 |
| SARS-COV-2 - lipid bilayer with ACE2 binding s protein spikes. |
It seems the future is currently flying at us on a daily basis, so I'm still finding it hard not to hyper-focus on events and feel I may as well use this blog for catharsis.
I've ended up spending quite a lot of time talking about the antics of politicians, which I'd normal tell others to ignore, but in this instance the situation is so heavily dependant upon exactly what measures are announced, when and how the public reacts.
Index:
2020-03-29 Sun - Pointing Fingers
2020-03-30 Mon - Missing reports, farm labour, excess oil, Korean expert
2020-04-02 Thur - Symptoms, Vit treatment, Exit strategy
2020-04-03 Fri - Developments (under-reporting deaths in Europe vs China)
2020-04-04 Sat - Followup
2020-03-29 Sun - Pointing Fingers
2020-03-30 Mon - Missing reports, farm labour, excess oil, Korean expert
2020-04-02 Thur - Symptoms, Vit treatment, Exit strategy
2020-04-03 Fri - Developments (under-reporting deaths in Europe vs China)
2020-04-04 Sat - Followup
2020-04-05 Sun - Science - GAVI, CRISPR, summer reprieve?
2020-04-06 Mon - Science 2 - ICU survival rates, Bio-molecular basis of virus
2020-04-07 Tue - Science 3 - BP med danger? Bio-molecular simulation explain all?
2020-04-08 Wed - Unintended Consequences (Advertising apocalypse, BoJo in ICU, etc)2020-04-06 Mon - Science 2 - ICU survival rates, Bio-molecular basis of virus
2020-04-07 Tue - Science 3 - BP med danger? Bio-molecular simulation explain all?
2020-04-10 Fri - Unequal impact (racial, economic and geographic inequities)
2020-04-12 Sat - Dissecting government decision making, cats & dogs and creativity
► 2020-03-29 - Pointing Fingers:
• The domestic coronavirus outbreak seems to have given Boris Johnson (and other incumbent leaders around the world) political invincibility. The 'rally around the flag' effect has him up at a 73% approval rating, the highest for any conservative government since such metric began in 1943 [Bloomberg].
Which makes sense during a crisis or war, generally. This certainly fits with the vibe I get when talking to most of my friends (those who aren't politically polarised already). Although I saw one post hinting that there may also have been some astroturfing, with copy-pasted supportive sentiments on social media [Twitter]. (Probably insignificant in this context.)
• That record polling was even unaffected by the announcement of his infection (and both health secretaries, etc). Which The Daily Mail has attempted to pin on the EU, via chief negotiator Michel Barnier, who was also diagnosed a while before [The New European]:
It's laughably implausible, given Barnier's not even been to the UK recently, so it would have to have passed via an intermediary politician. Prince Charles or Nadine Dorries far more likely. The very risibility of this nonsense claim is probably the reason I saw it plastered all over my Twitter time-line. Again, right wing intimations going viral, for free spread of their repulsive rhetoric. Including me posting it here, to illustrate the point...
• Trump has been ranting about China a whole lot already [Twitter]. Scary rhetoric, trying to blame the other major super-power (which America is economically dependant upon).
Now UK government ministers (e.g. Gove) are starting to make noises about of Chinese culpability and the need for a reckoning [Guardian]. Which is scary because 20k total deaths is currently the *optimistic* estimate, just for our initial peak [Telegraph | Reuters]. This is likely to cause a lot of anger, looking for a target.
Whatever the number of deaths, they could easily have been halved, if the government acted just 3 days earlier, or more. (3 day doubling rate for deaths has been fairly constant so far.) But there's no appetite to entertain criticism of government, with such strong national solidarity. Boris reporting in sick might even bolster this effect. All in this together. Even if it's getting off the hook from being asked difficult questions.
And as in the December election campaign, much of the media covers the governments embarrassments, e.g. Laura Kuenssberg amplifying a very shaky "the science has changed" line [Evolve Politics]. Now some conveniently forgetting [Twitter] that Johnson and Vallance ever floated the "herd immunity" [Sky News YouTube] theory to "allow the disease, [...] to move through the population", only mitigating its effect [FullFact | YouTube].
I'm not sure how much domestic hate can be piled onto China, before rhetoric need turn into actions (particularly in America). Probably a lot more... But I'm imagining violence against Asian looking persons in America to potentially get out of hand. Currently, there have been fairly mild but widespread incidents, even in the UK.
Beyond that, I don't know. There's big financial tensions already, between the super-powers, with a trade deficit that's made China the number one owner of US debt, by a long margin. Definitely Trump could look to redress that with sanctions, or unreasonable reparations, or something. But any military actions could escalate quickly if Trump is as unhinged as he often seems. Of course, an all out (nuclear) war is not something that any of us are likely to survive, but short of that, I feel that the world needs China to win, in order for civilisation to progress. So we need to be on the loosing side, if tensions do ramp up to the point of kicking off...
Maybe there will be more fury at anyone perceived to have stepped out of line, with distancing. Animosity towards strangers is natural and the media's done a very effective job throwing attention that way, too. One set of photos of supposedly panic bought food being thrown out can go national and/or viral on social media. Witch hunt mentality being the dark side of more online social activity.
• Thankfully, Trump has done a U-turn, from pushing resumption of economic activity in 2 weeks, to officially extend social distance guidelines out to the whole of April [CNN]. I'd love to know what conversations or pressure it took to make him eat humble pie like this. Although 180s are his normal. The threat of imminent catastrophe might eased for a while, but we've no idea how things will look a couple months after that...
• News coverage, articles and commentary continue to talk about the number of coronavirus deaths who would have died anyway, e.g. on Sky News below [Twitter]. Or claiming that many are being wrongly included in the stats, just because they tested positive, when dying of other illnesses - BBC presenter Andrew Neil [Twitter].
I'm suspicious that Downing Street (as coordinated by Cummings) may attempt a discrete 'nudge' campaign to promote ideas moving us towards a return to a fully fledged herd immunity strategy (with 50% + infections and huge death toll). At the least, I'm certain they'll be watching social media trends to gauge what moves would be politically viable.
• Conversely, others, while highlighting cases of younger people dying, mostly outside of hospital [Twitter], are also begging the question of whether these will have even been counted in the official stats? Probably not, given testing has been in hospital only, with deaths at home or in care homes reported as excluded [Guardian]!
Major media outlets have also reported that a email to staff at King's College Hospital suggested that the national figures being reported are much lower than what they are actually experiencing [Telegraph]. This was aired as a question in Sunday's briefing and not answered. These media conferences are increasingly uninformative, with government representatives easily able to dodge answering, when there's no come back from the reporters on the other end of a video conference line and they can just repeat the same mantras, while looking professional, boring viewers away.
► 2020-03-30 - Missing reports, farm labour, excess oil, Korean expert:
• Many countries are failing to report everything (to varying extents). It seems that China, at a local level, may be avoiding categorising asymptomatic and other types of cases as new infections, hence keeping the case count no higher than 1 per day in Hubei province (where the outbreak started) [FT].
I feel this probably isn't cause for particular concern, more just a part of the nation's structural neurosis. Although with a densely packed 1.4Bn population, China, like most big countries is a tinderbox for recurrent outbreaks. And they did re-close cinemas almost immediately after some tentative re-openings [Deadline].
Domestically, and internationally, China is pushing a narrative of being a "leader in the virus response [...] and how it is the global savior, and how it’s 'donating' supplies" [Slate]. There's certainly facts behind this, but China is a manufacturing base for much of the world and I'm not sure that the humanitarian and assistance offered abroad adds up to a significant amount, yet. Like this small team with equipment to the UK [China Daily]. Almost any amount could be overlooked by the majority of our media, regardless.
A friend living in Asia thinks China will probably stamp down hard on the dodgy food markets that are thought to have permitted the virus to jump species from bats. But they'll also hide this process and deny that this was ever a problem. (Which sounds similar to what happens here, with politic scandals, except they might actually rectify the situation.)
He also pointed out that all the retail closure, over here, mean that the new clothing stock that was 'on the water' in shipping routes, will now be pilling up. And that the near total lack of demand will be hitting south Asian and other counties with lower level industrial economies dependant on such manufacturing. The nations that will also be hit hardest trying to mitigate epidemic spread, given a lack of remotely workable jobs and advanced telecommunications in general.
Although, realistically, if this level of heroism is required for the continued production of essential products, we really are in a lot of trouble.
• Even more essential, farms are scrambling to find labourers to replace their usual seasonal migrant work forces [FT]. Eastern Europeans and north Africans generally do most of the gruelling produce picking across Germans, France, Netherlands and Britain. But travel restrictions have killed this for now.
We were already staring down this particular crisis due to Brexit. Supposedly the government is working on the issue continually, but it will be tall order to press (temporarily) unemployed service industry workers into 6:30am starts in cold, wet fields for minimum wage (or less). Perhaps this pressing need was in mind while creating the gaps in emergency income support. I'd hope that better pay might be brought in, too, as a fair incentive for highly undesirable work. Even if that pushes up food prices.Farmers themselves are generally older, average age of 59 [Guardian]. So agricultural expertise would be particularly in jeopardy during a full outbreak. The wet winter already took a toll in the UK, prompting some financial support. Distribution is also a problem, with restaurants closed growers need to connect with new distributors. And some are calling for a new "dig for victory" type national campaign. But I don't think we've heard much about this in the media for the last week or so (with the immediate body count ramping up).
• Various airlines have bumped up the retirement dates of older aircraft [Business Insider]. "KLM and Qantas both flew their final Boeing 747 flights" [Twitter].
Commercial jet fuel use is down by a staggering 75% (5M barrels per day) [Energy Now]. Overall fuel use by may be 25% down, with supply now producing a 20M barrel/day surplus that the industry is struggling to find storage for. It's being parked up in shipping super-tankers. (I hope there's no major spill incidents as a result of unusual procedures, mixed in with sickness, etc.)
With the immediate lock-downs continuing for at least a month and substantial disruption likely for most of the year, it seems sure everyone will hit their climate change emission targets for this year. But the huge surplus with make oil extremely cheap. It was already being over-produced in a trade war, with Iran and Russia trying to bankrupt US shale production. So this could, paradoxically, stall demand for electric cars and solar power generation [Independent].
The pandemic is certainly a huge distraction from dealing with climate change, with climate change conference (COP26) in November potentially cancelled, for example. But there are some reasons to be optimistic [Medium]. A widespread switch to more distance work (especially if epidemics continue to threaten). Reduced consumerism. Momentum for social/state action. And maybe some oil production will go bust and demand not bounce back as strongly as expected. Fingers crossed.
• A great interview with prominent coronavirus expert, Professor Kim Woo-joo from [South] Korea University Guro Hospital [YouTube via Twitter]:
He explains in detail the measures South Korea put in place to pretty much contain the spread, without a substantial lock-down.
- The huge amount of early testing, contact tracing and tracking of those isolated at home through mobile phone apps.
- That the country's brush with SARS-COV (the first one) and MERS got them more prepared than the West. And yet still their doctors are burning out, treating patients.
- He also give much more nuance to virus survival times on various surfaces - substantially longer in the cold of winter, up to a week on a smooth desk, for example. And how 5μm droplets from the mouth may become aerosolised if projected far enough.
- That masks have certainly be shown to reduce infection rates to doctors. That ideally everyone in society should be wearing them, too, to reduce spread a little more. I feel that we'll need to move towards measures like this over here, too, as part of an exit strategy to return some more economic normality, while awaiting a vaccine.
• The Professor also mentions loss of smell and taste as very common and specific symptoms. Something that hasn't been highlighted at all in advice so far, despite the Junior health minister reporting this [Independent]. Supposedly asymptomatic patients may have this issue too, accounting for a sudden rise in anosmia. Intense fatigue also being common early on. Via [Twitter].
I imagine government may be trying to keep messaging simple and well understood. They might also want to avoid spreading the symptom net too wide, to avoid even more people self-isolating, reducing productivity and NHS staffing further, still.
► 2020-04-02 - Symptoms, Vit treatments, Exit strategy (Catching up with missed updates after my adrenaline worn off...):
• Digestive symptoms may be way more common too, often starting *before* typical ones (and so helpful for confirming diagnosis.
18.6% of cases had diarrhoea in this study (verses typically stated rare ~3% incidence) [Walter Kluwer via EurkaAlert]. 40% had loss of appetite. Only 2% vomiting.
Digestive symptoms are also associated with more viral activity detected in the gut & stool, plus longer and more severe illness. In this study 31% of cases with pneumonia (i.e. more severe) had diarrhoea [The Lancet preprints].Also papers in the American journal of Gastroenterology [1, 2].
• Vitamin-C mega-dosing was already a staple recommended intervention from Dr Sarah Myhill, who has long treated patients with ME/CFS (while the NHS does nothing) and provides free information online [DrMyhill].
Unquestionably an expert practitioner, with an enthusiastic and open minded group of patient followers, I still take her advice with a little pinch of (pink) salt. Here she is [YouTube] explaining her home treatment plan upon Covid-19 symptoms - nasally inhaled iodine vapour from a salt pipe and ascorbic acid to bowel tolerance (like multiple tea spoons worth of powder vitamin C!):
- Shanghai Government officially recommending it at the start of March [Orthomolecular]:
"[L]arge doses of vitamin C can have a strong antioxidant effect, reduce inflammatory responses, and improve endothelial function. . . Numerous studies have shown that the dose of vitamin C has a lot to do with the effect of treatment. . . [H]igh-dose vitamin C can not only improve antiviral levels, but more importantly, can prevent and treat acute lung injury (ALI) and acute respiratory distress (ARDS)."
- A New York hospital has been trialling intravenous vitamin C in Covid patients [New York Post]. Led by Dr. Andrew G. Weber, it was only a relatively modest 1.5 grams, up to 4 times per day.
- Dr Richard Cheng (Chinese American) talks about Chinese treatments using vitamin C, praising the use in the US, but emphasises that the high dose is essential [YouTube]. Up to 200 grams in an IV! Case dependant.:
He does recommend it as a potential preventative measure for health workers, but mainly talks about its use in severely affect patients in this paper [Medicine in Drug Discovery prepublish]. Mentioning this Finnish study showing IV vit-C significantly reduced mortality in ICUs and almost halved duration of stays [MDPI]. As well as showing great success in 50 moderate to severe patients with Covid-19 in China.
As an additional part of hospital's treatment therapy, there is game changing promise to greatly reducing ICU and overall bed need. If it is indeed efficacious. And *if* (bigger if) it is seen to work in time and widely utilised. It would certainly be an interesting vindication of the use of food supplements as medical aids. Suddenly diminishing stigma (and my own uncertainties), bypassing dogma and the typical roadblock of expensive clinical trials (which no pharmaceutical company has any profit motive to fund). But of course, there are various studies of vit-C that show little or no benefit in similar and different settings.
• Melatonin supplementation has been *speculated* to be of great benefit during acute Covid-19 infection, explained at great length in this Chinese academic (theory only) paper [Science Direct].
It's extremely safe (and cheap). Is a well-known (and potent) anti-inflammatory and anti-oxidative molecule. It may dampen the exaggerated immune response and cytokine storms seen in severe Covid-19 cases, which lead to acute lung injury and respiratory distress (ARDS). Melatonin is also helpful in the ICU setting for reducing vessel permeability, anxiety and sedating. It is produced in the pineal gland, in the brain, when it's dark. Production is lower in elderly, helping to account for generally reduced sleep duration with age, and so lower levels might correlate with the increased mortality rate of older patients.
That paper and this blog [Evolutamente] talk about melatonin controlling inflammasomes and a lack of melatonin leading to rapid depletion of vitamin C stores in the body (during Covid-19 infection). Then oxidation of hemoglobin into its unstable ferric form that may become cell-free in the blood, causing dyspnea and respiratory distress. Maybe. This paper explores the connection between release of red blood cells and ARDS [NCBI].
• Anecdotal report from someone ill with Covid-19: an ICU nurse advised gargling mouthwash containing Chlorhexidine Gluconate to help prevent infection in the throat spreading down into the lungs. (Warm water with a drop of iodine or 3% Hydrogen Peroxide might be viable alternatives.)
[Update 2020-04-08] Great [Peter Kolch Twitter] thread on theory and studies into effectiveness of gargling to prevent upper respiratory tract infections (and spread downwards) from a virologist.
Water might be just as effective as mouth wash (which is fine too). But neither have been seen to have a very strong effect. ~36% benefit from water in old 387 person Japanese study (gargling is now part of official advice in Japan).
Other US study saw no benefit and iodine (diluted Betadine) might have made things slightly worst. Potentially by causing damage to cells in the throat. Problem is most viruses are hidden inside infected cells, so you can't wash them off in a meaningful way, like you can with bacteria.
• Dose dependant? - Severity of viral infections is generally known to be dependant upon the magnitude of the initial exposure [NY Times]. A big dose of viruses gives the immune system less time to spool up and will tend to progress further. Explaining why the young (34 y/o) Chinese doctor first reporting the new outbreak died (exposed to many patients). And why many of our medical workers may be getting sick and are in such grave danger without proper personal protective equipment (PPE).
• Gagging staff? - But Public Health England have been threatening disciplinary action against any staff talking to the media about their worries and lack of equipment [Union News]. I can understand why it's helpful to avoid undermining morale unnecessarily. But these problems seem to be endemic to the system and the Government's largely been brushing questions about this aside, so far.
• However, even mainstream media personalities (and most papers) are finally waking up to the Government's monumental failure to ramp up testing and provide sufficient PPE. E.g. Andrew Neil (BBC and Spectator) [Twitter], gov mislead on ramping up of testing [Twitter] and on the lack of accountability in the briefings [Twitter].
• The first 4 NHS doctors to die from infection were all Muslim [Aljazeera]. Highlighting yet again how dependant we are on immigrant workers and ethnic minorities, greatly over-represented in medicine (and how counter-productive Brexit xenophobic sentiment is).
 |
| Adil El Tayar, Alfa Sa'adu, Habib Zaidi and Amged el-Hawrani. |
• Some talk of "green shoots" and the new cases count levelling off [Sky News (Prof Steven Powis)]. In theory this could line up with that start of social distancing measures in the UK.
But the shape of the case count graph suspiciously mirrors that of the graph of total tests, over the last 5 days. To me it seems like it might mostly mean that testing capacity is saturated at about 3 out of 8 tests coming back positive:
 |
| WorldOmeters |
 |
| BBC News - this graph in section titled "How many tests is the UK doing?" has since been removed! |
• Hungary's Viktor Orban has taken emergency powers, for an indefinite period, that effectively allow him to rule by decree [Twitter]. As PM he is an outspoken nationalist right winger. At least on other EU country has spoken out about what is effectively a dictatorial power grab, but overall response has been muted [Guardian].
Moves from UK (and US) that sound similar, though more limited in nature, could be argued to have set a precedent for this. They also worry me directly, of course, given my complete distrust of the current executive, based on previous action (using all available loophole to derail parliament over Brexit and referendum cheating, etc).
• Exit strategy (or lack of)...:
This is what a plan like look like, for a country to return to something-not-entirely-unlike business as usual [Peak Prosperity, YouTube]:
- International travel restrictions are already in place and lock lock-downs. Moving beyond these...
- Face masks are quite deeply socially unpopular in the west, but they are ubiquitous in the Asian countries who've controlled this and I think they are going to be essential here (until a vaccine resolves things). The critical PPE shortages for health workers will (somehow) need to be addressed, then previous advice modified and supply found for (at least) basic cloth masks for everyone.The US CDC (Centre for Disease Control) are considering whether to make a general recommendation on this, although concerned that it shouldn't reduce people's adherance to social distancing [Washington Post]. For now this is gaining traction mostly as a grass roots initiative e.g. [Twitter].
- Aggressive testing, like South Korea, and Germany, to an extent. But it's worrying clear that UK Gov currently has no timetable for when testing might truly be ramping up [Carole C, Twitter]. But that's going to *have* to happen, for us to depart from the current, broad social distancing measures.
- Contact tracing has been abysmal in UK's supposed "containment" phase. Obviously it's reliant on quick, widespread testing, to be able to confirm so that others can be informed of potential infection and isolate.
In Singapore an efficient system of tracing (and tough enforcement of potential case isolation) is allowing business as usual to continue. Although their confirm case count is ramping up (currently 873), given the influx from abroad, as a travel hub.
Apparently the UK is working to implement a smart tracking scheme, too [BBC]. This article talks explicitly about Singapore's open source "TraceTogether" implementation, praised by privacy experts for the minimal data gathering, relying more on detecting other nearby users user's Bluetooth signals. (As I was also informed about a couple days earlier by a friend living in Singapore.)
But, there's talk of the Chinese system, like we previously saw in this YouTube video. With GPS and user symptom tracking, plus scanning QR codes to be permitted into certain public spaces, restaurants, etc. Which would be justified. But I'm sceptical of UK gov's own technical capability to bring this in and wary of the big tech companies being worked with, so far, particularly if Palantir is a major player (having worked with ICE in US to track down illegal immigrants).
And I'm not sure if the current public romance with government's response will be sufficient to overcome our general distrust of them, relative to e.g. Singapore's high regard:
 |
| 2019 Edelman Trust Barometer Global Report 2 [PDF]. |
- Of course there needs to be financial support to enable contacts to quarantine (and continued social distancing related payments until then).
But also for mobile phone hardware, to enable everyone (who wants to) to participate. Vouchers that cover the cost of an adequate new handset, if not handing them out directly. We do not want poor literally forbidden from public/private spaces. A sticking point will also be the elderly, who are the least tech savvy - many over 70s may not have suitable equipment. And getting them to actually carry their handset everywhere might be a joke.
There's potential to spark a major move towards full digital enfranchisement. A statement [BBC] from Gov, Ofcom and ISP companies trumpeted (partial) removal of data caps. Some of those weren't already removed after recent changes to UK advertisement rules on "unlimited". And vague talk of leniency of unpaid bills.
But it seems like it might not be the time for universal broadband roll-out (as per Labour's manifesto); consumers may in fact be suffering a little, due to caution from BT Openreach, with their engineers avoiding home visits for switching providers and some other non-essential tasks [BBC]. But it's reassuring to know that they have been identified as key personal and provided PPE, when necessary.
• Bill gates has been trying to push the US towards taking more assertive actions, now [The Hill]. Also, to pre-build manufacturing capabilities that will eventually be needed for each of the likely vaccine candidates, to shorten the lead time for reaching mass market availability (and the rest of the globe). Even though that would mean some sites go unused (when the related vaccine fails to prove efficacy).
• Seems like a hard sell, especially given that social distancing may be becoming more of a partisan issue, with republican contemptuous of social distancing [The Atlantic] and Trump using his power for petty partisan, and person, discrimination, etc [TruthOut].
• (Badly affected) New York's governor, Andrew Cuomo, lamenting the insane medical hardware purchasing market, where all the states bid against each other (e.g. for ventilators) and then DEFRA (national disaster response) joins that fray too, driving prices higher, instead of just buying all stock at the federal level and distributing it as needed [Guardian YouTube].
The additional US problems makes the UK mess look almost tractable! Although I've also seen multiple reports of tests and ventilators from the UK being sold abroad after a lack of response from UK gov. As with this story of the US dithering, loosing out on equipment [The Intercept]. Also highlighting that protectionist blanket export bans would cripple supply chains and hurt everyone. Although that would fit the leitmotif of nationalistic politics around the world, these day.
► 2020-04-03 - Developments:
• Anecdotal incidents - of my ~30 or so online gaming contacts and old friends I might talk to anyway, one has definitely had Covid-19 and two others have had possible symptoms. Plus several people I know in the ME/CFS community have almost certainly been through it. Yesterday, we found out that a guy a few houses up the road (the same age as my parents, in their 70s) had died a few days after returning from a cruise.
• 'Missed' emails - have been blamed repeatedly by the UK government for missing out on many offers of equipment. It's genuinely impossible to tell if the executive have been distracted and massively incompetent in some cases. I'm imagining Cummings having gutted the staffing as part of internal purges, not yet having finished rebuilding the teams, or horrendous bottle-necking from overly centralised control, unable to deal with sudden wave of contacts... But given the change in story in some instances, they're definitely not being forthright, either for political reasons or self-sabotage (e.g. to fumble into a herd immunity type scenario). So far I've read of:
- GTech ventilator manufacturing plan unexpectedly shelved (2020-03-26), six days after getting the go-ahead [Worcester News].
- Failed to join EU scheme for joint ventilator procurement, claiming email was missed, a few days after very publicly acknowledging the scheme but saying we wouldn't take part because not part of the EU any more (2020-03-27) [Business insider].
- An offer of 25'000 ventilators and 50M test kits from supplier Direct Access was apparently ignored for 2 weeks, then had no response after registering with the ventilator scheme, selling the equipment abroad [Independent]. Yes, it's down to the NHS, if they were forwarded the details, to decide if the equipment is suitable. Maybe their management is a mess too. But no response to such a substantial offer is pretty damning.
- Ignored emails from university labs offering their facilities, as per Mark Harris, a Professor of Virology at Leeds (2020-04-03) [Twitter].
• Farce - BBC presenter left in utter disbelief [Twitter] and double checking as given the report that just 30 (three zero) ventilators (of the 30000 needed) will be ready for the start of next week [Independent].
Then there's ridiculous footage (right) of army boys passing medical supply boxes down a human chain, instead of simply wheeling the cage trolley over to the stacked pallet [Twitter]. Which might be the perfect microcosm of the whole UK situation - putting on a good show for the cameras being basically the entire plan.
• To be fair, there's been much love of Rishi Sunak [FT] and praise for the Northern-European financial support schemes designed to retain employees [The Atlantic]. So maybe there's some smarts to UK economic planning, even if millions fall through the cracks, larger companies might be able to resume business closer to where they left off. Whereas the US scheme arguably promotes redundancy with unemployment based payments predominant.
There have been 10 million struggling to claim unemployment in the last 2 weeks (many kicked off health insurance). Whereas the 2007-09 crash/recession only reached 9 million in total! That will mean major long term structural economic damage, if this drags on, with companies hesitant to re-hire afterwards.
• BBC appears increasingly to be acting as a state controlled broadcaster:
- Still lack of strong criticism after all the mainstream papers finally stopped giving the executive an easy ride [Paul Mason Twitter].
- Weird cut away to the news and weather, mid press conference, right after an awkward question to (just returned) Health secretary Matt Hancock about testing [Twitter video]. Sure, "just a mistake", but there were a lot of those conveniently favouring Johnson in BBC political coverage during the December election, too.
- BBC news health articles seem to keep getting major edits to be more government friendly, as with this one with a section on the total number of tests done in UK, which I mentioned above and tweeted about [Twitter].
- Bizzare [Twitter] thread duplicating the questionable use of graphs and out-of-context numbers from this [BBC News] article by Nick Triggle. Again implying that mass infections wouldn't be such a big deal. (Which I'm hoping isn't betraying a veiled intention of the executive's to give up on avoiding this.)
It uses the relatively modest 500k deaths figure (if we'd taken no mitigations) from UCL study, which is actually in the impossible hypothetical of 100% hospital treatment. So multiply that by 2-5 times when hospitals would have inevitably have collapsed.And quoting Prof Sir David Spiegelhalter saying there would be "a substantial overlap" between Covid deaths and those who would have died anyway over the course of a year, next to a graph (right) comparing the two (apples and oranges style) with visually almost 100% overlap. Then claiming Prof Neil Ferguson said it could be almost 2/3rds (without a quote).
It's absolutely right to point out that these strict lock-downs are probably causing major collateral health impacts, as well as economic ones. It's interesting in putting a number on this, of a lost life expectancy "tipping point" at around a 6.4% decline in the size of the economy (equivalent to the 2007 recession). But it's hard to say how quickly that will bounce back, maybe far faster this time. And the direct health impacts from poverty could be totally nullified by simply giving better government income support (and progressive taxing of wealthy). A straight political choice it's clear has been arbitrary, now the deficit is being exploded.
Out of work Virgin and Easyjet cabin crew are being encouraged to go and support the medical staff there [BBC]! Which sounds a little insane, but certainly there'll be a pressing need with staffing levels currently hit so hard, as per this memo [Twitter]: "[...] from Great Ormond St hospital today. 73 out of 181 staff have tested positive and 318 staff members off sick."
• The government announced potential "immunity passports" to permit those who've successfully fought off an infection to be able to end their social distancing [Guardian, via Abi Wilkinson Twitter]. It's pragmatic. But implemented too early, in conjunction with the gaps in financial support, it could counter-productive in creating some strong incentives for individuals to risk deliberately infecting themselves, so as to be able to work, earn, eat, etc. Again, big risk of confused messaging.
• The first UK police emergency powers arrest was quashed, after it was decided the black woman in question had been charged incorrectly [The Times on Twitter]. Obviously there needs to be more training of officers, but this is a pretty dire early indication, for abuse potential and overreach.
• An explosion of chronic post-viral illness seems almost certain to follow in the wake of this pandemic [Cort Johnson for Simmaron Research]. On the positive side, that will provide a great study opportunity to better understand and help the millions around the world already stuck in such illness states (like me, with ME/CFS).
Cort gives a rundown of a few follow-up studies on patients who contracted the original SARS-COV (2003) virus. A Toronto study saw 17% unable to return to work 1 year on. Another study saw 15% with permanently reduced lung function. So this could mean SARS-COV-2 could add a substantial new *on-going* disease burden. Worrying considering that 54% of severe (hospitalised) cases in New York have been 18-49 years old, according to Governor Cuomo [MarketWatch].
The focus on dissuading younger persons from risking infection has been that *some* may die, although far less statistically likely. But if 10-20% fail to fully recover, as seen after the more deadly SARS infections, previously, that could be at least as economically damaging and an significant additional reason for caution that's not being mentioned, so far.
Obviously the attention of the medical community, media and public is on the more immediately pressing spread and deaths. And ME/CFS is, by definition, only diagnose after 6 months (or more) of unresolved symptoms. So we might not start hearing anything about this until the end of this summer.
• In the worst affected European regions, so far, total 'excess' deaths appear to be double the number confirmed in hospitals and officially recorded as Covid-19 [The Economist, via James Tozer Twitter]:
Above, in red are the official Covid-19 deaths, pink is others, which are far in excess of the base line death rate (both simple and extrapolated from modelling).
As in the UK, where we've suspected 25% addition deaths uncounted from outside of hospitals, there are probably a lot dying at home, or in homes, never tested. There may be collateral impact of hospital service saturation causing excess deaths without infection. Hard to be sure at this point.
So, as scary as Italy's tally looks, that we are following closely, get ready to multiply that by about 2...
• A fairly big deal is being made [e.g. Twitter] about reports from the White House that US intelligence agencies have been telling them that China has been lying about their case and death numbers. Or rather, are supposedly unaware of the true extent, themselves, because Midlevel regional bureaucrats are too afraid of passing bad news up the chain [NY Times1].
It sounds like they are talking about no reporting the ~25% of asymptomatic cases at all. And the Wuhan death total might be double that officially reported. Which sounds very much on a par with what we're seeing in the above analysis of Italy, funnily enough.
I've already fretted about the international finger pointing. Apparently this is been running the other way, too, with Chinese censors allowing, and maybe media promoting, misunderstanding or disinformation of the virus originating from a US army base [NY Times2 | NY Times3]. Along with Kremlin-aligned western websites. It's hard to be sure of the reach of such disinformation domestically within China, but it feels like it might be overblown, here. At any rate, Trump and Xi Jinping seem to be avoiding antagonistic language, after a phone call [NY Times4].
• It looks like Trumps son-in-law, Jared Kushner, who's been running a shadow coronavirus task force, may have tangled government business up with his private interests in Alphabet backed firm, Oscar Health, co-founded by his younger brother Joshua [The Atlantic].
Aside from being yet another major ethics violation, it may have significantly hampered the US public testing response that its new website was supposed to facilitate (as incorrectly announced by Trump as being delivered by Google). Over here, it's been speculated that a similar kind of "jobs for the boys" might have led to Dyson (a major Tory party donor) ending up with ventilator contract approval over rival UK vacuum manufacturer, GTech.
• USS Theodore Roosevelt aircraft carrier Captain, Brett Crozier, was removed by acting US Navy Secretary after whistle blowing on (and/or leaking to press) the dire situation aboard his ship, where infection is spreading uncontrollably [BBC]. Senate Democrats criticised the dismissal.The whole situation just goes to highlight how useless America's insane 'defence' budget is, when there aren't the epidemic response capabilities to even protect it's armed forces. Also ironic, given the criticism being ramped up against China for suppressing outbreak information.
• Smartphone demand took a 40% hit in the first quarter of the year, in China [BBC]. But more significantly, disruption of the complex, international manufacturing supply chains and design processes are likely to ripple out for the next couple years. With new features ditched from this years models for a start.
So it seems like I may have been at least partially wrong, in my initial exceptions (over 2 weeks back) - there might not be an immediate run on consumer hardware, with all physical retail locations closed. But the longer term supply is uncertain and worrying, given global interconnectedness there's major potential for big problems in producing the electronics our world now relies on.
► 2020-04-04 - followup:
• I received an SMS phone message link to an NHS video about rheumatology conditions that increase Covid-19 susceptibility. Mostly about medications suppressing auto-immunity, so not really relevant to my recent investigations into (shockingly!) low bone density.
Pretty clunky [video], but thorough, I suppose. A second message link was broken. They appear to come from the local hospital service, so assuming it's no new tech company initiative, here. My mother, with high blood pressure and supposed asthma, has ironically had no contact since our initial Gov lock-down alert on March 24th. Presumably no mobile phone number registered.
• CDC has indeed officially recommended the general public use face masks, as an additional safety measure [Wired]. A radical and welcome change in the western narrative. Regardless of Trump's pouts, refusing to use one himself.
- The World Health organisation (I'd failed to mention above) are also looking at whether to advise this [Guardian]. I don't think they've said anything new yet, but they had this advice for mask use, which seems sound [WHO].
- UK gov conference, yesterday, it was stated, by deputy chief medical officer Prof Jonathan Nguyen-Van-Tam, that [YouTube at 53:48 | BBC]: "...there is no evidence that general wearing of face masks, by the public who are well, affects the spread of the disease..."
Huge caveat there of "who are well" given that we know people are contagious well before (and maybe after) symptoms begin. Because masks certainly reduce other coronavirus shedding from infected individuals [Nature]. But apparently this opinion is confirmed in consultation with Hong Kong official who's been appraising unpublished new evidence from there, for the WHO.
• Given our struggles to implement a sane response, how have other less sophisticated countries been coping? There's scary words from Philippine president Duterte: "shoot them dead". Although his past solutions to problems (the ones we've heard about) have involved killing citizens, too:
Mass starvation looks to be a potential issue (hunger reportedly causing the unrest and police response here). There are scenes of unhelpful action, with Indian authorities hosing down migrants with bleach (won't reduce potential infectiousness and could damage lungs). I'm still scared for major atrocities, particularly against already oppressed minorities, under the cover of pandemic response.
• Mobile phone masts set alight in relation to conspiracy theories that 5G roll-out is the true cause of Covid-19 symptoms [BBC]. As I was saying in part 1, anti-vaxers believing in these fallacies won't perceive current events as a vindication for the need for vaccinations.
The heightened impact of the pandemic on people's lives and escalating climate of fear seems only to heighten the emotional appeal of the misinformation. Which is all part of a network of interlinked ideas (I'd call a "memeplex"), including chem trails and other things they are genuinely terrified about, for themselves and children everywhere. They see the thinking of the rest of society as programmed and in need of waking up to these scary (alternate) realities, where compellingly simplistic rhyme has pushed out the complexity, uncertainty and counter-intuitiveness of the real world.
No way that social media ridicule or stilted assurances from official bodies will do anything but confirm their fears. More scary epidemic realities could potentially push more extreme measures from them. We may have reached the point of Charlie Stross's novel "Halting State" (with its Rule 34 police).
• Lol, yes, this! 👇 [Twitter]
• But apparently we're *still* resurfacing 'herd immunity' [Twitter], despite the Health Secretary (rightly) dismissing it as a viable plan [Independent].
Peter Jukes [Twitter] linking it squarely to Dominic Cumming's past writings and thinking (back to 2013), highlighting (new to me) links to ridiculous wrong pseudo-intellectual Richard A. Epstein [Byline Times]. Who may well have informed Trumps thinking too [NY Times]. Perhaps there was direct coordination of strategy between Downing Street and Trump's aids, in our mirrored, costly procrastination phases.
I'm *really* hoping that we don't push back towards that openly, or by stealth, per (hopefully) paranoid Twitter fears. Certainly not as an *alternative* to effective treatments, mass testing and tracing. Those would have to be in place first to even make it viable (but still an awful idea).
• Crude oil not the only product piling, potatoes are becoming a problem as fast-food french fries take a major hit in the Netherlands [Reuters]. I wonder if that represents a public health benefit, that might be observable in years to come, or if the population is replacing chips with equally bad (or worst) home prepared alternatives?
• There's hope in the air for societal change, with the Financial Times [FT] writing about the need for "Radical reforms - reversing the policy direction of the last four decades" i.e. neoliberalism, Thatcherism [via Twitter].
Certainly a new level of support for the out of works seems likely to be an ongoing issue, as companies are now speeding up work automation, in light of difficulties with isolated staff [Guardian]. Although I'd assume that many of these efforts would themselves be hampered too, for now.
• This piece [Guardian] highlights how there's a substantial delay in identifying cause and officially reporting each death, that makes the overall official figures appear to lag a few days behind reality. So it's not just failure to report coronavirus deaths from outside of hospitals, which UK's seems set to include (soon?).
• Great animation of entire history of weekly new US unemployment claims shows the shocking scale and speed of current economic impacts! 😵 [Twitter]:
• This [Twitter] thread from 2 months ago is looking kinda prophetic, now: "There is potential for a mere difference in coronavirus detection ability to cause something as large as an immediate geopolitical shift from US dominance to China." [My highlighting.]
Well, there's more than just testing at issue, of course. But this outbreak has starkly contrasted the relative vitality of China compared hollowed-out and half senile US. Sure, China took a big economic hit for a month (with half of it quarantined), but is largely back to business now.
US is going to be on full lock-down for months more and that needle-off-the-page unemployment spike, bankruptcies and general chaos will take many years to fully wind back in. So it seems like we really are watching a sharp inflection point in relative power. US in huge recession as China pootles off (dependant on domestic markets for demand growth). Perhaps west to east in general, with EU hurting pretty bad, too. Although big uncertainty about India, Pakistan and south Asia.
► 2020-04-05 - Setting aside daily drama, for a thorough look at the science:
• Gavi, the Vaccine Alliance (aka GAVI) CEO Seth Berkley has a fairly in-depth TED interview about the global picture for SARS-COV-2 vaccine development and roll-out [YouTube | TED Connect]:
- GAVI's work on getting an Ebola vaccine approved relatively quickly, in 5 years, down fro the usual 10 to 15. Help from big pharma and working with regulatory bodies to minimise bureaucratic holdups. Being able to using it on later African outbreaks (it difficult conditions). That the initial spend on development came after 9/11, when Ebola made a list of potential bio-weapon agents.
- All the various stages of development and trails that candidate vaccines need to go through.
- WHO has a list of ~44 different candidates around the world, with maybe twice that under development by biotech firms, big pharma, universities, etc.
- Important to initially allow this diversity of different possibilities to "bubble up" with a variety of approaches, new and old, before then co-coordinating to promote and fast-track the most promising.
- For example, one new company used purely the RNA sequence to make a candidate in just 40 days, while a French team is working on adding the nCOV's protein spikes to an existing measles vaccine that should give good immunity.
- Herd immunity from infection is definitely not certain - many corona-type cold virus don't give lasting immunity. Hence people get the same infection later, even without it mutating, as the flu virus and HIV do.
- There's various adaptive trial organisational techniques that can allow more dynamic shifts between stages. But manufacturing on scale will be one of the biggest hang-ups, hence Bill Gates rightly talking about building that capacity up in advance of proving efficacy.
- We need to cooperate and coordinate globally as much as possible (and the WHO is best placed to organise this). First, to ensure the most promising candidates get the most resources. Then, to make sure production is quickly available around the world as a public good (not charged for initially), where it is in most need (e.g. medical workers, elderly and at risk, first).
- Countries should not be hoarding vaccines. If there's a big on-going African pandemic, for example, that can spill over to the rest of the world, giving far more opportunity for the virus to evolve new strains more closely adapted to human physiology.
- We should keep financial focus on vaccine development after this pandemic is resolved! More pandemics are certain. With research funding (and attention to preparedness 'war-games', like military is good at) we can look in detail for which animal viruses are most likely to jump species. We can better cover civilisation's peripheries, where outbreaks are most likely to start and develop. We can build vaccine technology platforms that will allow dropping in a brand new virus to very quickly produce a vaccine using an established (approved) system.
- He mentions [CEPI] - Coalition for Epidemic Preparedness Innovations is a global
alliance financing and coordinating the development of vaccines against
emerging infectious diseases, as already doing these things and working on Covid-19. UK Gov already announced £210M support for this on 26th March, after a G20 conference where CEPI asked for $2Bn to develop vaccine candidates [CEPI 2]. A very affordable price tag, next to the trillions of dollars in economic disruption that are occurring due to shut-downs.• In the longer term, the exciting CRISPR (genome editing) system, derived from bacteria's natural defences could be used for anti-viral therapy and as a prophylactic alternative to vaccinations. After a substantial amount of development on brand new delivery systems and safety testing.
This Cas13d based in vitro (i.e. petri dish) experiment targeted and successfully "obliterated" SARS-COV-2 RNA sequences [CRISPR 101]. In the paper [biorxiv], the authors speculate that we could potentially protect against 90% of all known coronaviruses by targeting half a dozen highly conserved short sequences of RNA. This would also make it virtually impossible for them to evolve to bypass the system via mutations, as highly conserved code is generally essential for function.
• Will Covid-19 be seasonal? I.e. will it die out in the summer?
This is what we would expect, from looking at previous corona viruses, e.g. in the University College London study [UCL News].
And Influenza (flu) viruses are structurally very similar to SARS-COV-2 and their incidence has an extremely distinct seasonal fluctuation [WHO GISRS FluNet]. In the southern hemisphere, where the seasons are reversed, so is the peak [WHO]. But the global picture is overwhelmingly dominated by the far larger northern population:
Flu related deaths have an even sharper peak around mid-winter:
As this [New Scientist] article explains, there are three main reasons for this:
(1) Flu virus is more stable in cold dry conditions when there's less/no UV light (that will sterilise surfaces in direct sun).
(2) People on average spend more time indoors, in closer proximity.
(3) immunity is a little lower, with Vitamin-D at its nadir, after a lack of UV skin exposure for several months.
It's probable that all these factors will apply to the new coronavirus, too. However, because it's entirely novel to the entire population, it appears able to overcome unfavourable odds. Even in hotter parts of the world, coming off the back of summer.
Australia is a very comparable country to the US and UK, in terms of development and most other regards, but having had a record breaking summer (with record breaking wold fires) during our winter. It has certainly seen local epidemic transmission. But they also appear to have been quite quickly successful at shutting down the spread of new cases [Aus Gov Health Dept]:
The majority of their new cases came from abroad (now subject to 14 quarantine), the vast majority of those from Europe and Americas, rather than direct from China. So lucky in their natural travel isolation.It seems they've been contact tracking new cases pretty well to establish origin (right) and testing sufficiently. I've not looked into how their containment measures compare to ours, but I'd say that's evidence that spread will be easier to control as we head into summer.
That seems to be the vague indication from the majority of the dozen studies the New Scientist article mentions: controversially, one found hot weather to be much worst for spread. The rest were more as expected, with one specifying an optimal temperature around 10°C. But mostly they are very uncertain, given how preliminary the data, so far.
Of course, the flip side to reduced summer spread is that some countries in the global south may have things far hard in a couple months time. Then again for us in another 7-8 months.
This European Commission funded project, CS3 (Copernicus Climate Change Service), created a visualisation that overlays deaths on global climate maps (temperature, humidity). It might be used to help predict future epidemic outbreaks of Covid-19 [CS3]. If it is indeed significantly modulated by weather conditions.
 |
| Annotated screenshot from the app [CS3 (2)]. |
So this hints that temperature (or luck) may indeed play a significant factor, given that Spain, Italy and Iran are not top destinations for people departing China. Also explaining Russia's low numbers, despite very close links with China, without resorting to a massive cover-up.
It would predict that India might stay relatively protected, with other equatorial nations that are always hot. Of course, the main population centres of the world are largely along this temperate band, where conditions have been historically best to support human civilisation. So naturally you'd see the biggest outbreaks in this zone, regardless. But there has been no substantial outbreaks in the hottest nations, yet, according to this data. Which is a hopeful sign for us.
► 2020-04-06 - More science - ICU outcomes, bio-molecular basis of infection:
• Ventilator survival rate - is at most 50%, according to this article [npr, via Reddit].
In small Seattle study [NEJM] of 24 Covid-19 ICU patients, 18 (75%) needed mechanical ventilation. Of those, 9 died (50%), 6 had recovered enough to breath unassisted and 3 continued to need ventilation.
Worst still in this Chinese study of Wuhan patients [Lancet] 52 (7%) of 710 patients (confirmed infected) needed ICU care. 37 ICU patients (71%) needed ventilation. 30 of those needing ventilation (81%) had died by 28 days in ICU. A higher percentage of the older cases, of course.
We can see a little more detail of how this is panning out in the detailed Intensive Care National Audit and Research Centre UK reports [ICNARC 2020-04-04]. Note this is total ICU cases, with ~95% requiring ventilation:
Note that there were many times more new patients (2244) than those admitted 30 days earlier (690), because our epidemic was still in an exponential growth phase. The graphic somewhat accounts for that, but ultimate death rate is worst in this report (at 50%) than the one from 8 days earlier [ICNARC 2020-03-27] that was linked in the article, where the curves met around 60%. The longer ventilation it's needed, the lower the chance of survival. And the poor souls in ICUs are often taking weeks to die.
In absolute terms the picture looks like this, with the vast majority of UK cases still being kept alive in ICU (middle two curved areas). I believe the shaded "Lag" area is the delay in receiving reports, as we heard about with delayed official death data (above). So the plateau is a statistical artefact, father than a real slowing of the additional case load (unfortunately).
Interesting to see how high a proportion of men are in critical care (grey bars, below). Perhaps, another mirror image of the incidence of chronic illnesses (like ME/CFS), where women are greatly over-represented (e.g. ~75%). Female physiology theorised to prioritise survival over maximising healthy peak performance (for care giving social roles, etc). Or viral activity or symptoms just happen to more strongly affect those with male sex hormones...
The [NY Times] article explains the practical ins and outs of mechanical ventilation. Like: patients are sedated and receive pain relieve before insertion of the intubation tubes. Faster, smaller breaths are preferred to reduce damage to lungs. Bacteria (and other germs) may used the tubes to infect the lungs, hence anti-biotics are used after a few days, despite the main problem being *viral* pneumonia. A tracheostomy tube may be inserted (surgically) from the outside of the neck, by a couple of weeks, to avoid permanent damage to the vocal chords, too.
So, all in all, the ventilators that there has been so much fuss about acquiring are at best a coin toss with death. It's clearly best to minimise the number people getting to a stage of severe illness, either with new therapies or suppressing epidemic spreads, preferably.
 |
| SARS-COV-2 RNA sequence as pixels [Reddit] |
(Right) The virus's single strand RNA code, with its 29'903 long sequence of A, U, G, and C bases converted to pixel colours. At ~8KB of data, that's around the size of the smallest possible file on my Windows PC, while human DNA is 2.9 billion base pairs long (double stranded). Raw, that would take up most of a regular DVD, like an computer operating system. Although my full genome sequence file from Dante labs is only 300MB, with data compression.
Many times we've heard about the spike proteins that make up the corona (crown) shape of the virus particles. How they bind to ACE-2 receptors on human cells, in a highly specific lock and key fashion.
In addition, the human cell needs to have TMPRSS2 (Transmembrane protease, serine 2) [Wikipedia] embedded in the cell membrane, to cleave and activate the ACE2 receptor so as to open up the membrane and pull the virus and its RNA genetic code inside:
 |
| From this paper [2020-03-04 MDPI]. |
Up close, the protein spike receptor binding actually looks more like this. Each little bump being a molecule in a protein chain. They are folded into a (fairly) rigid shape that's specified by the order in which the different molecules are coded and reproduced by the DNA/RNA from which they come. Kinda like molecular origami:
 |
| From this paper [2020-02-28 Nature]. |
Genetic variation, between humans, in TMPRSS2 (but not ACE2) might account for some of the variation in Covid-19 severity [2020-03-30 MedRxiv].
Interestingly, the ACE2 protein, and the gene that makes it, are not expressed more strongly than average in the lungs, in general [Protein Atlas |Wikipedia].
 |
| (Interesting that intestine has so much ACE2 - are guts particularly susceptible to harbour infection?) |
Looking more closely at ACE2 expression, it seems that it's stronger in the nasal passages, possibly explaining this as the primary site of initial infection (and contagion), well before lung symptoms start [Sui Hang, Medium]:
 |
| "COVID-19: WHY WE SHOULD ALL WEAR MASKS - THERE IS NEW SCIENTIFIC RATIONALE." [Medium] |
► 2020-04-07 - Science 3: BP med danger? And computer modelling explains all?
• Because the surface bound ACE2 enzyme is (probably) the rate limiting step for viral replication, there has been fairly intense speculation about the potential dangers of medicines that interact with or affect the prevalence and availability of this enzyme. Specifically blood pressure (BP) medications.
ACE2 (Angiotensin-converting enzyme 2) normally functions in the body by converting Angiotensin II (a free floating signalling molecule) into Angiotensin-(1-7). What insane naming conventions! Angiotensin-(1-7) then binds to Mas receptors, causing vasodilation (i.e. expanding of blood vessels which lowers BP). The ACE2 enzyme also lowers BP a second way, because it is reducing the amount of Angiotensin II in circulation. Less is able to activate AT1 (Angiotensin II receptor type 1) And AT2 receptors (on cells). These receptors have a vasopressor effect (anti-low BP).
 |
| From [NephJC]. |
- ARBs (Angiotensin Receptor Blockers), drugs like Losartan, bind to the AT1 receptor (but not AT2), having the direct effect of preventing arteriolar contraction and sodium retention effects. They are used commonly to try to reduce high BP.
- ACE inhibitors (ACEi or Angiotensin-converting-enzyme inhibitors), drugs like Fosinopril, block the action of the ACE enzyme, reducing the amount of Angiotensin I converted to Angiotensin II. So less activation of AT1 and AT2 receptors, keeps BP from rising. ACE inhibition also raises the level of bradykinin which lowers BP, too.
As this fantastic, detailed, and constantly updated article on the subject explains [NephJC]: both ARB and ACE inhibitor medications have been seen, in several mouse studies, to increase the expression of ACE2 (i.e. cause cells to have more of the enzyme on their surface). By maybe as much as 3 to 5 times the prevalence.
That's the alarming part, given that more ACE2 would presumably mean more opportunity for SARS-COV-2 virus to break into our cells and replicate! Hypertension has been correlated with increased risk of complication and death from this infection. So the implication is that this connection might be due to these individuals taking ARBs or ACE inhibitors.
However! The correlation might just be because high blood pressure is more common in the elderly (who are susceptible for other reasons). Also, some of the mouse studies, and most of the human studies saw no upregulation of ACE2.
Furthermore, the ARB, Losartan, is actually being trialled as a treatment for Covid-19! Because it effectively blocks ACE2 receptors. I don't really understand the molecular mechanism of this, but is explained in this video [MedCram YouTube]. With low levels of Angiotensin II, AT1 receptors apparently sit docked to the ACE2 enzymes (on cell membranes), such that ARBs block ACE2 binding. Screenshot:
... So ACE inhibitors may be protective as well. Both reduce inflammation and avoid increased tissue permeability, pulmonary edema and ARDS.
Another common use for the drugs is to protect kidney function (seen damaged sometimes in severe Covid-19 cases). Also to treat heart failure, for which it is very important not to suddenly stop these medications!
All professional societies who've investigated this issue (e.g. cardiologists, cardiovascular, renal, hypertension, physicians in many countries) are firmly stating that patients using these drugs should continue to do so!
Biological systems are immensely complex and counter-intuitive in their actions and there's no strong evidence to indicate a problem at this point. Also, if my understanding is right, *and* ARBs and ACEi do cause ACE2 upregulation, then the worst thing you could do is to stop taking them during an active infection! A decease in expression could take many days/weeks (its unknown) and *will* spike blood pressure under normal circumstances, plus you'd loose any protective effects.
• A molecular computer modelling paper has been creating some excitement [ChemRxiv]. It may explain many of the key symptoms and puzzles of the disease progression! I've seen it linked in a couple of places, including this [Yishan Twitter] thread, which summarises it nicely.
 |
| Hemoglobin [Wikipedia]. Fe = iron. |
In addition to using our cells to make copies of the virus particle, its RNA code instructions fabricate half a dozen protein molecules. Some of these help crank up production of viruses and error check the RNA copies. But also, a 3 of these "non structural proteins", floating about, appear to eject the crucial ionised (electrically charged) iron atom out of heme molecules. This leaves the constituent porphyrin rings unable to form heme for the hemoglobin in out red blood cells (RBCs)!
Which would explain much of the difficulty breathing - affected blood cells can't carry oxygen, or carbon dioxide, suffocating the body in a way ventilation can't properly fix.
Computer renderings of the 6 SARS-COV-2 virus helper protein molecules:
The "orf1ab" protein molecule crowbars its way into the place of the iron atom, with some help from ORF10 and ORF13. Then it stays stuck there. Below - computer's simulation, with various molecular forces. I've little idea what's going on beyond seeing two different visualisations of the heme molecule docking with the orf1ab protein:
They also simulated Chloroquine's molecular interactions, finding that it appears to bind these helper proteins, potentially preventing them from doing further damage to hemoglobin. This could explain why early treatment with Hydroxy-chloroquine is helpful against disease severity, but late on it has little effect - after the damage has been done to RBC, the body may be too weak to make undamaged replacements.
Intense lung inflammation (the the distinctive 'ground glass' damage seen in scans) stems from the alveoli being unable to exchange carbon dioxide and oxygen very frequently. Given the lack of functioning RBCs. Anaerobic conditions ensue. Some were speculating the hypoxia (low oxygen) might form a vicious feedback loop (not sure what that would involve).
Hemoglobin also carries blood sugar, particularly when hyperglycemic. So diabetic patients (with poorly controlled blood sugar) would be hit hard. That's a confirmed risk factor for Covid-19 and particularly worrying for western countries with high levels of obesity (e.g. the US).
About 65% of the body's iron is in hemoglobin, usually, with most of the rest (~30%) stored in Ferritin (or Transferrin, ready for use). Ejected iron ions might explain why ER/ICU doctors are so often seeing elevated ferritin levels [Twitter] even considering it a strong diagnostic marker [TexAgs]. Although, apparently Ferritin is generally elevated during infections or hypoxia, anyway [Wikipedia].
 |
| [Evolutamente] - pseudo-science or insightful...? |
I'm very unclear on the biochemistry here (so would love an explanation!). But it seems like these papers differ, with Evolutamente's talking about hemoglobin being destabilised (and dropped from RBCs) via oxidation. Then being a liability causing a major burden on anti-oxidants. Again, a thing [NCBI]. Hence the usefulness of vitamin-C (supposedly).
Other notes on the modelling study:
- Favipiravir appears to inhibit the envelope protein and ORF7a, preventing the virus from entering cells, or catching free porphyrins. I don't understand how the virus uses porphyrins...?
- ACE2 receptor is not bound very strongly by the virus protein spikes, so other elements needed to assist, is this where the porphyrins come in?
- The protein helper system (and virus) is said to appear very old, in evolutionary terms. They were previously used to supply energy (outside of a host) and used to increased cell permeability, or something...?
• Update 2020-04-08 - It sounds like this NY City emergency medical doctor, Cameron Kyle-Sidell [Twitter] has been seeing patients exhibiting strange symptomatology, like they have altitude sickness. Fitting perfectly with the above hypothesis of hijacked haemoglobin.
He's pushing for other ER docs to spread the word that patients need oxygen, but not pressure from the ventilators. That would be typical treatment for ARDS in viral pneumonia, but may be causing unnecessary lung damage in Covid-19 (see also more detailed [MedScape] interview):
[YouTube]
• MedCram has just covered the modelling paper on [YouTue], 30 minutes ago (after many comment requests). He says that he has been seeing Covid-19 patients that look like typical ARDS patients (in contrast to the NY ER doc, above). He sees PaO2 (oxygen dissolved in the serum) low in addition to RBC oxygen saturation being low. Implying impaired oxygen permeability of lungs, due to inflammation, rather than inability of RBC to hold oxygen.
He spells out that the paper is pre-published (without any peer review). But also highlights the end of he paper, which hypothesises low RBC oxygen exchange causing lung inflammation. The reverse of classical medical wisdom.
• So maybe the modelling paper is off the mark, or there are different patient presentations. Some seem to be saying there two distinct phenotypes (symptom manifestations). One with hypoxia despite normal lungs and the other with more typical pneumonia like ARDS [Mark Ramzy Twitter]:
• Update 2020-04-12 - The hemoglobin attack meme seems to have gone viral, particularly with this ropey, unreferenced but self assured, pseudo-science blog post, since deleted [WayBackMachine].
It's carefully debunked in this [Medium] post by an Matthew Amdahl, MD, PhD, expert in heme globins. He's planning to write a full article about the (presumed) inspiration, the Chinese modelling study, above. But from what he spells out, a lot of that is on shaky ground:
- Heme/porphyrin in RBCs is held inside a 'heme pocket' - a space barely large enough for two-atom molecules like oxygen (O2). So attack proteins could not access it.
- However, he says the original paper claims "viral proteins can bind to isolated porphyrin (without the iron and not bound to any protein)". So before being used for heme in RBCs. How fast is the turnover of RBCs...?
- The lung bilateral damage is entirely consistent with viral pneumonia.
- Optical pulse oximetry detects oxygen bound and unbound heme ratio, so high amount of heme with no iron would give nonsense reading, rather than low saturation.
- RBC donor transfusion may do more harm, with hemolysis of RBCs leading to release of toxic products including more heme.
► 2020-04-08 - Unintended consequences:
• "[Advertising] spending has fallen 41 percent on TV, 45 percent on radio, 43 percent in print publications, and 51 percent on billboards" [NY Times].
Even online platforms seeing bumped up user numbers are missing out on revenue. Facebook revenues "weakening" and Google's biggest customer, Amazon, is decreasing its placements, although I'd guess that's because they struggling to fulfil the huge additional demand for home groceries. Retail shops, restaurants, hospitality and travel are all going dark on their ad campaigns.
Also, many advertisers are "blacklisting" news articles about coronavirus. To stay clear of associations with deaths, illness, etc. UK papers have banded together, highlighting this huge problem for their revenues, during a time when the public's relying on information from them (more than ever). They could loose £50M in the next 3 months, alone [NewsWorks].
Sales of physical copy may be substantially down too (e.g. my Mum not collecting her daily and thinking more so about cancelling subscription). So we could see many papers fold, or beg governments for financial support - potentially a very thorny situation, politically, if its not then forthcoming to all outlets in need. The current Government has already been avoid almost all scrutiny (e.g. over the December election, before and since). So a further weakening of the 'forth estate' would be very worrying.
Those companies adventurous enough to place ads are walking a minefield in having to avoid potentially major PR backfire, if hitting a slightly discordant tone in such a charged atmosphere and rapidly evolving situation [AdAge].
 |
| Jennifer Baer [Twitter] |
• Oxygen supplies are also a struggle in UK hospitals, as cases are still climbing [BBC]. The central distribution pipework has insufficient capacity to supply so many patients requiring ventilation, simultaneously. Some hospitals have already needed to be spread patients around to different wards, to spread the load.
Oxygen suppliers themselves are also working around the clock to make the stuff (and the army are supporting deliveries, right). I've been wondering about this, given that this kind of public facility chemical use is kind of niche, compared to larger scale industrial processes. Probably pretty inflexible production and very specialist distribution vehicles.
• Darkly amusing trivia - President George W Bush was actually obsessed with pandemic preparedness [Twitter | ABC News]. So he kinda got the wrong disaster, with 9/11. On that topic, its worth noting that Covid-19 seems to have put a clear end to a (now historical) global cultural period defined by 9/11 and Bush's "War on Terror".
• China is legislating a ban on wildlife trade (e.g. the dodgy meat markets) that may actually work (for at least 10 years). Unlike the previous clamp down, after SARS in 2003, which didn't have a lasting legal framework [New Scientist]. Some of the trade may be displace to other places. But I feel this should substantially reduce the chances of another zoonotic pandemic originating in the country. Good news!
• Spain is permanently implementing a Basic Income [Bloomberg, via Reddit | Forbes]! Yes, they have a socialist (coalition) government, and I've no idea how much EU central planning and Euro currency restrictions might get in the way of this actually coming to fruition...
... But this is fantastic news for us, too, in the long run. To see a major nation seriously pursuing this as a long term goal will put huge pressure on even a Tory UK Gov, if they appear to be doing well while many in UK are still struggling badly with a protracted financial recovery.
• Less good news - the UK Government's 3.5 million antibody tests are all useless [Times, via Twitter]! I can't understand why this hasn't been massive news; I've only seen the Times article state it directly, and being linked, for example, in this [Guardian] piece, which dances all round the issue without explicitly stating the news. It makes me very suspicious that Gov may have asked news outlets to avoid talking about it, to maintain public calm and order (or gagged them).
I'd expect this setback to destroy our Health minister's target of "100,000 coronavirus tests a day in England by the end of April" [BBC]. I've heard this was reaffirmed in last nights press conference... But I've only seen reported the opposite (albeit from an unreliable source), that acting deputy PM, Dominic Raab, dodged saying this [Twitter].
• Boris Johnson was taken to St Thomas' Hospital 2 days ago [BBC]. He may have been in luxury private outpatients section on the top floor, before being moved to the Covid-19 ICU and put on oxygen [Telegraph]. Although not a ventilator, as yet.
I'd assume they're just being extra careful, in case he deteriorates rapidly. Maybe they are up to speed with the latest understanding of the illness, and know oxygen alone, early on, is the best therapy. He is 55, male and overweight, so at fairly high risk. I've no idea of diabetes or blood pressure.
Given the UK's system of governance, there's no official second in command to take over automatically. The cabinet ultimately has the power to make all executive decisions. Dominic Raab, as newly minted Deputy PM, has no official power over his colleges, or to change tact on major national issues [ITV].
A former lawyer, prosecuting war criminals in The Hague, Raab has long been a staunch Brexiter. While Brexit minister, was derided for "saying that he hadn’t fully realised how reliant Britain was on the Dover-Calais ferry crossing for trade" [Reuters]. He seems very much a straight up sociopath (which is always nice), as shown in this compilation video by LBC radio [Twitter | YouTube]:
Some find this Government by committee worryingly, especially in the context that parliament is still suspended and unable to scrutinise [ITV]. Possibly indecisive, due to the ambiguity of who's in charge. And no longer with a mandate from voters, which attached to Boris's nebulous, bumbling notions that everything will kinda just be OK.
And political editor Peston doesn't even mention the other Dominic (Cummings), who's Johnson's (and Gove's) Svengali, behind the scenes. Many in the Tory party still hate him and have briefed the press against him. If (God forbid) the worst happens to Johnson, then there's a leadership contest in the party (presumably not immediately) I'm imagining a major power struggle between the old guard and Cummings new order, given he's unelected and might be left without a leg to stand on.
► 2020-04-10 - Unequal impact:
• Those having to work from home or not needing to work (retired, etc) are getting a bit fed up of being stuck at home for weeks on end. But as this [BBC] article highlights, lock-down problems are far worst for a substantial minority. From this King College London & [Ipsos MORI] poll of 2250 UK citizens (age 16 to 75):- 15% are already seriously struggling, with a further 26% also in trouble within 8 weeks.
- 7% are certain they will be unable to pay for housing and food, with another 33% thinking that is likely to be the case for them, too.
- 4% are sure they will (or have already) lost their job due to the crisis, with 22% more expecting to.
We know from the DWP that there have been 1 million new universal credit application [Twitter]. In the US there have now been 16M unemployment claims with 20M at least (15% total) expected by month end [NY Times]. And we know a lot of people are falling through the cracks between the support schemes, for various reasons.
I think there could well be public unrest within a month or 2, starting in the hardest hit areas, flats with no gardens and the least community provisions, younger individuals hit harder, etc. And given that public gatherings are illegal, we could well be seeing scenes of skirmishes with police in gas masks and riot gear, using heavy handed measures, with over-stretched resources... Unless a more encompassing financial safety net is deployed (a viable universal income, for a start).
- There appears to be very high compliance with measures, not surprising with over 50% close to someone vulnerable. But high anxiety and a significant minority with a the odd misapprehensions or belief in disinformation. (Like 30% thinking the majority may have already had it asymptomatically, as per that wrongly reported speculative Oxford modelling paper.)
• Coronavirus is greatly amplifying inequality [Guardian]. While anyone can catch the virus, the crisis is hitting the poor hardest. Those on low paid jobs are least able to distance work and more likely to be doing something fundamentally essential. Many employers aren't taking up the Government's (80% staff wage) furlough scheme, for whatever reasons. And these workers are far more likely to have to use public transport, greatly increasing infection risk.
There is hope in the air, though. With widespread recognition of this situation, even normally reserved BBC new presenters are going on rants that would have been the exclusive preserve of socialists like (now ex) Labour leader, Jeremy Corbyn [BBC YouTube].
Hence ignored or ridiculed by most media. Kind of galling that the party consistently expounding these ideas was so soundly defeated in December election (I wonder what would have happened with that election a year later...). But it was said at the time they won the war of ideas, and we're seeing the proof of that now. We just have to hope that our trickster Tory(ish) gov actually implements measures genuinely aligned with these sentiments.
• Secure, wealthier households may well increase their savings, with restrictions preventing spending on activities and shopping for unnecessary items [IFS].
• At the top end, hedge funds have been raking in record profits from the huge movements in the markets [Guardian]. With exclusive access to financial investment vehicles and casino-like bets that pay big when values drop, etc, some firms have made 3,612% or 4,144% returns in March alone! I expect this means that standard pension investments will have been fleeced, as usual, as a result.
 |
| [INARC report 2020-04-04] |
Initial outbreaks are very lumpy in their distribution, with a few (generally accidental) super-spreaders having a huge impact. So an amount of this could be bad luck.
But there are much strongly risk factors, too: "For example, South Asians live in more deprived areas and have more cardiovascular disease and diabetes [...] in larger, multi-generational households" many in housing officially classed as overcrowded. So less able to effectively isolate.
 |
| [Guardian] |
Alexandria Ocasio-Cortez points out the racial disparity in environmental justice, with far higher exposure to air pollution and correlated higher rates of asthma. In Mott Haven (NY), where 97% of residents and Black/Hispanic, the nearby highways and through traffic of diesel delivery trucks was reported to have raised Asthma hospitalisations to "five times the national average and at rates 21 times higher than other NYC neighborhoods." [Guardian].
Type 2 diabetes has been seen at a 3 times higher rate amongst the black demographic of south London in this 2015 study [Diabetes UK]. Indicating a medical science blind spot, as it is less associated with waist fat and cholesterol levels, commonly measured to more successfully treat white patients. And as we saw [above], there's the possibility that high blood glucose could be hit particularly hard, if hemoglobin is indeed attacked.
Medical system biases are substantial in excluding persons of colour, in the US: "scientists speculate that this reduced access to care is due to the effects of systemic racism, ranging from distrust of the health-care system to direct racial discrimination by health-care providers". This racial discrimination is even reflected in the computer algorithms allocating health care. Usually not up for scrutiny, one was found to give less than half the number of referrals for extra care (17.7% vs 46.5%) to black patients, compared to what they would receive based on need alone [Nature].
• This [NY Times] article paints a much more pronounced disparity in mortality. With the population adjusted death rate, per 100k of that demographic, echoing the ~2x factor seen in UK data:
 |
| [NY Times] |
“A study found that 75% of front-line workers in the city — grocery clerks, bus and train operators, janitors and child care staff — are minorities. More than 60% of people who work as cleaners are Latino, and more than 40% of transit employees are black.” [Twitter]So, as well as being poorer, with more underling health problems, and more overcrowded living conditions... black and Hispanic minority workers hold a hugely disproportionate percentage of the essential jobs that must continue. Putting far more of these people at far high risks of exposure. Also [Washington Post].
 |
The surgeon general, Jerome Adams, appeared to be trying to bridge that gap, in this address about the mortality divide [YouTube].
I'm not sure how patronising (or genuine) people may find some of his colloquial language. Specific suggestions to avoid alcohol, tobacco and drugs might feel discriminatory... But certainly many non-minorities seem to be failing to comprehend the drastic disadvantages [Twitter]. Maybe misinterpreting the awful stats purely as indifference to official instructions, or ignorance.
Finally, in NY city (and other US cities) neighbourhoods are very ghettoised, with local hospitals serving the (poorer) black/Hispanic areas far less well provisioned. For various reasons that often boil down to systemic racism.
 |
| [Financial Times] |
This enormous disparity continues to highlight our NHS's dependence on foreign workers at all levels of (perceived) skill. How disproportionately more are in the front lines caring for our nation's health, than making use of the care capacity.
Still no hint from gov of potential Brexit delay, though. Despite growing political pressure and businesses sounding the alarm that the new "points based" UK immigration system, outlined 1 month before lock-down, could cripple them, in excluding essential workers below a salary of £25,600 [FT].
 |
| [Reuters] |
The outbreak has highlighted the stark living conditions of migrant workers in the wealthy city state. Overcrowded dormitories, now under lock-down, may be turning in to death-trap outbreak incubators. 20k residents (mostly Bangladeshi and mother South Asian manual workers) living in 12 bunk rooms with unclean shared facilities [Reuters].
• Despite no major outbreaks yet, developing Asian nations are already getting a hammering. They have a far greater economic dependence on manufacturing, which is being hit hard by the lockdowns in the west, where clothing retailers are now all shuttered. Many companies have tried to renege on payments for goods already in production or 'on the water', having been shipped [BBC].
Bangladesh, Indonesia, Cambodia, Vietnam and Myanmar have been taking a growing cut of clothing manufacture away from China (as operating costs there have grown with higher levels of development).
With migrant workers unable to travel (or work) to send back money, and manufacturing shut down, the global economic impact could be particularly devastating in these countries. The IMF and world bank were urging (wealthy) creditor nations to defer interest payments from (poorer) debtor nations and grant "special drawing rights" to permit them to buoy those nation's currency reserves to the tune of ~$500Bn [Guardian]. Which I believe has been put into motion (from a TV interview with economic Joseph Stiglitz).
► 2020-04-12 - Dissecting decision making:
 |
| [Instagram] |
This susceptibility of cats was confirmed, in principle, in high dose lab testing on animals. That showed dogs were essentially not susceptible, also 2 out of 12 dogs (of infected owners) tested in Wuhan did show (weak) traces of the virus. This [Medical Express] article explains the various studies.
It also makes clear that there's very minimal risk of transmission to humans from pets (other humans should always be your first concern). But effectively cautions against french kissing your furry friends, if you think you might be infected.
- Advisers were from too narrow a range of fields.
- Some kind of breakdown of communication between the advisory committees and top level government that muted the alarm of many advisers.
- Advisers had simply assumed that the level of lockdowns seen in China were unacceptable in the UK, so didn't even model such options. And mass testing apparently wasn't considered either. Leading to a self fulfilling prophesy of unchecked exponentially growing outbreak.
- Flu pandemic plans were being followed by a kind of default, failing to be fully adapted to the deadly differences.
- A test was developed by 10th Jan, but deployment was constrained to a single London lab. No plans were made to utilise the hundreds of available labs around the country until mid March "when many abruptly received requests to hand over nucleic acid extraction instruments". Which really stinks of overly centralised and secretive control over decision making. Something very Tory and exemplified even more in the new Cumming's approach. Trying to make government more streamlined.
- Making decisions in a vacuum - from Feb 13th to Mach 30, ministers "missed a total of eight conference calls or meetings about the coronavirus between EU heads of state or health ministers" and ignored invitations to the EU's joint ventilator procurement scheme. Clearly politically motivated decisions, in the context of Brexit mono-focus.
 |
| Prof Edmunds seems most cited in the article [Reuters]. |
- The herd immunity U-turn, following the March 16th revised Imperial College modelling paper from Neil Ferguson's group, was said by him, to a Parliamentary committee, to be due to Italian data showing double the previously estimated ICU need for ventilation of critical patients. (As I said at the time, a factor of 2 wouldn't have made that much difference to the peak demand.) But another adviser says it was more that the Italian lockdowns opened up the political acceptability of those measures.
The title of the [Reuters] piece appears to squarely blame the scientific advisers. Which doesn't really fit with: "these scientific advisers concluded early the virus could be devastating" and their March 2nd assessment that "up to four-fifths of Britons could be infected and one in a hundred might die" - i.e. same as the 500k in the U-turn inducing modelling report over 2 weeks later.
But that feels far too in-line with politician's blame avoidance manoeuvres. Their jobs, after all, are largely doing public relations management, experts at shrugging off hard questions and public scrutiny. At press conferences they've been claiming repeatedly (ad nauseam, in fact) to be "following THE SCIENCE"!
 |
| Video snapshot from [Independent]. |
She is apparently back in play, despite refusing to appear before the Home Affairs Select Committee 4 times this year. And after blatantly forcing out a the head civil servant of her department, Sir Philip Rutnam, who practically broke down during his announcement of his departure, that he's suing the government for constructive dismissal [Guardian | Wikipedia]. She's broken the ministerial code twice, holding a dodgy meeting in Israel in 2017 and taking a private appointment in 2019, both without seeking approval. And she's responsible for the new points based immigration system that businesses are rightly extra worried about kicking in at while this crisis continues.
It's been no secret that Dominic Cummings is on a crusade to rip up government's old structure, having forced out many of the old guard and appealed for "weirdos and misfits with off skills" to apply [Guardian]. Hopefully just aiming for fresh thinking, I was suspicious that this could be code for "fellow sociopaths". One of the new appointees, Andrew Sabisky, resigns after pressure from the media who'd dug up previous comments of his apparently supporting eugenics and other objectionable opinions [BBC].
• So in this context, [FT] reports of "One Number 10 insider said there was “growing anger” at Sir Mark’s alleged “inability to execute what needs to be done”." I.e. Tory ministers throwing the blame for all issues upon the cabinet secretary (UK's top civil servant).
Also blaming the NHS for its bureaucracy (and Public Health England). Which is no doubt largely due to the the mess of endless reorganisations that have been brought in piecemeal by mostly Conservative governments, since Margret Thatcher, aiming to sneakily privatise our health provision [Independent].
Anyway, it's important to scrutinise the past mistakes because the decision making organisation of our government because it's the same key personnel at the top now, as during the deadly delays of last month. I.e. "Mr Johnson, chancellor Rishi Sunak, Cabinet Office minister Michael Gove and health secretary Matt Hancock [...] Sir Mark, chief medical officer Chris Whitty and chief scientific adviser Patrick Vallance." [FT] and presumably Cummings, on the down-low.
And there continues to be strong hints that they may even be trying to return to a mass-infection policy [Byline Times]. Be that deliberate or just zombie policy inertia. NHS documents suggested newly brought in data firms were running simulations of "targeted herd immunity" at the end of March (well after gov distanced itself from this).
• For outside perspective, I highly recommend this excellent round table [YouTube] debate between technical independent experts - a virologist professor, epidemic response adviser, top flight health provision director and parliamentary chair (all Dr's):
They highlight reasons for the flaws in UK gov thinking (e.g. lack of appropriate response experts - too much modelling focus) and unpick the hype and misunderstanding around ramping up testing. Far more enlightening viewing that the daily briefings - which continue to mostly avoid answering questions, despite now finally giving journalists the chance to respond to gov answers.
 |
| Jacinda Ardern, New Zealand's PM [MSN]. |
But they were also lucky, importing very few cases for a long time. In NZ, no doubt this was thanks to their geographical isolation, at the end of the line for flights, and small population (less than 5M). In absolutely terms NewZealand's lockdown came after the WHO's official pandemic warning. That triggered UK and US to finally start, slowly implementing measures and no doubt made it politically far easier for NZ to act decisively.
Greece is a little bit more interesting, as I wondered why it didn't experience a similar rapid take-off to Italy and Spain, in the same temperature range and close proximity. They've perhaps be trying to impress the EU with a strong response and were already acting as "Europe's shield" in pushing back immigrants wanting to come in from Turkey (according to above linked article).
 |
| Newton from [NewYorker] |
Creativity can't be forced. The reality of the coronavirus disaster rapidly unfolding on a daily basis, has, in practice, been an enormous cognitive burden - Charlie Stross talking about working at ~25% productivity. He's also trying to redesign the entire sci-fi narrative arc to accommodate the unmissable cultural bombshell [Twitter]. And other Authors saying the similar.
This [NY Times] article explores the fallacy of a creativity boom, particularly from the perspective of musicians. They are particularly hard hit by venue closures and being unable to meet up, plus mounting financial pressures. Also the more general harmful myth, that pain and strife fuel artistic output (making money and ultimately happiness). Artist are especially vulnerable to worsening working conditions. This disaster will hurt the arts deeply and there's a good chance they'll be last on the list for re-opening, re-funding and so last to fully recover.
• The idea of hypoxia from hemoglobin hijacked by viral proteins, from the Chinese computer modelling paper I talked in detail about, has certainly started to go viral [TechStartup | WebArchive]. I've appended some debunking information to the end of that section [above]. I was always sceptical, if excited, now more sceptical of the details.
UK gov cancelled orders for the simple ventilators [Reuters via Twitter]. So maybe they also cottoned on to what I reported there: ER/ICU docs trying to spread the word that (many) severe Covid-19 patients need just high oxygen ventilation, not high pressure. That would be typical in pneumonia cases, but might be causing damage in atypical Covid cases.
►2020-04-18 - Updates continue in my Coid-19 blog Part 3...
No comments:
Post a Comment
I'm very happy to see comments, but I need to filter out spam. :-)