<p>This is an update to my earlier show to pull together what we know about the Coronavirus on this date, and what measures we can take. It focuses on the lack of solid information at this point and suggests a prudent course to stay safe. <a href="https://www.palain.com/health-topics/coronavirus-update-20200507/" class="uri">https://www.palain.com/health-topics/coronavirus-update-20200507/</a></p>
<ul>
<li><a href="https://www.palain.com/health-topics/scientific-and-medical-reports/" class="uri">https://www.palain.com/health-topics/scientific-and-medical-reports/</a></li>
<li><a href="https://hackerpublicradio.org/eps.php?id=2685" class="uri">https://hackerpublicradio.org/eps.php?id=2685</a></li>
<li><a href="https://www.cdc.gov/flu/about/burden/2017-2018.htm" class="uri">https://www.cdc.gov/flu/about/burden/2017-2018.htm</a></li>
<li><a href="https://en.wikipedia.org/wiki/All_models_are_wrong" class="uri">https://en.wikipedia.org/wiki/All_models_are_wrong</a></li>
<li><a href="https://www.healthdata.org/covid/updates" class="uri">https://www.healthdata.org/covid/updates</a></li>
<li><a href="https://www.medpagetoday.com/infectiousdisease/covid19/86127" class="uri">https://www.medpagetoday.com/infectiousdisease/covid19/86127</a></li>
<li><a href="https://www.cnn.com/2020/05/04/health/us-coronavirus-monday/index.html" class="uri">https://www.cnn.com/2020/05/04/health/us-coronavirus-monday/index.html</a></li>
<li><a href="https://www.palain.com/health-topics/coronavirus-update-20200507/" class="uri">https://www.palain.com/health-topics/coronavirus-update-20200507/</a></li>
</ul>

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<p>
Extracted from <a href="https://www.palain.com/health-topics/coronavirus-update-20200507/">Palain.com</a> under the tearms of Creative Commons Attribution-ShareAlike 4.0 International License. 
</p>

<h1 >Coronavirus Update 20200507</h1>

<p>The coronavirus pandemic is continuing throughout most of the world, and I wanted to put down some observations on where we stand today. First, note that I put the date in the title. This is because the situation in some ways changes day-by-day, even though there are continuities. That makes it a dangerous place to be because it is human nature to look for the latest news and jump on it if it looks good. And that is a prime mistake because we do not in fact know enough at this point to be confident in these news reports. I would refer you to my earlier essay, <a rel="noreferrer noopener" href="https://www.palain.com/health-topics/scientific-and-medical-reports/" target="_blank">Scientific and Medical Reports</a>, which is highly relevant right now. While I could not have predicted this pandemic when I wrote it, it contains basic principles that are <em>always</em> relevant. </p>



<p>The nature of the press is that it is like the carnivorous plant in the movie <em>Little Shop of Horrors</em>, always crying "Feed Me!" And of course we are all interested if not to say anxious for any news on the course of this disease and where it is taking us. What this means is that you will see a unstoppable stream of news stories touting the latest study on one or another aspect of this. Add in the desire of politicians to spin things to their advantage, and you have a recipe for disaster. To keep sane, remember a few basic principles:</p>



<ul><li>One study proves nothing. There are lots of studies, and many of them are one-and-done without having any effect on medical practice. If there is an interesting result, it merely indicates an area for further study.</li><li>Study results are only meaningful when they have withstood peer review and have been replicated by other scientists. This process does produce good results, but only with time. Only in movies do scientists go into the lab and come out 24 hours later with the answer.</li><li>If you really want to know when all of this will end, there are only two answers. It can end very soon with an accompanying loss of life because the virus is still spreading. This is starting to show up in places that ignore the science. Going outside without a mask and carrying on as usual is not brave, it is stupid.</li><li>The other answer is that a gradual relaxation of isolation can happen if it guided by sound science. Unfortunately, as just explained, that sound science is still being sought, and will take time.</li><li>When you see the vast majority of doctors and scientists saying the same thing, that is your best assurance the information is accurate. </li><li>Right now the number one priority is testing, testing, testing.</li></ul>



<p>So, with that background, do we know anything at this point? Yes, we do. But we also have a lot of unanswered questions.</p>



<h2>Second Wave?</h2>



<p>The first big question is whether there will be a second wave, and this is something that every qualified epidemiologist I have heard from says is guaranteed. And the reason is that a certain "fatigue" sets in with staying in isolation, and at least some people will convince themselves they don’t need to do it. They are wrong, and they will guarantee that second wave. In the 1918 Flu Pandemic, the second wave was far worse than the first wave. And don’t forget there was a third wave in that pandemic until it petered out in 1920. The best thing you can do is keep isolated if at all possible, and follow all of the guidelines: </p>



<ul><li>Wear a mask if you must go out, such as for groceries.</li><li>Many stores are offering special hours for seniors. If you are one, take advantage.</li><li>After a shopping trip, wash or disinfect items carefully. Remember that soap is all you need to defeat the virus, but use disinfectant wipes when soap is not practical.</li><li>After returning, strip and place all of your clothes in the washer. The detergent should kill any virus that is there.</li><li>Wash your hands with soap frequently.</li><li>Try not to touch your face.</li><li>Maintain at least two meters distance from anyone not in your household when you do go out.</li><li>Try to stay fit. I go for walks in my neighborhood if there aren’t too many others out, and when there is someone else out, I give them a wide separation. I also do gardening in my own yard, and exercise in my home. That won’t prevent you from getting the disease, but it may prevent you from dying of it.</li></ul>



<p>Yeah, this is all of the stuff we have been hearing all along. But annoying as it is, it <em>does</em> work if you do it.</p>



<h2>Is the virus mutating?</h2>



<p>Yes. In other news, water is wet. Face it, mutation is what organisms do, and that has been true for billions of years. The question you really have is "Is it getting worse?" And right now the answer is "We don’t know." Sorry I can’t give you any more determinative answer, but we are only at the "one study" phase right now, and we are a ways off from the "peer-reviewed, replicated consensus" phase that will resolve this. There are indications that at least this virus does not mutate as much as influenza, but even that may require more study.</p>



<h2>Am I Immune?</h2>



<p>We would all love to know if we are immune. This requires two big things to give a good answer. First, does having the disease and then recovering give you immunity? And the sad truth is that we don’t know yet. The common cold is a coronavirus, and you never get immunity. Influenza is a virus, and getting it one year provides no immunity the next. And if getting it once does provide immunity, we still need testing to discover this. The number one priority right now in all locations should be testing, testing, testing. That is the prerequisite for doing any decent epidemiology. There was a report (note: <em>one study</em>) out of South Korea that indicated that some people could get the disease twice, but they re-analyzed the data and decided that it might have been false positives. That is the kind of thing that happens when scientists are trying to do a year’s worth of work in few weeks, which is what they are doing.</p>



<h2>Is It More Infectious Than We Thought?</h2>



<p>Again, very unclear. And even less clear is what this implies. An argument is being made that if the rate of infection is higher, given the number of deaths, that would imply it is less lethal. And that is being used to argue in favor of this not being a big deal, so reopen everything. But to put it in perspective, in the 2017-2018 flu season, which was on the high end of deaths, we had <a href="https://www.cdc.gov/flu/about/burden/2017-2018.htm">61 thousand deaths in the U.S</a>. Today, in just over 2 months, we have 75 thousand deaths in the US, and that is with all of the extraordinary measures we put in place to keep people safe. To make an argument that Covid-19 is no more dangerous than the flu is to be criminally stupid at best.</p>



<h2>Didn’t They Predict More Deaths?</h2>



<p>Why yes, they did. A widely used model in the US is from the Institute for Health Metrics and Evaluation (IHME), at the University of Washington. And they have issued forecasts that ranged from hundreds of thousands of deaths to around 60,000 deaths. Clearly they have no idea what they are doing, right? Not so fast. As the statistician <a href="https://en.wikipedia.org/wiki/All_models_are_wrong">George Box</a> famously said, "All models are wrong but some are useful". In this case you have to factor in two things. One is uncertainty, of course. To forecast how many people will die, it helps to know how many people <em>have</em> died, and this has been subject to fierce debate. </p>



<p>And here it gets difficult, since one argument is over what counts as a Covid-19 death. And since every one of our 50 states has their own health reporting system, there is a wide disparity. One example of this is the idea of "excess deaths". If a given area has a pretty regular death rate for a number of years, and suddenly that death rate jumps 500% in the midst of a pandemic, it is reasonable to suspect those "excess deaths" are a result of the coronavirus. But if those deaths get counted, others will argue that it is inflating the numbers, and that only a positive coronavirus serum test should count. Since each state does this differently, this leads to the odd result that the disease appears more or less lethal depending on your state of residence. And that means politicians have incentive to get the numbers they want.</p>



<p>The other factor complicating things is the phenomenon known as the "self-preventing" prophecy. You see, the initial high estimates tended to be "This is what will happen if you don’t take strong measures", and of course they were very high. And we know that governments like the UK and the US looked at those predictions, and started to take some stronger measures. So after a little bit, new predictions came out that were lower <em>as a result</em> of those measures. And now we are seeing misguided efforts to get people to go out and resume normal life, and <em>as a result</em> the newest forecasts are going up again. This is a feedback loop, in other words. </p>

