Mischievous Ramblings II

Well, poo.

 

Turns out the voting database I downloaded for the 2018 election is flawed.

 

If you add up the entire population of its county subdivisions, you get almost 363 million people in the US, which is about 35 million too many.

 

Obvious error is that it doesn't list New York County, it lists New York City with a population of 21 million and change, which is more people than the entire state of NY has.

 

grumble.

I suggest you read this with a drink in hand

[This is an email I sent a couple of friends who requested my take on things]

Lots of links down below.

 

If you’re going to read one, read this one (it’s also down below):

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

 

If two, add this one:

https://www.axios.com/coronavirus-report-us-uk-strategies-e45bc5d4-d2f1-40e2-825e-429b2b7c1b50.html

 

 

Here’s the short version:

COVID-19 is more infectious and more deadly than a typical (or even a serious) seasonal flu.  Estimates of total infections in the US range from 65 to 230 million without attempts at mitigation, with accompanying death tolls of 600K to 9 million.

 

The big worry is overwhelming our hospital capacity so that serious cases cannot be supported until recovery.

 

Social distancing, infection avoidance (hand washing, sanitizing, avoiding touching the face, etc.) are our only current weapons to mitigate spread of the disease.

 

Forgot to add: when you look at numbers of deaths, those infections happened at least 3 weeks ago (possibly 5).  So we are looking into the past. Depending upon doubling rate, the current expected deaths from infections happening down will be between 8-64 times larger if the doubling rate is 6 days and 16-1000 times larger if the doubling rate is 3 days.

Here’s the long version:

 

The Disease:

While numbers continue to come in, there appears to be no question that SARS-CoV-2 (the virus which causes the disease COVID-19) is both more infectious and more deadly than a typical seasonal flu.  Depending upon the research the doubling rate of COVID-19 appears to be somewhere in the 3-6 day range, and the death rate looks to be a minimum of about 1% (with full treatment options available) and a maximum of maybe 4% (if the healthcare system is overloaded and treatment options become more limited).

 

Incubation period can be up to 14 days and a full course of disease is 20-30 days.

 

The Spread:

Up to 80% of cases are thought to be mild, many of them completely asymptomatic.  There is no symptom based diagnostic that can differentiate between COVID-19 and a bad cold or the flu.  Up to 15% are “serious” requiring at least medical monitoring if not hospitalization, and around 5% are “critical” requiring significant medical intervention (at least oxygen, possibly ventilation) meaning the use of ICU or CCU beds.

 

Some research indicates that people infected with SARS-CoV-2 shed virus days before they become symptomatic (if they ever do) and for some time after they “recover” if their cases are mild.

 

Transmission is not yet known to be aerosolized, but appears primarily droplet-based.  Basically, people with the disease shed virus through natural secretions including mucous and feces.  A sneeze projects infected droplets for at least several feet, and those droplets stay on surfaces for at least hours and possibly days.  When a sick person touches their face they are likely to get traces of mucous on their hands which they then deposit on surfaces they touch, including tables, door handles, keyboards and screens, and so on.

 

Estimates of infection rates in the general populace over the course of the outbreak range from 20%-70%.  The time frame is not usually specified but we are most likely talking about under a year, depending upon mitigation strategies.

 

In the US, that means between 65 million and 230 million people will be infected.  65 million is roughly the number of infections in the US during a bad seasonal flu year.

 

At 1% mortality, that’s 650K - 2.3 million deaths in the US.  At 4%, it’s 2.5 million to 9 million.

 

Treatments and Vaccines:

A vaccine will take at least a year to get through safety testing and trials.  Initial testing has already begun on at least one vaccine but first attempts don’t always work.  A safe assumption is that a vaccine is at least a year and a half out, possibly two years.

 

For now, treatment is strictly supportive, meaning that serious and critical cases get put to bed and watched.  As their breathing is reduced, first oxygen and later mechanical ventilation are used to keep the patient alive while the disease runs its course.  In some cases, secondary infections will be treated with antibiotics.

 

Mitigation:

Without a vaccine, the only mitigation available is limiting the spread of the disease.  Epidemiologists use R0 (“R-nought”) as a measure of replication of a disease in a population.  If R0 is 1, each infected person gives the disease to one other individual (on average) and the number of cases in the population is stable over the long term.  If R0 is below 1, the number of cases falls over time.  If R0 is above 1, the number of cases increases over time.

 

The only weapon we have against this disease spreading is reducing R0.  The easiest way to do that is to reduce the number of contacts between infected people and uninfected people.  Unfortunately, infected people don’t have a giant sign on them saying “COVID-19!  Stay Away”.  Since many cases of COVID-19 are asymptomatic, and because patients shed virus before being symptomatic, we cannot isolate patients nor can we selectively avoid them.

 

The solution is to reduct contacts with _everyone_.  “Social distancing” means drastically reducing the number of direct in-person interactions you have with people.  Staying home.  Staying at least six feet away from people when you do go out.

 

Alongside reducing contacts goes reducing the chance of infection.  Since SARS-CoV-2 must enter the body to infect you and you generally pick it up on your hands, hand-washing often (for at least 20 seconds) is a useful mechanism to reduce infection rates.  Where hand washing is not possible, hand sanitizer (at least 60% alcohol) is better than nothing.  Avoiding touching your face with possibly infected hands reduces infections through the mouth, nose, and eyes.

 

Effects of Mitigation:

Modeling shows (and the experience of Hubei Province in China confirms) that radical contact reduction (“lockdown”) is effective in slowing or even stopping the spread of the virus.

 

But the level of contact reduction has to be big.  At least 75% on an individual basis.  That’s why all the recommendations to stay at home (“shelter in place”), close business, avoid crowds, etc.

 

 

 

Sources

Here’s where I start every day.  During the early stages, these various surveillance sites all agreed on the numbers.  Now they don’t, but they generally end up syncing up at least once or twice a day as they troll for numbers and update:

 

https://ncov2019.live/data

https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

 

This is automated graphing of various statistics about the outbreak:

 

https://www.worldometers.info/coronavirus/

https://www.worldometers.info/coronavirus/#countries has a sortable table which lists information by country including new cases and new deaths in the last day

 

Here’s an article about the modeling which apparently changed the White House direction from “meh” to “OMG”: https://www.axios.com/coronavirus-report-us-uk-strategies-e45bc5d4-d2f1-40e2-825e-429b2b7c1b50.html

 

And here’s the report itself: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

 

Editorial on how this economic hit is different and what we should do about it: https://www.marketwatch.com/story/theres-a-second-curve-that-needs-flattening-the-recession-curve-2020-03-17

 

Like any big story, Twitter is the place for the latest, if you can sort through the crap.  I follow a guy by the monicker epsilon: https://mobile.twitter.com/epsilon3141

 

Analysis of hospital bed capacity on a state-by-state basis and when COVID-19 cases will fill the system: https://www.healthleadersmedia.com/clinical-care/see-when-states-will-face-hospital-bed-capacity-shortages-during-covid-19-outbreak

 

Outbreak math: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

https://finance.yahoo.com/news/marty-makary-on-coronavirus-in-the-us-183558545.html

Why didn't I do this sooner? Oh, yeah....

Transcend Travel CPAP/APAP.  Image borrowed for fair use from Intertubes.

 

Sara and I both use CPAP (Continuous Positive Airway Pressure) devices.  These are small machines that sit by the head of our bed and force air through a hose, into a mask that covers our nose, and down our airway to our lungs in order to keep it open while we sleep.  It is a treatment for Severe Obstructive Sleep Apnea (SOSA) which is a condition in which the airway closes periodically during sleep.  We actually use devices called APAPs (Automatic Positive Airway Pressure).  Each of us has two APAPs, one for home and one for travel that is smaller and runs easily off a battery.

As a geek, I want access to medical technology that I have to use, and I want data on my usage (my pulmonologist says that I am his poster boy for compliance, and seeing the data is part of that for me).  As a pilot, Sara requires data from the CPAP for her flight medical.  Both of us want to be able to program the devices to change their pressure parameters as our needs change.  To do this, you need special software, and in at least one case, a special piece of hardware and cable for the CPAP.  We have all of that.  We have everything we need to access data on and program each of the four machines (two types) that we use.  I have visited multiple pulmonologists in the 15+ years I've used CPAP, and never has one been able to read data off my machine.  But I can. :-)

You also need a Windows machine.  The CPAP market is not so large that the manufacturers build great software, and they only build it for Windows.  Some of them use outdated hardware specifications (like 9 pin serial ports and 8 pin DIN connectors).  Many will write to one or another kind of SD card (some only to original SD, not SDHC, some to micro SD, etc.), but all of them I've encountered require Windows software to extract data and get reports.

Have I mentioned how much I hate Windows?  I have an old media PC I bought from someone at Amazon that I run the software on.  It's old and crappy and never connects to a network, and only comes out to run this software, but to do so, I have to keep a monitor around and move my keyboard and mouse while I set the machine up somewhere, and it's just a pain.

So I thought, I'll buy myself a cheap old Windows laptop, maybe even with a serial port, running Windows 7 or 8, and it'll be cheap and easy to move around and I can reclaim the cubic yard of office that the current device and monitor and keyboard and mouse occupies.  And I did.  I went to the local neighborhood computer repair place and bought a used ASUS laptop for $150, and it's just what I needed even if it doesn't have a serial port and runs Windows 10.

I need to install two applications on it.  One for each brand of CPAP.  And it takes hours.  The first app is on CD, and it doesn't have a disk player, so I move one over from my Mac and it reads it but it won't install the software because the software uses a library that isn't included in Windows 10 and won't install off the CD in Windows 10 and I have to research it and find the newer 4.0 version that includes the older 3.5 and 2.0 versions and install it and see if the installer will recognize it and I try to install that software four times before it works.  The second piece of software isn't nearly so bad so I only need to install it twice before it works.  And then it takes 40 minutes for the Windows 10 system to recognize the USB to serial adapter and find a driver for it, and another 30 minutes to update the Windows 10 system files.

And finally it works. And I have a portable system that I can use to access my own medical data and program my own medical devices.

And this morning when I turn it on to suck data out of my CPAP, it takes 20 minutes to update Windows 10 again.  Two days after I last updated it.

Now I remember why I didn't do this sooner...

 

Cross Posted to Group News Blog

Ya Think?

There better be more than a "trace amount" of peanuts in my raw spanish peanuts!

Slackers get theirs...

I love this:

 

More things in Heaven and Earth...

There are more things in Heaven and Earth, Horatio, then are dreamt of in your philosophy.

-- William Shakespeare, Hamlet

This is one of them:

The Red Hot Chilli Pipers are playing Bremerton, WA, early in March. I must see this for myself.

The Swiss Musical Starship

From Hammacher Schlemmer, for a mere $31,500, comes The Swiss Musical Starship, which plays 35 seconds of the Star Wars theme, the Star Trek theme, and the Imperial March, coming in at a mere $300 per second.

Is this the modern equivalent of Let them eat cake?

Curmudgenly Thoughts

I don't know if I want to live in a world where the University of Oregon Ducks are a sports powerhouse.

I grew up in Eugene and outside Myrtle Point, Oregon.  My father taught at the U of O.  The official sports slogan I remember was "Go Big Green!", but the usual local usage was more commonly "Go Little Yellow!" as the basketball teams generally didn't reach .500 playing at Mac Court ("Pack the Pit!") and the football teams didn't play a bowl game between 1963 and 1989.  The one thing I remember the U of O being somewhat successful at was track and field.  We watched "Pre" run fourth at the 1972 Olympics.

There was a certain rightness to the world when the U of O and OSU fought for the bottom every year.

Curse you, Phil Knight!