Thursday, March 19, 2020

COVID-19: Not just the elderly; all age groups are at risk

If you were pre-retirement age and comforted that only old folks were getting severely ill from COVID-19, understand that things have changed.

Middle-aged folks are also severely impacted. And even infants, who seemed entirely protected in early reviews, are at risk.

The high risk assessment for the elderly came from very early reports out of China, but now that itʻs a pandemic, and thereʻs a lot more information available, the picture is growing more complex.

The upshot: While the death rate is higher among the elderly, the hospitalization rate is only slightly lower for folks in the middle-age category. One in ten or so people in almost every age group get so sick they need medical intervention. Those under age 20 seem to do the best, but anyone with underlying health conditions is at increased risk.

It is another justification for the seemingly severe recommendations for keeping your human contacts to a minimum, and for keeping those contacts at a distance.

Here is a Centers for Disease Control report on patients within the United States.

It reconfirms that death rates are highest among the oldest patients—up to a quarter of infected people older than 85 are dying. The death rates go down as ages go down, but only the kids under 19 appear to avoid the severest symptoms.

Of the 12 percent of known U.S. patients who were hospitalized, "18% were 45–54 years, and 20% were aged 20–44 years."

Thatʻs 38 percent aged 55 or younger.

In France, half were younger than 65. In Holland, half were younger than 50.

And while infants rarely get the disease, and the symptoms tend to be milder than in adults, infants do get it. Here is a China paper about one fatal case. 

During one week in January in China, six children, with a median age of three years, were hospitalized with Covid-19. It wasnʻt pretty for them: 

"All six children had previously been completely healthy. Common clinical characteristics included high fever (>39°C) (in all six patients), cough (in all six), and vomiting (in four). Laboratory investigations showed that the levels of lymphocytes, white cells, and neutrophils were below the normal range in six, four, and three patients, respectively. Four of the six patients had pneumonia, as assessed radiographically, with computed tomographic scans of the chest showing typical viral pneumonia patterns."

That was from this paper in the New England Journal of Medicine.  

Here arerecommendations from Johns Hopkins for parents with infants. 

And here are Centers for Disease Control recommendations for those with kids. 

As this is written on March 19, 2020, there have been a quarter million positive cases worldwide, and 10,000 deaths.

©Jan TenBruggencate 2020

COVID-19: Bored while homebound? Plant a garden. The benefits are many.

Nothing to do and worried about food as we all hunker down for the duration of the COVID-19 pandemic?

Plant a garden. Or get to know a farmer whoʻll deliver fresh vegetables.

Our farmers, lacking access to markets, are incentivised to find a way to get their crops to a market, any market, and many are looking at options including delivery.

And if you have a plot of land, and are stuck sheltering in place, once the rain stops, maybe till up a few square feet. You could be eating your own fresh vegetables in a few weeks.

Radishes will get you a harvestable crop in 21 days. Arugula, green onions or carrots in a month. Spinach in six weeks. Bush beans in six weeks to two months. Kale or broccoli in a couple of months.

Starch crops take longer. Sweet potatoes can be ready in three or four months, kalo in nine to 12 months for the corm, but leaves can be harvested for boiled or steamed greens much sooner.

Tomatoes generally can take three to five months to harvest, but cherry tomatoes can be ready in six to eight weeks. Cherry tomatoes have the additional benefit of being less susceptible to being stung by fruit flies.

Gardening not only gives you something to do in these difficult times, but the product is good for you, too.

During World War II, people in the Islands (and across the nation) planted what were popularly called Victory Gardens or War Gardens. Food supplies were uncertain, so folks planted their own crops in whatever plots of land they had.

Iʻve been told that Hawai`i was largely self-sufficient in food—or at least in many kinds of food—back then.

The message: Support your local farmer, or grow your own. It will have the side benefit of helping you understand just how much work it takes to produce your food.

© Jan TenBruggencate 2020

Tuesday, March 17, 2020

COVID-19: The numbers donʻt look good

Anybody whoʻs still suggesting this whole COVID-19 thing is overblown...theyʻre lying to you, or theyʻre misinformed.

It is in fact frightening, and fast getting worse. The United States is still at the start of the upward trend in infections.

Consider this fact that you havenʻt heard on the news: The European Union now has had three times more cases per capita than China.

Here are the numbers: China has had 81,000 cases, and has a population of 1.4 billion. That works out to 57.5 cases per million people.

The European Union has 69,900 cases and a population of 446 million. Thatʻs 157 cases per million residents—three times worse than China.

The United States so far has just 6,420 cases in a population of 331 million, or 19.4 cases per million.
Those case numbers come from this site. The E.U population numbers are from this site. 

Chinaʻs case load has dropped dramatically. They did that with draconian measures, including aggressive quarantine, bounties paid to people who turned in quarantine violators, tracking peoplesʻ cell phones and requiring everyone wear masks whenever outside.

South Korea had a severe outbreak, and approached it in a very different way, with the most expansive testing program in the world: More than 270,000 of its residents were tested as it tracked down and quarantined anyone who was sick with COVID-19.

South Korea has 8,320 cases. That works out to 162 cases per million of its 51.5 million residents. But it has dropped its number of new cases dramatically. The magazine Science printed a story today on how South Korea did that. 

As I write this on March 17, 2020, Italy has the worst caseload in the European Union and perhaps the world—521 cases per million residents. (31,500 cases in a population of 60.5 million.)

Just looking at the numbers suggests much worse is yet to come for the United States. Our population is about 328 million. 

If we are able to limit our outbreak to Chinaʻs size, weʻre looking at 19,000 cases. (57.5 times 328 million.)

If we can keep it to Koreaʻs, then itʻs 53,000. (162 times 328 million.)

But if we get to Italyʻs situation, itʻs 171,000 (521 times 328 million.)

One issue is that while China and South Korea used two different strategies to begin to get a handle on the outbreak, the United States has been using neither. Not aggressive, almost punitive quarantine measures like China. And not aggressive, intrusive testing like Korea.

Our national hope seems to be that a combination of voluntary isolation measures and a moderate testing protocol will do the trick.

© Jan TenBruggencate 2020

Monday, March 16, 2020

COVID-19 Fake News: Bogus "cure" rumors, debunked here

The bogus  home cures for COVID-19 are showing up all over.

Fortunately most wonʻt hurt you, and some might even ease symptoms a little, but not cure you. That said, some of these crazy "cures" can kill you.

Hereʻs one lie: Gargling with salt water will wash the disease out of your throat and youʻll be better. Or gargling with warm salt water and vinegar will kill the virus.

Simple logic reminds you that the virus isnʻt only in your throat. Itʻs also in your nasal passages, in your lungs, in your blood, and even in feces. Gargling isnʻt going to have any impact on most of those locations.

Gargling with or drinking bleach, which some have suggested, has the additional downside of being dangerous as well as ineffective. It can burn your throat and stomach, it can collapse your blood pressure, it can put you into a coma. Donʻt do it. Hereʻs some information from the New York State health office. Also, wiping or spraying down your body with a bleach solution may clean your skin, but it wonʻt have an impact on the disease inside you.

Eating garlic or drinking garlic soup might keep people away from you due to the smell—which is an interesting take on social distancing—but thereʻs no evidence it helps with the disease. Here is that one and a few other myths from the World Health Organizationʻs website. 

Drinking large amounts of alcohol or water wonʻt prevent or stop the disease. The World Health Organizationʻs twitter feed debunks these theories. 

There are predatory personalities online, on radio and on TV who promote bogus cures of several kinds. Often, youʻll find theyʻre selling their special "cure." Theyʻre getting rich on the backs of the sick. Some have already been told by government agencies to stop with the fake cures.

Fortunately, there are several websites that are actively responding to malicious and erroneous medical information about this outbreak. Hereʻs one.

The upshot: donʻt do stupid stuff just because some stranger (or even a friend) told you it might work.
© Jan TenBruggencate 2020

Saturday, March 14, 2020

COVID-19: Kaua`i has its first confirmed cases, and debunking fake news--folks, the barges are still coming

Kaua`i today was confirmed to have its first active cases of COVID-19, in a tourist couple who are being kept in isolation.

The couple is at an undisclosed site overseen by Kaua`i County and being monitored by the state Department of Health. The case is being managed according to protocols set up in advance in anticipation of the event.

The confirmation, which was announced in a mass email from Kaua`i County a couple of hours after midnight, was based on testing of the couple performed yesterday (Friday, March 13, 2020).

Meanwhile, the stateʻs epidemic rumor mill continues to churn.

One of the most active rumors, that cargo to the island is being disrupted, has spawned new runs on supplies.

"I have never seen Costco so full. They had lines snaking away from the checkout counters, some of them all the way back to the pharmacy," one friend told me Friday afternoon.

At Safeway, two women asked me whether it was true that Young Brothers barges have been blocked from coming. Others reported rumors that the harbors have been closed.

None of that is true. I talked to store officials, who insist their supply lines are intact, and harbors and shipping officials. Food and toilet paper are still making their ways to the island. 

What the panic buying and hoarding has done is move supplies from store shelves, where people can get them as needed, into peoplesʻ home larders, where excess supplies are not available to people in need.

Matson took the step of issuing a press release in response to the rumors: 

“Matson intends to maintain all service schedules as normal with three arrivals a week to Honolulu and twice a week calls to each neighbor island port.

Young Brothers, the inter-island barge service, issued its own statement:   

"There are currently NO changes to sailing schedule or cargo acceptance at all ports. YB will continue to monitor COVID-19 and its impact to the State."

© Jan TenBruggencate 2020

Friday, March 13, 2020

COVID-19 Fake News: Stuff people are saying about the disease thats just bull

There is lots of information about COVID-19 out there, and some of it is bad information.

Hereʻs some of the stuff Iʻve been hearing thatʻs not true, or not entirely true.

Q. A friend asked whether, once youʻve had the virus, youʻre immune in the future.

A. The answer is, probably, but not certainly. 

Youʻre generally immune to a virus after having gotten it—at least for a while. However, there have been rare cases in which people have appeared to be over COVID-19, and then got sick again. Was it simply a relapse of the original infection or a new one? Thatʻs not yet clear.

There is also indication that the virus has evolved, at least in China, and that there are now at least two versions of COVID-19 out there. If youʻve had one, you might still be susceptible to getting the second. Hereʻs a link to a scientific paper on that.

The Centers for Disease Control says this: "The immune response to COVID-19 is not yet understood. Patients with MERS-CoV infection are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19."

Q. Another person said flu goes away in the summer, so this will be gone by mid-year.

A. Donʻt count on it. This disease has not been around long enough to know. Hereʻs what the Centers for Disease Control says about that: 

"It is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during other months.  At this time, it is not known whether the spread of COVID-19 will decrease when weather becomes warmer.  There is much more to learn about the transmissibility, severity, and other features associated with COVID-19 and investigations are ongoing."

Q. A co-worker told me he read that if itʻs a dry cough itʻs COVID-19, but if itʻs a wet cough itʻs the flu.

A. Wrong. (Sometimes.) 

As this guide from Johns Hopkins Medicine notes, thereʻs no sure thing with symptoms. A dry cough occurs most often in COVID-19, but not always. Same with fever—some patients have one, some donʻt. Same with soreness and tiredness. Same with shortness of breath. 

A World Health Organization study in Chinaʻs outbreak found that fever occurs 88 percent of the time,  dry cough in 68 percent of cases, fatigue in 38 percent, sputum production in 33 percent, shortness of breath in 19 percent, sore throat in 14 percent, headache in 14 percent, joint pan in 15 percent, chills in 11 percent, nausea or vomiting in 5 percent, nasal congestion in 5 percent, diarrhea in 4 percent, and coughing up blood in 1 percent and  and watery or inflamed eyes 1 percent.

Q. Someone asked, if I get tested, will I know for sure that I am or am not infected?

A. If you have symptoms and a positive test, youʻre infected. The test can confirm that the disease youʻve got is not a cold or flu or other virus and is COVID-19. 

If you have no symptoms and you can get someone to test you, chances are it will be negative. But that doesnʻt necessarily mean you donʻt have it. It could mean you donʻt. Or it could mean youʻre infected but havenʻt been infected long enough to test positive.

"As with all currently available tests, it’s not yet clear how long a person needs to be infected before testing positive, or whether someone who's infected could be identified by the test before displaying symptoms." 

Q. If I get sick, I can only infect others while I have active symptoms.

A. Wrong. You can infect people a day or two before your active symptoms show up, and you might be able to pass the virus to others for a week or more after youʻve recovered.
This German study found active viruses for many days after symptoms disappeared.

© Jan TenBruggencate 2020