhan virus and will strongly disapprove of those leaders who take minimal action.  They believe a total state lock down is the right approach to save lives, and that voluntary social distancing is just inadequate.  I think we should follow California and New York's example and order a full lock down immediately.

Attorney General (AG): Unfortunately, our state law does not permit us to legally order widespread, indiscriminate business closures where there has not been a disaster or imminent disaster with significant loss of life or property.  Likewise, we do not have the authority to curtail citizen movement.

COS: Well, that's one opinion.  Mr. G's political advisers all believe that the media are going to tear into President Trump for only making recommendations when martial law could have saved lives.  We know how effective the media is when it acts in concert against a politician.  We also believe they will blame Mr. G if significant numbers of people die or they see deaths in an overcrowded hospital and G has not ordered a full lock down.  Mr. G, and all of you, won't be able to get enough votes to win your local dog catcher election.

AG:  Well, I guess we can quote the State Disaster Code title and number, and make the pronouncement look official.  I think Dallas County in Texas did that.  We just leave out quotes on relevant passages--that is, the measures we make up that don't exist in the law.  Even if somebody files in court against the order, I doubt any judge is going to risk their position and halt our actions.  And I doubt any journalists will even bother reading the code.

Secretary of Health (Health): Like our Disaster Response Laws, the Health Emergency Laws only allow shutdowns and quarantines when there is evidence or expectation of serious contagion.  Besides that, we've only had a few tens of cases, mostly in our few cities, and a single death.  Nearly 90% of our counties are rural.  Because of existing social distancing and hygiene actions, I and our other doctors believe the spread of the virus will be slow.  We don't anticipate high deaths or hospitals being overwhelmed.  If we see a surge of cases in a city, it should be enough to lock down that city.

COS:  Again, that's one opinion.  News reports have indicated up to half our population could catch the virus and up to 1% of everyone that catches it could die....

Health:  Interrupting... Those were worst case projections and not likely to happen...

COS:  Interrupting...  It doesn't matter what is likely to happen.  The voters fear the worst, and expect strong measures to stop it.  Fear, emotion and appearance matter in politics, not truth and reality.

Secretary of State (State):  But our studies show a total lock down will bankrupt 80% of the farms and businesses in the state, cause up to 75% temporary unemployment and maybe 30% permanent unemployment.  Our economy will tank, and our citizens will blame us.  We won't have enough resources in the state to restart those businesses.  The voters will take it out on us at the next election.

COS:  That's a common misconception.  The media, and of course most of the public, will blame Trump first for taking a weak stand and avoiding strong measures.  If the $1,000+ payments to workers and loans for small businesses don't work, the media (and of course most of the public) will blame Trump for not accepting the more draconian measures Pelosi and Schumer are pushing.  If there is a deep recession or depression after the crisis is over, they will blame Trump, whether he wins or loses the November election.  We'll be in the clear.

G:  So, in the short term, we think a statewide lock down is necessary to calm the voters' fears and assure general approval of the way our administration handles this crisis.  If it tanks our economy, we hope the fed's payments and loans will bring us out of it.  And if they don't, the media will blame Trump anyway.  Well, I've heard the Chinese send their viruses all through the Internet, so we need to keep this short.  Let's make it so!

Friday, March 20, 2020

Wuhan Virus VI - Is California America's Breadbasket? Or a Government Quarantine Lock Down Area?

They say that California provides a lot of the food used in the US.  Now California Governor Newsom has ordered all 40 million residents to stay at home.  Do you think that is going to help your food availability at your local grocery?

No people to run the massive farms.  No people to process the food for shipment.  No people to transport the foods to your market.  No food at your market.

You have a good day.  And enjoy the politicians' insane panic.

Thursday, March 19, 2020

Wuhan Virus V - The US Is Not China

I just heard that the Pennsylvania governor just ordered all non-essential businesses closed.  With the ‘Keeping Up With the Joneses, oops, the Other Governors’ one would expect this to spread across the US.

This is insanity.  We have an interdependent economy.  Keeping it going depends on commerce, the production of a wide range of goods, and people with the funds to make purchases.

We are not China.  China locked down one province and several cities.  Maybe a 100 million out of nearly 2 billion.  They had businesses going strong in much of their country providing food and goods for those locked down.

Having one governor after another throughout the US shut down all non-essential businesses removes that uncrippled sector of the US economy that can support the hard hit, locked down areas.

If this insane panic response spreads, the US economy will tank and it won’t come back.  To restart businesses you have to have funds.  If you’ve bankrupted 70% of American business by mandatory shutdowns for two months or more, that’s a huge bill. A trillion dollars of aid will be like a drop in the bucket.

Maybe all suppliers for the closed businesses will deliver the goods they need on restart on credit for a couple of months—after the crisis is over.  But the employees rehired are also going to expect to get paid.  If the feds inject more money in some super-massive aid bill, there will be inflation, serious inflation.  Maybe the economy will stabilize at a lower standard of living, but maybe it won’t.

I would now upgrade my recommendation to prepare with some extra food and water.  It seems prudent now to go full prepper.


Topic number two.  The latest news is that individual checks for the crisis would be for people with incomes under $100,000.  But the data the IRS has is for 2018.  If you’ve retired, or your income was higher than that in 2018 but you’ve been laid off because of government or big business response, you won’t get diddly.

If they do this, they need to send everyone the checks, but point out if their income is higher than the limit in 2020, it will be expected to be returned to the government in their 2020 fed tax return.

My Experience with Military Health Care

This morning, I want to describe some of my experiences with the military health care system.  While these may sound pretty negative, I want to emphasize that I was almost always very happy with the care provided once I got in to see the right specialist.  All of the people were nice, helpful (as much as the system allowed), and appeared very professional.

I'm a retired Lt Col in the Air Force.  I was an engineer, so all my experience was with stateside clinics or hospitals.  I've used TriCare Prime since retiring.  That means I'm assigned a local military hospital or clinic and must get all of my care (other than emergencies while traveling) from that facility.

First of all, you have to see a primary care 'physician' to start addressing any medical problem.  Most of those visits are now with a nurse practitioner that is not a physician.  The primary care person will refer you to a specialty clinic if they think you need it.  The referral goes into the system, and you are supposed to be called within 72 hours to schedule an appointment.  I'm told the rules say the appointment must be within 30 days of that call.  My own experience is that is more like 5+ weeks now.  If you need an MRI, CAT scan, or x-ray, you generally have to make another appointment for those.  Labs and pharmacy are usually walk in, once a provider has entered the request into the system.

While I was active duty, I didn't use the medical system a lot.  I think I had molars and one or two minor issues.

But I do remember one situation.  This was after the country was saying we were over-prescribing antibiotics and we needed to cut back.  Apparently, the military told their providers to minimize use of antibiotics.  I went in to the military clinic at their morning sick call after two weeks with a serious cough.  I was coughing up green nodules of mucus about 2/3 of an inch in diameter.  I kept one to show the doctor.  But I didn't have a significant fever.  He claimed that meant no bacterial infection and thus no antibiotics.  He gave me a prescription for cough medicine.

Well, it got worse for about a week and a half and then I went into the emergency room.  They gave me antibiotics and it went away in a couple of days.  I've never again gone into primary care for any kind of cold or flu.  Maybe I got a loser, but I suspect not.

After retirement, I found out through a routine PSA check that I had cancer.  I took the surgical route and have been cancer free since.  There were some side effects of the surgery that they had to take care of.  While the system was a bit slow, I was very happy with that care.

Now I'll get to a recent (year and a half ago) bout with vertigo.  I was on a camping trip, luckily only about 3 miles from the car.  The world spun and I could hardly walk for a day and a half before we came out early.

By the time I got to the emergency room, half a day later due to distance.  I was just unsteady.  They were able to reintroduce the world spinning with some head movements, and tried a maneuver.  They sent me home with advice to get to primary care within 72 hours.  Well, primary care had an opening about 7 days later.  They listened to me, did some checks for a stroke (every doctor during this period did checks for a stroke) that showed nothing, and put in a referral for an ENT visit.  That one was relatively fast at only about a three week wait.  So a month after the bad episode, I got to see someone who knew about vertigo.  During that month, I had some minor bouts, but was slowing improving in steadiness.

At ENT, they did the stroke tests, then some head maneuvers to see my reaction.  Of course, it didn't spin that time.  So they put in a request for an MRI of the inner-ear canal system.  That delay was only about 3 weeks, but then another 3-4 weeks after before I could get back into ENT.

They told me the that the MRI was negative.  Did some more stroke tests and head maneuvers.  I told them about the balance issues I was still having and some very mild spinning episodes.  They sent me home with some instructions on how to resolve vertigo with home head maneuvers.

I did some research on my own and found out there was a series of tests that could be run.  So I called in and asked if I could have them done.  The doctors so far had said they didn't know what caused my vertigo.  They set up the tests about two weeks out.  Then another month to get back in to ENT to discuss the results.

Basically, they told me the tests showed one side of my head had a 30% degradation in its balance capability.  And they referred me to a neurosurgeon.  They also referred me to physical therapy.

That took another month, and a bunch of calls to TriCare, as he was off-base.  He saw me and put in a referral for another, more extensive MRI of the neck and brain.  That took more weeks to get and to get back into the surgeon's office.  He showed me the results and said nothing appeared to be wrong.  He recommended another visit in a year.

So 9-10 months after the event, and 3-4 months of unsteadiness with the occasional spinning world, my vertigo experience was over.  I had found out that on one side I had a slight balance issue. Note I have never fallen other than a couple of times on the trail in slippery stuff.  And other than this period, I've never had balance issues.

My take away is that in most cases, doctors don't have a clue.  They are well trained, knowledgeable, and professional.  If you have a standard problem with obvious symptoms, you are good.  But the system cannot move fast enough to get you to a specialist while episodic symptoms are still severe.  Cancer, of course is different, as it doesn't usually go away.

I had 10 months of waiting for appointments that never determined what caused the episode and never provided any relief from slowly disappearing symptoms.  I do think the physical therapy helped as it stressed my balance system and allowed me to regain my confidence.

My wife has had a different kind of experience.  She has asthma, allergies, and gets periodic infections as a result.  She seems to have about a 50/50 opinion about her doctors.  Some she says are idiots and some she likes.  She seems to have to go to the ER to get antibiotics as she cannot get seen soon enough at her primary care when she gets an infection.  She's had a strong cough now for quite some time, and they cannot fix it.  I won't go any further, but she too doesn't think much of the military health care system.

The reason I went through all of this is to point out the drawbacks of a Medicare for All or single-payer government run system.  Care is rationed, no matter what you think.  And you won't be happy waiting for over a month or several months when you have a serious problem.  And you also won't be happy that doctors are forced to follow government guidance (on medicines and tests) on how they treat your problem, whether they agree or not.

Please take my advice.  Don't vote for anyone advocating government run health care.

Wuhan Virus IV - It's Not the Virus Hammering Our Economy

Last night, I was furious.  My wife claimed our county, we are adjacent to Bexar county which contains San Antonio (Bexar), had prohibited all dining-in in restaurants.  While Bexar is huge and densely populated (1.94 million), our county is huge and mostly rural (141 thousand, with one medium size city and a bunch of suburbs).  We have no GrugHub, no DoorDash, no UberEats. The medium sized city is mostly restaurants and stores.  The people commute in to San Antonio (for the most part) for work.  I've heard that our county has one person confirmed with the Wuhan virus.

I suppose it's the 'thing to do' for mayors or county managers to close their businesses and drive them into bankruptcy.  As an article in the Washington Times said, "...amid growing signs the virus that started in Wuhan, China, will hammer the American economy."  But it's not the virus that is hammering the economy.  No businesses (except maybe the nursing home in Washington) are closing because their staff are sick and aren't showing for work or the customers are sick and are staying away.  It's the politicians and CEO's that are putting people out of work and shutting down businesses.

What I don't like is that it appears a local 'Lord on High' can declare a health emergency and tank their economy.  They don't order quarantine of the sick (it's voluntary unless you are in the ICU), order special protective isolation for those at high risk, order massive testing, or modify their local production facilities to provide more medical products and items.  No, they just order the economy shut, with the hope that the virus won't spread.

I get it that elderly and those with bad medical conditions are at risk.  Isolate them, and get them supplies.  Everyone else do social distancing and good hygiene.  If the 'Lords' see a local outbreak, take drastic measures.  But keep the economy running!

One complaint I have about a lot of actions by judges and city/county managers is that they take actions that are not supported by law.  I don't see how when all the restaurants in a county have not broken any laws, they can simply be run out of business because of fear of something that might happen.

So I went online to 'google' how a city or county can justify ordering businesses closed.  To me, it's not enough that a manager or judge thinks people are at risk.  We have a country of laws.  If the law does not allow taking a property arbitrarily (like the Constitution prohibits), they shouldn't be able to order them shut down either.

I found nothing explicitly out there to answer my question.  But I did find a Dallas (Texas) county judge's ruling that he was closing all restaurants except to take out and drive thru.  He cites a Texas Code 418.108.  That talks about disaster/emergency actions allowed by the state and counties.  Mostly it talks about situations where they have natural or man-made disasters and war.  They explicitly talk about situations with great loss of life or property or where that loss is imminent.  The code actually says county/city officers empowered to enforce emergency management, and county judges, may issue emergency declarations to allow/deny access to disaster areas.  It also talks about defining those areas.  The other actions allowed are the normal disaster support stuff.  By the way, the county judge has priority in Texas over the city/county managers.  I'm not sure why the legislature would think that wise...

But the Dallas county judge didn't define any disaster area and limit access.  He said people cannot go into any restaurant and sit down and eat. I'm talking about maybe 1,000 restaurants where there has been no evidence of Wuhan virus. What's to prevent any of these little Lords from saying you cannot go to work, or all businesses with over 10 people have to close?

I watched China lock down all of a city/province, not allowing people to leave their homes even for work.  And I thought, that cannot happen here.  Many pundits claimed we are better prepared and wouldn't need or even allow such lockdowns here in the US.  The President, rightly, has issued a National Emergency (they say 7 of those happen every year, most people don't even know about) to free up funds to use for this crisis.  And he even made a set of recommendations for social distancing and isolation.  None of which said to close small businesses or shut down restaurants.  

But the little local Lords all panicked and now we are going to tank the economy.  Not because of the virus, but because of fear.  Where are all those plaintiffs that stop every Presidential executive order at the courts?  All of them think it's okay to allow a local Lord to kill their livelihood?

Wednesday, March 18, 2020

Wuhan Virus III - Telework & Economic Reality Sets In

So this morning I saw at least three articles that reflect my pessimistic outlook for government mandated closures of businesses.  One in the New York Post, one in the Washington Times, and one by Tucker Carlson of Fox News.  I think obviously the federal government grasps the concept with their $1 trillion push for money to furloughed or laid off workers and small businesses.

Then we see Governor Cuomo's latest edict.  All New York businesses must now allow 50% of their employees to work from home.  How does that work with a manufacturing plant, a bakery or dairy, a hair salon, or any other service industry?

It's easy for people to say telework, it's much harder to actually do it productively.  Sure, writers and journalists can send in their work product.  Programmers can usually do remote coding from home if the project isn't sensitive or classified.  Federal HIPAA laws won't even allow sending medical information over non-secure communications or to third parties.  How can a doctor or nurse work from home even if it's just giving advice?

If you are an office worker, telework is a possibility.  But generally, you have to have access to the company telecommunications system (email, messaging, chat), it's office apps, and the company sensitive databases.  Sensitivity may be due to personally identifiable information that is either protected by law or exposes company liability for disclosure, or it may be proprietary or actual classified information the company doesn't want to disclose.

So to telework from home, you either have to securely log in to a computer at your company or you have to have much of the same software on your home computer you do at work.  Hardware, software licenses, and data bandwidth with your ISP all cost money.  And usually these are procurements that will take weeks.

By the way, after I had a cancer operation (with side effects), I teleworked (at various levels) for about six months.  The side effects (embarassing, so I won't describe them) got less over time, so I went from about 80% of a week at home down to 20%, then went back to work full time.  There were tasks I couldn't do because of classification issues, and meetings I couldn't avoid where unclassified connections weren't allowed.

So a mandate of at least 50% teleworking at EVERY New York company is just plain stupid!

I'm hopeful that we'll actually see a strong inflection (drop) in the rise of new Wuhan virus cases over the next two weeks--during the 15 day period the federal government is calling for social distancing measures.

That would give them the opportunity to back off modestly on the social distancing and allow small businesses to recall some of their furloughed workers.

If that doesn't happen, the $1 trillion fed push will make 30 days of economic cessation survivable and recoverable.

Beyond that, either we need to start accepting health risks, or we need to prepare for a significant economic recession that doesn't go away for a long time.  If the latter happens, my guess is the federal government goes socialist with the Democrats' 'free everything' plan implemented.  I really don't want to live in that world.

Monday, March 16, 2020

Wuhan Virus II - Flattening Theory & Unintended Consequences

My last post showed a bit of emotion on how I felt about forced closures of schools and businesses.  Now I would like to take a step back and address this at a more theoretical level.

First, people everywhere say that the government wants to flatten the curve of the spread of the Wuhan virus.  That means instead of a tall brief hump (e.g. a narrow gaussian curve) they want a long shallow hump.  China's situation showed that the tall brief hump might take 2 months--the time they took for the new cases to start significantly dropping.  I presume an anticipated flattening will then take 4-6 months or more.

The goal of flattening though is to prevent overwhelming the medical and hospital services.  Supposedly, a flattened curve will mean they don't run out of ventilators and other supplies and medicines and fewer people will die.  Thus pushing flattening is based upon prioritizing minimal loss of life.  But prioritizing one thing always de-prioritizes other things.

In a poorly run situation, those other things include the jobs of workers, the continued operation (versus bankruptcy) of businesses, and the income and taxes of those lucky enough to keep working.

How do I define a poorly run situation?  Panic directives made by local, city, and state governments.  We have plenty of disagreements at the national level that will minimize the chances of bad large scale fallout.

But we have a federal system that decentralizes many government decisions.

So when a local government decides to close schools, restaurants and retail establishments they consider non-essential, just to provide social distancing and minimize the spread of Wuhan virus, there are unintended consequences.

Take Ohio as an example.  They had 5 cases of Wuhan virus as of yesterday, and they closed all restaurants and bars in a 12 million person state. So .00004% of the population were sick with the Wuhan virus.  But they put what, a million people, out of work with a simple state directive.  Do you think this might be a bit too early in that curve when we are at the very start?  You've put those people potentially out of work not just one or two months (tall short curve) but up to 4-6 months (the flattened curve).  How many of you can survive on your savings for 2 months, let alone 4-6?  They are going to have to expand food stamps almost instantaneously to support those people.  And where does the money for those food stamps come from?  Have the feds authorized it yet?  I'm sure they will.  But you don't think they are going to raise taxes on those who still work?  And anyone that goes back to work later?

And how many of those restaurants and bars will survive a 4-6 month shutdown with no income?  Oh, you say the government will give them a loan.  I'm sure those owners just love the thought of paying back another loan, even if they were surviving on a cash flow basis and weren't paying off startup loans already.  But who pays for those loans?  More taxes.

Then as I mentioned yesterday, you have other closures, schools being the big one.  All those kids keeping mom or dad from working because they cannot leave the kids with the grandparents.  More loss of income, assuming you have a two parent family.  Loss of all income if you are a single parent.  And surely most essential workers are parents too.  Who fills in for them?

Think about the children and working age adult situation.  Children don't get any significant illness.  They can be a carrier and pass it on to their parents who are middle aged, almost all under 50 years old.  They don't get significantly ill either unless they have underlying medical conditions.  What you don't want is children or parents in close contact with grandparents (50-90 years old).  Most of them are not anyway.  Co-dwelling extended family groups are rare now in the US.  Most young people move out of their parents house when they get permanent jobs and grandparents stay in their own homes or move to assisted living centers.

Problem is, if the Wuhan virus does not mysteriously die out by late spring (as the flu does yearly), these local government directed closures are going to ruin the economies of their regions, and do great damage to the national economy.  But the economy reflects your livelihood.  Your chances of work, income, leisure, and freedom.  It's not just an abstract 'the economy.'

Now let's look at what might happen if local and state governments held off till they had serious problems.

People will get sick.  Most everyone will self-medicate unless they are over 70 or have serious other medical issues.  One Washington doctor said the number critically ill, requiring hospital or emergency care is now about 5%.  She thought the death rate might be as low as 0.1% or 1.0%--that is the percentage of those that get sick.

Everyone 70 and older (and most 60 and older) will self-isolate and stay in.  They can probably get food delivered to their homes or if they must, go out with gloves, masks, and sanitizers while staying away from people in public.

So let's say 50% of the population were to get the virus in the next 3 months.  I kind of think of that as a worst case, but whatever.  Out of 329 million people, that's 164.5 million.  The population 70 and over is about 10% of our total, actually around 35 million.  So if they acted like everyone else, 17 million would get sick.  But they don't act like everyone else.  They don't work and they won't expose themselves unnecessarily.  The 5% that get critically ill figure amounts to about 8.2 million of that 164.5 million.  So that seems a reasonable guess as to the number of elderly (over 70) that would actually get critically ill.  Of that number, 160 thousand to 1.6 million might die.  That compares to the number of deaths in the US annually of about 2.8 million.

According to the Internet, it takes about 3-6 weeks to recover (if you do) if you are seriously ill.  Assuming  a two week hospital stay for each, that allows for at least four 'turnovers' during a two month worst case hump.  So at any one time, about 2.05 million would need hospital care in an 'unflattened curve'.  Google says we only have about 900,000 hospital beds (way down from earlier years).

That is bad.  We really want to avoid the brief tall hump.  But spreading it out isn't intended to change the number of sick, only how many are sick at one time.  According to my calculations, you need at least a 4 month long hump to not overwhelm the hospitals.

But a 4 month hump with everyone out of work and home from school ruins the economy and YOUR livelihood.  I didn't even mention potential rampant inflation when the feds print money to cover all the loans and emergency help everyone needs, demands, and expects.

So closing schools and businesses early has a potential dark downside, the ruination of the US economy, that we need to avoid.  Sure, like Scott Adams said, he doesn't see individuals panicking.  But local politicians, driven by medical professionals that want to avoid overwhelming their hospitals, seem to believe that mandating separation at the expense of their citizen's livelihoods is a better short term measure.  Of course its not just medical professional advice, its fear and pressure from voters.  But I don't believe most of them weigh the risks and potential consequences.

They need to think longer term, and they need to think about individuals' jobs and income.  Flipping their panic switch too early will be way worse than waiting a bit too long.

Sunday, March 15, 2020

Wuhan Virus I - Economy Destroying Safety Measures

Government, especially governors and mayors, need to stop and think about what they are doing.  It was my understanding we were trying to flatten the contagion curve, not stop the virus.  And do it without destroying the economy.

[Update:  The only change to the original has been the title number.]

I was all in for bans on large gatherings, social distancing, preparation for isolation, and good hygiene.

But this isn't China.  You cannot just stop a business for 1, 2 or 3 months, then order it to start back up.  The business will go bankrupt.  I doubt most operate on a cash basis with no debt.

What does a waitress do to buy food and pay bills when a restaurant is ordered to close.  In God's name, I hope they all have bought long-term supplies of food.  I doubt anyone will shut off their electricity and water.  But their credit card debt, car loans and house loans are going to go into default.

The restaurant won't have any income to pay the waitress.  The National Emergency loans up to $50 billion won't get disbursed quickly, and it won't be enough.  The restaurant also won't have income to pay its lease, buy supplies, pay for the food in its refrigerators and freezers that are going to spoil.

Then take the schools, with the kids that everyone says are almost virtually immune to the virus.  When they go home because a governor or mayor ordered schools closed, at least one parent is going to have to stay home with them.  That parent cannot go to work.  It's easy to say telework, but most of the work in this country is not people just sitting at a computer all day.  Half the under 45 crowd is going to have to stop working at their job.  The business is not going to have those people producing products or making money for the company.  The company won't be able to pay them.

I really doubt that all those people running our infrastructure systems (water, electricity, waste, transportation, etc.) don't have children.  Do you want the lineman in your neighborhood at home with the kids during a thunderstorm when a tree falls on the power-line bringing you electricity?  Or the engineer that know how to handle a pump failure in the water distribution system?  Or the fire man that is going to put out the fire in an apartment building?

Then closing all retail outlets except pharmacies and groceries.  The US was supposed to have converted to a services economy after manufacturing left.  What do you think services are?  People supplying goods and services to others.  By definition it requires interaction.

Then what about the remaining 25% of jobs, businesses and government organizations that are not ordered closed?  Those people still interact, usually in large groups.  I know the defense organizations I worked for won't close, cannot telework (classified operations), and are forced into small spaces to save building, construction and maintenance costs.

How do you think those people are going to feel being forced to 'socialize' when most others are staying at home?

And we did all of this when (as an example) Texas had 50 cases diagnosed out of 29 MILLION people.  They didn't wait till the last minute.  They started closing everything when they are saying most everyone, except in pockets of contagion, has a low chance of getting sick.

Flattening the curve--extending the pandemic--may be great for keeping hospitals from getting overrun.  But if you extend that curve from 30 days to 90, 120 or longer, you just kill the economy.  We will become a socialist nation because we have to.  No businesses will be able to come back after that without government help.  Who pays for that help?  We do.  And there are a LOT of businesses in the US.

Scott Adams said today that he saw no panic.  I say the response you are seeing is insanity.  Get a grip and live with the risk.  Or lose your nation.  I hope it's not too late, or that Wuhan virus somehow disappears in the next 3 weeks.

Saturday, March 14, 2020

Joe Biden's Mental Decline II

Seems like a good time to do an update on the democratic primary process.  For the rest of this blog, I'm going to just assume Joe Biden is having increasing mental/cognitive problems.  Maybe it's dementia, maybe it's Alzheimers, maybe its something else.  If you disagree, stop here.

I was wrong, as of now, in my guess that he wouldn't debate Bernie Sanders.  However, the DNC did update the rules to eliminate Tulsi Gabbard, and actually anyone other than Bernie and Joe.  They required any debater to have at least 20% of the convention delegates from previous primaries.  Since at the time both Bernie and Joe each had more than 40%, no one else could be eligible to participate.

Then both Bernie and Joe canceled any rallies because of the corona virus.  This is quite a win for Joe as he's ahead, and it means almost no opportunities for the public to see new examples of mental decline.

I'm guessing at Sunday's debate we'll see Bernie enthusiastically advocating for his policies while Joe shows his 'vitality' by attacking Bernie (and Trump).  Bernie refused to attack Hillary, and I suspect he will do the same with Joe Biden.  Joe will not return the favor.

Actually, since Bernie stabbed himself in the back by praising Castro, Joe has an apparently untouchable lead in the primaries.  He can actually afford not to even both with Bernie at the debate.  If they had been neck and neck, it could have been different.

So all Joe really has to do at this week's debate is hide his mental decline.  Medication, a short debate, sitting (versus standing?), and sticking to a few talking points might get him through it.

You notice, it doesn't matter anymore whether someone answers a moderator's question.  A moderator could ask whether the candidate thinks the sky is blue, and a candidate could talk about drought in South America, and they would just move on to the next question.

After that debate, Joe still needs to get to 50% of the delegate total.  I don't think anyone doubts he can do it, since no one else is running.  It appears the democrats think they can shore up the ticket with a strong, mentally clear, vice presidential candidate.

But Joe will still have to get through one or more debates with President Trump.  At least most people think so.  I still think Joe will refuse to debate Trump.  Guess we'll see.

Coronavirus VI - Update

OK. Now I'm starting to get a bit irritated.  I warned my wife there would be runs on the stores several weeks ago and we ought to get some non-perishable food.  She pretty much told me to shove it--that I didn't know what I was talking about.  Now the local stores are empty, not just of sanitizer, but most food.  And she's blaming Trump.

I'm not sure how she expects a president to keep shelves stocked in a capitalist economy.

But what really irritates me is that people didn't buy just a bit more, they went all out at emptying the stores.  I really didn't expect empty shelves for most food items.  Do people have empty refrigerators, freezers and pantries during normal times?  Empty space that would allow them to do massive stocking?  I guess they can fill up the kid's bedroom with canned goods.

But from what I can read and infer, production and shipping of most items has not been severely impacted.  Supplies should be getting to the stores, just like Amazon continues to deliver (items not associated with cleaning and sanitization).

Another thing I had worried about early, but at least recently have discounted, is the possibility that electricity or water supplies could be curtailed.  But I haven't heard of any lockdowns where those essentials have been cutoff.  Not Wuhan, not Italy, not even the one-mile radius that New York imposed.  Apparently, government is at least competent enough not to intentionally start riots and kill people with no electricity or water.

Second, HEB (our local grocery monopoly) has apparently said it may close some stores--temporarily?  My wife points to the empty shelves.  But HEB prides itself, and advertises that it buys local.  But there are no stories on the news or online that supplies cannot get to the stores, only that they are being sold out.  Intermittent empty shelves may create some unhappy customers.  But same input (slow) and same output (quick) seems to me to imply that profitability should not be affected.  Why would a store close unless their supply stopped or unless customers stopped buying?

Restaurants to me seem to be the highest risk small business in my area.  I know I won't eat in a fast food restaurant until this is over.  They didn't clean their tables even before this 'pandemic'.  But I can take a Clorox wipe with me to a sit-down restaurant and feel fairly safe--as long as no one is coughing around me.

It's the actual extent of the spread of the virus through the community that seems to present the greatest unknown, and worry.  Johns Hopkins says 43 people in Texas (out of 29 million residents) have the virus.  I assume they are quarantined or self isolated.  They may be the people at Lackland they brought in from the cruise ships.  Anyway, either the virus has spread unnoticed (i.e., most people get mild symptoms), or very few people have it.

Now minimizing social distance and trips out seems wise.  Having a decent stock of food and cleaning supplies is always good.

Better yet would be widespread testing of everyone to show that 43 out of 29 million is the true number of corona virus cases in Texas.  And we would be free to go out!  Testing only the severely sick may be economically practical, but it is a fool's solution if you want to continue with a strong economy.

I'm assuming the government is doing whatever it can, as quickly as it can, to prepare for a more significant spread.

But it ought to be also working to get widespread testing for the general public to allow for a calming effect, and for targeted care of the sick and those who may spread the virus.

It's been warm the past week.  I hope spring is here for good, and the virus will back off.

Wednesday, March 11, 2020

Speculation on Coronavirus V - It's Not the Flu

This morning, I read two articles (relevant to this post).  One was from a doctor in Italy who has seen his hospital overwhelmed with corona virus victims.  Nothing else is being supported.  Most are dying or nearly dying with double pneumonia.  He says many doctors and nurses are infected and have spread it to their families. The patients who aren't going to make it aren't getting meds to save them for those that they will help. Then I read an article by a retired Lt Col marine.  He thinks the stats are much worse for the flu.  No need to panic.  Just wash your hands, spray or wipe everything, and minimize social activities.

According to the marine's stats, if I happen to get the virus, I have a 3.6% chance of dying (my age group).  He doesn't list my somewhat younger wife with asthma.

But suppose a large percentage of the elderly people you know are all in the hospital with pneumonia.  How do you think they are going to help the people with less fatal problems?  It's not going to happen.  If you break your leg or have an ear infection, will you want to go to the hospital?  Do you think they would spend time on you even if you do?

Hopefully, it won't get that bad in my area or yours.  But it might.  Acting like its just another flu is a ridiculous response.

And I don't know what your local situation is, but there's been no hand-sanitizer, clorox, or iso-propyl alcohol on the shelves in my area for a couple of weeks.  No masks either.  And it isn't available on Amazon.  How do people continue to wash, wipe and spray if they don't have any?

Monday, March 9, 2020

Speculation on Coronavirus IV - Nonsense Reporting

I was about done with my series on the corona virus.  But today's lead posts on Fox and the New York Post made me reconsider.  For example, on Fox, one post said coronavirus is very transmissible.  The next one said it is less than that of the flu.  Which is right?

But first of all, I'm tired with 'the panic is worse than the virus.'  Tell that to the people that died, or the people stuck on infected cruise ships, or locked down in their apartments for over a month in Wuhan.

I'm also tired of comparing world-wide flu strain deaths (68,000 to 80,000 per year??) with a new virus (3,400+ deaths).  The comparison is just nonsense unless you are trying to convince someone that covid-19 is not that bad.  Even then, the comparison remains nonsense.  We have flu vaccines that almost anyone can afford.  Everyone knows they have a chance of getting the flu, and they know the process to seek medical care.  I defy anyone to effectively defend the flu infection numbers they report.  The deaths are probably pretty accurate, but no one has ever tested anyone I've known for the flu.  If they don't have a fever, they claim it's a virus instead of bacteria.  In either case, they treat the symptoms.

With the new coronavirus, they have tested a relatively small group of people, and for some reason, say they are "presumptively" positive.  That tells me they are making a guess.  When they come down with the coronavirus and enter the hospital, they claim an active case.

My point is, it is presumably (I'm guessing too), early in the spread of coronavirus.  It appears that no one knows whether it is actually worse or not as bad as the flu.  Though the high incidence of death among the elderly and those with existing health conditions suggest it is significantly worse.

Maybe it will slowly decline as warm (and humid?) weather comes to the northern hemisphere.  But that is a guess; maybe a good guess based upon experience with other viruses like the flu strains.

But the flu comes back every fall and winter.  It's quite possible coronavirus will spread out through the population and come back harder next fall.  Will we have a vaccine?  Some reports have indicated that early reports of vaccines for previous viruses like SARS have not come about.  They complained that funding was dropped, and I suppose there was no profit anticipation for the pharmaceutical companies.  Will vaccine efforts be dropped in this case too?

Finally, a few words about the Wuhan lockdown.  From what I've read, China also locked down each apartment complex in the city.  People were getting their food by large scale delivery from the groceries.  That is a much more extensive lockdown than I think is feasible in about any US city.  New York might be the possible exception.  In most cities, most people do not live in mass apartment complexes.  Instead, they are in individual dwellings.  A city like San Antonio has a huge population, but I would guess that over 75% of the population lives in individual dwellings throughout the county.  In such a situation, people either have a stock of 2 months of food, or they all have to go to the grocery.  And much of the population won't have the opportunity to stock for that long, or the resources or space to do it.

Further, no US governor or mayor wants to inconvenience their voters or damage the economy in their area.  That doesn't mean that some democrats wouldn't be unhappy causing mild panic with ineffective states of emergency that might hurt President Trump.  But actually locking down neighborhoods, towns, or cities with criminal penalties isn't something most politicians in the US will do until it is too late.

My take away is that we just don't know.  Be as prepared as you can, but don't hoard.  Take precautions to minimize your chance of infection.  Don't attend large functions just because your mayor or governor says the risk is low.  If they actually develop and offer a vaccine, take it!

Friday, March 6, 2020

Joe Biden's Mental Decline

There was a story on Legal Insurrection this morning where someone used the term 'cognitive decline' when talking about Joe Biden's inability to talk through a concept.  I think that's better than 'mental decline' but hated to reuse someone else's terminology.

What I actually wanted to talk about was how I think the media and DNC are going to protect their presidential front runner, Joe Biden, from any exposure of his probable mental disability.  That is, any poor performance significant enough to impact his chance of being elected.

Personally, from what I've seen of transcripts and short videos, it looks to me like he's got some kind of Alzheimer's or general senility that prevents him from speaking coherently when he's not reading from a teleprompter.

If that is so, what I expect the DNC to do is cancel any future Democratic debates, especially any that are two hours or longer.  They may have one or two that are an hour long, if they think Joe's meds or his stamina can last that long.  But I really suspect they will announce that the multiple previous debates plus all the town halls have been enough to present the primary voters with a stark choice between Joe and Bernie.

That will have the additional benefit of the DNC not having to change the rules to eliminate Tulsi Gabbard from future debates.

If Joe is the democratic nominee, and President Trump wants debates, I expect Joe will claim that he is unwilling to be on the same stage as an illegitimate president and reprobate like Trump.  Obviously, I think President Trump is a great president, I'm using words I think democrats would say.

All of that would mean potential voters won't get to see anything but a few brief, scripted, teleprompted speeches by Joe Biden between now and November 2020.  If, as I suspect, 80% of the voters have not seen anything of Biden since he was VP, this will greatly improve his chances of winning.

Tuesday, March 3, 2020

Speculation on Coronavirus III - The San Antonio Error

My planned discussion of the Wuhan lockdown will have to wait for another day.  I live north of San Antonio, and yesterday, the CDC released one person from Lackland Air Force Base that had supposedly finished quarantine with two negative tests for COVID-19.  Then a third test came back positive.

I don't know whether the person had recovered, or was never ill.  But he/she went to the Holiday Inn Express, then on to one of the city's bigger malls. The individual ate at the food court and shopped in several stores.  The individual was then sent back to Lackland.  The mall was closed and 'disinfected.'  The city and county declared medical states of emergency and forbade any quarantined or formerly quarantined individual from entering the city or county.

I thought it was peculiar when the CDC distributed returning citizens at various military bases across the U.S.  I figured they must not have sufficient quarantine capacity at any one facility.  But it sure seemed like a recipe for causing multiple contagion points.  And Lackland is awfully close to the center of San Antonio.

I've been telling my wife to stock up in case there are runs on food and other materials, and she's been effectively ignoring me.  That's a polite way of describing her reaction.  Then late yesterday, she went to the store to get some things.  Apparently, most of HEB (the Texas grocery monopoly) and Walmart were both nearly empty of food and overrun with people hauling water and other stuff out.  She was pretty upset.

Most of the conservative bloggers I read are saying the coronavirus is nothing more deadly than a new strain of flu.  And they may be right.  But that doesn't take into account the panic the public will show from all of the 'world ending' news reports.  And San Antonio's state of emergency is sure to rile up everyone down here in south Texas.

FYI San Antonio is a true democratic hotbed.  The surrounding counties are republican, but San Antonio and it's county, Bexar, are democrat.  So a democrat mayor issued a state of emergency.

I don't like panic inducing news and actions.  I do advocate being sure you have a reasonable water and food supply.  But don't overdue it.  Make moderate purchases and keep a good long-term capability that you can use for storms and long electricity outages.

On the other hand, I do agree with the city's actions at forbidding previously quarantined people entry into the city.  Unless they happen to live here.  Since the subject individual went to a Holiday Inn, I presume the individual is not a resident of south Texas.  That agreement would change if the CDC could show that it's testing and isolation procedures were reliable.

But having two tests showing negative, followed by a positive (after release of an individual) indicates one of a few possibilities.  First, illness from the COVID-19 might be recurring.  It appears to go away, but you still have the virus, and it takes hold again.  Since the individual seemed one of the first to be released, I think it likely he/she had shown no symptoms.  So this possibility likely didn't happen in this case.   [Update: I've read news accounts where this individual initially tested positive, so this might be the situation with this individual.]  Second, the quarantine process is not very effective.  The individual probably got exposed sometime in the 14-day no-symptom period, and the density of the virus did not increase to a detectable level till the last test.  This seems the most probable situation and suggests an extended quarantine period and better isolation procedures are needed.  The third possibility is that the test is just not reliable.  That could easily be the case.

Any of the three possibilities are worrisome.  I don't think they can contact all of the possible people that were exposed.  It probably numbered in the hundreds.  I guess we'll find out just how contagious COVID-19 is, a little sooner than I expected.

Monday, March 2, 2020

Speculation on Coronavirus II - The Numbers

I won't give my introduction again, see my first post "An Introduction."  What I will remind any readers is that I am not a doctor.  This is my speculation.  And it may all be nonsense.

I won't try to quote specific numbers, and here I am focusing only on China.  What I saw in the reporting was that China's infected numbers grew to about 75,000 and then seemed to stall.  In the meantime, numbers started growing around the world.

From all reports, it seems easy to catch.  People on ships, people traveling to Italy or China, just about anybody in contact with an infected person seems to get sick.

An early BBC report from China, after they isolated the city in Wuhan, showed that they allowed people to go in, but not to come back out.  At least that's what the crew reported.  They then went in, and a little while later, Chinese police escorted them back out.  Peculiar.  Also, a recovered Chinese national claims that when he went to the hospital early in the epidemic, the Chinese medical staff were wearing full HAZMAT/infectious gear that he had seen only in movies.  The Chinese seemed to think it spread easily.

So why did the Chinese numbers stop climbing?  Either the numbers actually stopped climbing, the Chinese are lying, or they simply stopped testing/reporting on the numbers.  I hope the former is true, but really suspect they've stopped formal testing and/or reporting.

Think about the quarantine or isolation procedure.  Suppose in a city of 1 million, 20,000 people have the virus, and the government stops people from leaving the area.  Would anybody enter that didn't live there?  Further, suppose they had an extremely large infectious disease isolation capability at the city hospitals that could handle 1,000 people at a time.  The rest (19,000) are told to self-quarantine at home.  Do they go to the store for food?  Or do their relatives, who then have to get the food to the infected person, do the shopping for them?  Self-quarantine, except for the survival hermit out in the woods, is not going to stop person-to-person contact with the sick.  Of course, everyone is going to minimize person-to-person contact and hopefully use good hygiene procedures to minimize contagion.

While the spread may be slowed, it's going to grow from an ever-greater base.  19,000 will become 25,000 then 30,000....  With the 14-day incubation period, there's going to be person-to-person contact.  But now, who's going to get the test kits into the city or the medical supplies needed?  I presume the Chinese army would use HAZMAT protection to deliver food, medicines and supplies.  At least to the extent protective gear is available.

They say half of the population of Wuhan left before the lock-down.  Some of those must have been infected and would be spreading it further.

I just don't understand a stall of the numbers.  Unless masks work, or most people are on a self-sufficient homestead and do not need or desire to socialize or shop, the numbers should not have stalled.  Most likely, it's the Chinese government not reporting numbers that would induce a panic.

But there might be one other situation where an infected-number stall is reasonable.  Oftentimes, you need a certain 'number' of pathogens to get sick.  Your body can fight off a small number, in many cases.  Suppose a high-density release started the epidemic, and high population interaction extended the initial spread.  Then the Chinese minimized person-to-person interaction, all of the sick started wearing masks, and good quarantine was provided to the really sick.  The spread per person might drop off with each 'wave' of newly sick.  Resulting in an eventual stall.

I suspect that happened with SARS.  But I don't really think it happened with COVID-19.  Since most of the symptoms look like flu, unless you do the right tests, it would be easy for China simply to classify most non-lethal cases as flu rather than coronavirus.  Simply order the hospitals to stop doing COVID-19 tests if the patient does not need the ICU.

Anybody see any CDC or WHO reporting from on-site Chinese health facilities in the affected areas?

Speculation on Coronavirus - An Introduction

If I actually hit the publish button, this will be one of a series of posts on the coronavirus COVID-19.  It is totally my speculation about what has, is and will happen.  I'm not a doctor.  My Ph.D. is in physics and electrical engineering, so I am good at solving problems.  But any or all of this could be nonsense!

From the numbers posted by Johns Hopkins University, the death rate for those diagnosed with the virus is now at 3.4% (March 2, 2020).  Reports seem to indicate nearly all deaths are the elderly or those with pre-existing health conditions.  For some reason, the accepted 'truth' is that the death rate is between 2 and 3 percent.  I'm not sure how they make that conclusion, but I suspect they are assuming there is a significantly large undiagnosed group of people with coronavirus--that have not died.

Either way, that means if the virus spreads in your community, you might expect one out of thirty to fifty people that catch it to die.

They also 'say' that the virus survives longer outside of the body than the flu, that it can 'hang' in the air longer, and that it may also be spread through fecal matter.  I would therefore guess that it is significantly smaller than the various flu viruses, and can probably penetrate cells easier.  Combined with the fact that you cannot tell whether a person is infected before symptoms show, and that a number of people have recovered (according to CDC tests) and then later tested positive again, one has to assume that this spreads much easier than the flu.

That is, if it gets out in your community, a lot of people will catch it.  That doesn't mean they will all show bad symptoms, get very sick, or even die.

One thing about the source of the virus.  It seems pretty amazing that China's most infectious bio-research facility was a couple of miles from the alleged food market where they say the infection started.  It seems more likely than not that COVID-19 was part of a Chinese bio-weapon or bio-research project that accidentally got out.  It's ease of spread, and worse-than-flu effects, seem consistent with a man-made or man-modified virus.

There are two things that really concern me about the virus and what happens in the future.  First, my wife has asthma and her lungs are not in good shape.  I'm really worried that she might catch it with a bad outcome.  Second, China and Italy have responded by isolating communities.  Some schools in the US have been closed.  If the virus spreads and the death rate stays high, we may see community closures throughout the US.

The problems with a city or town closure are how to distribute food, water, fuel and electricity safely.  I saw a run on gasoline a couple of years ago after storm damage to off-shore and near shore facilities.  The gas at stations disappeared in a day.  Luckily, gas availability returned in a few days before the cars ran dry and people were stuck.

But what if a city closure means no gas and diesel trucks get in.  No food gets to market.  Will the electricity grid stay up from power stations outside the isolated city? What about city water? How will they get their fuel.  With a claimed 14-day incubation period, you figure any isolation is going to be a minimum of 14 days and probably 30 days or more.  How many people keep that amount of food, water and/or fuel around?  If the U.S. starts to isolate cities or communities, there are going to be runs everywhere--on everything!

Clearly, the spread of COVID-19 is not at that point in the U.S., and President Trump has done a good job of delaying or slowing down the spread in the U.S.

Obviously, I don't want a panic, or think that one is appropriate now.  I do think you should start thinking about where you would get water and how long your food would last if they said no-one was going in or out of your town (without HAZMAT clothing) for the next 30 days.  Personally, if current outcome probabilities are accurate, I think town/city/region closures would be much more destructive than the virus.  They should be avoided in almost all cases.

One last point.  I'm pretty disgusted about the Surgeon General and others deriding citizens for buying face masks.  They claim they don't help prevent catching the virus (point 1), then they claim they want the masks available to protect doctors and nurses (point 2).  If they don't help prevent catching the virus, what good are they to doctors and nurses?  I know this is over-simplified.  But pass a law that in a national medical emergency, the Government can prioritize purchase/delivery of medical items to medical facilities and professionals.  Don't expect citizens in an open market to not make a choice in their individual best interest.