DISPATCHES FROM MOON OF ALABAMA, BY "B"
This article is part of an ongoing series of dispatches from Moon of Alabama
1298In 2019 the U.S. was ranked as the country best prepared for a pandemic. This year it is again at the top. As the Wall Street Journal headlines:
U.S. Leads the Globe as Coronavirus Deaths Pass 150,000, Hospitalizations Rise
The Washington Post adds another highlight:
U.S. reports 1,400 coronavirus deaths in a day — about one per minute
The number of new cases in U.S. have somewhat peaked for now as the sunbelt states have taken some measures to decrease new infections. But I am afraid that the trend down will (again) be very slow and that we will see another rise as some other states - Ohio, Tennessee, Indiana and Kentucky - show upticks in new infections. They may be the next ones who will get into trouble. The curve of new deaths from Covid-19 follows the new cases curve by three to four weeks. Deaths will probably peak at the end of August.
The economic damage the pandemic has caused in the U.S. is extreme:
The U.S. economy shrank at an annualized 32.9% rate in the second quarter — the worst-ever contraction on records that date back to 1947, the government said on Thursday.
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The staggering contraction beats the last record set in 1958, when GDP shrank at an annualized 10% rate.
Interestingly the contraction in 1958 was a direct result of the 1957/58 H2N2 influenza pandemic.
Globally the situations is mixed. South-east Asia seems to have the problem under control. India is a mess. South America has huge problems. Western European countries seem mostly okay for now but I expect another big rise there as people are beginning to lose discipline. East Europe looks bleak. There is little reliable dataavailable for the Middle East and Africa.
Over the last six month scientists and doctors have learned a lot about the virus and the diseases it causes. I use the plural here as the virus is causing so many different troubles that it is hard to see them as one malady.
A number of professors at the UCSF have written a very good piece which describes all the different effects they see in their patients:
We Thought It Was Just a Respiratory Virus - We were wrong.
When the pandemic reached Europe there were discussions about the published numbers of Covid-19 deaths. Had people who had heart attacks and were positive for Covid-19 died from Covid-19 or with Covid-19? Those who argued against lockdowns and masks believed that most of the heart attack deaths did not come from Covid-19 and that it was wrong to include them in the total Covid-19 deaths number. But the extensive damage the virus directly causes in a multitude of organs makes it clear that Covid-19 was most likely the direct cause of all those deaths.
There was recently a similar conflict in Idaho about the death of a pediatric nurse practitioner who had died of a heart attack caused by Covid-19:
The post, which Rep. Tammy Nichols, a Middleton Republican, shared Wednesday without comment, pointed out that Samantha Hickey, who died two weeks ago at 45, suffered a heart attack. The post by Cate Tedeski implied that Hickey’s death was somehow being misrepresented by the news media to scare the public.
It linked to an Idaho Statesman story that reported how Hickey, who worked for St. Luke’s Health System, died of a heart attack after contracting the coronavirus.
The cardiology doctor who had cared for the nurse practitioner went public and described the case:
SARS-CoV-2, or the virus that causes the disease COVID-19, is a new virus that we still know very little about. Not only can the virus cause severe pneumonia and lung failure, but it can also cause unique cardiovascular injury. In some patients with COVID-19, the stress from the infection and inflammation causes small heart attacks that can be identified through blood tests. In other patients and for reasons that we don’t understand yet, COVID-19 causes clotting within the blood vessels that can result in heart attacks and strokes.
In addition, the virus can directly attack the heart muscle itself and cause a disease called viral myocarditis. Myocarditis can happen to anyone of any age and it is unpredictable who will become severely ill. Sometimes, the virus causes so much damage to the heart muscle that patients die from rhythm abnormalities or shock because their heart can no longer function.
Sadly, Samantha Hickey died from cardiac shock due to COVID-19 myocarditis. She was an otherwise healthy 45-year-old before becoming infected.
Heart problems caused by Covid-19 are widespread. Consider this study which looked at cardiac changes in the MRI of people who have had Covid:
Findings: In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.
Two third of those people had not even been hospitalized. They were 'mild' cases. The heart damage in the 60% of the people who have had Covid-19 may be permanent. Even otherwise healthy people can have this outcome. Red Sox pitcher Eduardo Rodriguez is one of those casualties
Moreover the CDC has now acknowledged that some 35% of those who had a symptomatic Covid-19 cases have not fully recovered even after 2-3 week. This includes the 'long haulers' like Hannah Davis who recently gave this update:
I just crossed the 4 month mark of being sick w' #COVID19. I am young, & I was healthy. Dying is not the only thing to worry about. I still have a near-daily fever, loss of cognitive function, essential tremors, GI issues, severe headaches, heartrate of 150+, viral arthritis, 1/
Heart palpitations, muscle aches, a feeling like my body has forgotten to breathe. Over the past 124 days I've lost all feeling in my arms & hands, had extreme back/kidney/rib pain, phantom smells (like someone BBQing bad meat), tinnitus, difficulty understanding text/reading, 2/
Difficulty following conversations, sensitivity to noise & light, nonstop bruising. *Thinking* can cause headaches now. I'm not alone in the cognitive issues; it's as common a symptom as cough.
No one knows when #longcovid patients aren't contagious; many are alone for months.
...
Long term effects of Covid-19 are not rare. In Spain over half of coronovirus patients have developed neurological problems.
While we have learned a lot about the virus and the diseases it causes there are even more things we do not know. Many young people, most of whom do not have to fear death from Covid-19, seem to assume that the virus will spread to nearly everyone and therefore do not care about getting infected right away. That is a stupid idea:
With each passing month, researchers are learning more about how to best treat the sickest patients. While there still is no cure, there is now some evidence for how to use treatments such as remdesivir and dexamethasone, said Dr. Abraar Karan, an internal medicine doctor at Brigham and Women’s Hospital in Boston, so arguably, your chances of survival are better now than in February. “The longer you wait to be infected, the less chance you have of being part of an experiment, and the better chance you have to be receiving the outcome of a well-done experiment,” he said.
I had long assumed that The SARS-CoV-2 virus spreads mostly by aerosols in rooms with air conditioners. It was the only explanation for several superspreading events described in the early literature. The dozen people who were infected in a restaurant in Guangzhou had all been sitting in the cycling airstream of an air conditioner. Some 50 cases in a one floor call center in Singapore also pointed to air conditioning as the distribution element. The many cases in a large outbreak in a German meat processing plant were also caused by aerosols in a air conditioned atmosphere. A detailed analysis of that event is here. The authors summarize:
In conclusion, this study indicates that transmission of SARS-CoV-2 can occur over distances of at least 8 [meter] in confined spaces under conditions of relatively low air exchange rates and high rates of recirculated unfiltered air.
People infected with SARS-CoV-2 spread droplets and aerosols when they speak, sneeze or cough. Air conditioning systems also dry the air while cooling it. In dry air droplets from an infected person lose their water content very fast and turn into virus carrying aerosols. Aerosols do not sink to the ground. Air conditioning systems can spread them very effectively.
Air conditioning system in modern airplanes use HEPA filters that catch aerosol size particles. N95 (FFP2 in Europe) masks do the same. For all of those who work with other people in a closed environment in which unfiltered air conditioning is used I recommend to wear a mask.
There is research about other viruses that support this recommendation:
- Effectiveness of surgical masks against influenza bioaerosols
- Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks
- Respiratory virus shedding in exhaled breath and efficacy of face masks
- Masks Do More than Protect Others during COVID-19: Reducing the Inoculum of SARS-CoV-2
In contrast to the neglected importance of aerosols fomites have received way too much attention. Their risk was exaggerated. The chance that some virus in a droplet on some surface makes it into ones nose is very small. That is why I have not wiped one surface for fear of Covid-19 and have never changed my hand hygiene. The deep cleaning is nonsense. Such Hygiene Theater Is a Huge Waste of Time.
For air conditioned public rooms and offices upgrading to HEPA-filters in air conditioners should have the highest priority. Unless that has happened masks should be made mandatory in such places.
Posted by b on July 30, 2020 at 18:23 UTC | Permalink
Considering all the various mutations, can we cease calling it Chinese flu and just call it the TRUMP flu?
Posted by: Eugene | Jul 30 2020 19:31 utc | 2
Thanks for the excellent and ongoing COVID coverage.
US = 1,000+ deaths / day and damn proud of it.
Posted by: snow_watcher | Jul 30 2020 19:34 utc | 3
Immune related issues are not much fun. Generally only a small percentage of people have them. SARS-CoV-2 however looks to trigger an over the top immune response in many people, with inflammation doing far more damage than the virus itself. The lingering effects for many is likely to be continuing immune response.
As for aerosols, I think with SARS-CoV-1 there was a case in Hong Kong where a large number of people caught it from air conditioning.
Posted by: Peter AU1 | Jul 30 2020 19:35 utc | 4
“I had long assumed that The SARS-CoV-2 virus spreads mostly by aerosols in rooms with air conditioners.” All I needed to know was that it’s spread through the air. I started wearing homemade masks and bought a HEPA air filter for the house, two simple precautions among others such as hand washing, distancing, and avoiding confined spaces that have been recently crowded. I own a couple N95 masks from my workshop that I will use if things get really bad and I can’t avoid confined spaces.
Yet the medical community took the position that they would NOT be proactive on simple steps to avoid airborne transmission. For a couple months they counseled against masks, under the guise that they were NOT 100% effective. A competent CDC would have said: homemade masks are simple and easy, so let’s recommend their use until proven ineffective. The downside of such a recommendation would been trivial. But the cost of NOT recommending a simple prophylactic has been incredibly high—IMO professional negligence.
Now these morons are repeating the stupidity by ignoring the roles ventilation:
https://www.theatlantic.com/health/archive/2020/07/why-arent-we-talking-more-about-airborne-transmission/614737/
Posted by: JohnH | Jul 30 2020 19:40 utc | 5
@ the disinformationists posting @ #1 and #2
N95 Masks DO WORK, and the Proof is Available All Over the Net!
There has been so much oh-so-earnest and so much oh-so-authoritarian nonsense bruited about on this site about the non-effectiveness of the N95 masks that it's getting really, really disgusting. It also calls into question either the honesty (trolls?) or the intelligence of those who could so easily have just looked up the information from, and about, the inventor of the N95, Dr. Peter Tsai.
If they had done just that little bit of research, they would have discovered that the N95 works because of an inner layer of plastic fiber that carries an electro-static charge that attracts and destroys the virus, and that can be cleansed and sterilized for re-use by a number of different techniques.
Please do not believe any of the contra-factual and sometimes dangerous nonsense being spewed about by people who don't know what the hell they're talking about.
Oh, and N95 masks are not all “vented to breathe straight out without filtration.” Not those intended for medical use, for certain. There are some vented N95 masks that are intended for firefighters and other non-medical usages, and not for protection against viruses. And as you can see below, the electric charge attracts even sub-micron particles, so the idea that the mask cannot trap viruses because they're too small is simply more nonsense from uninformed and/or deviously motivated individuals.
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Here's just a small sample of information that's easily found all over the net:
Brief bio: Peter Tsai, Ph.D.
Employment: Research faculty, Joint Institute of Advanced Materials, The University of Tennessee, Knoxville
Expertise: Development of meltblowing (MB) systems and the electrostatic charging (EC) of materials for making air filter electrets. The MB and the EC developed by Tsai have been used in the industries worldwide making tens of billions of pieces of N95 respirators or face masks. He has received three prestigious awards from UT in recognition of his contribution to technology innovation. Tsai is a Fellow Member of American Filtration and Separation Society and a member of Electrostatic Society of America.
https://utrf.tennessee.edu/information-faqs-charged-filtration-material-performance-after-various-sterilization-techniques/
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Peter Tsai and the Electrostatic Filter Mask
https://engineeringethicsblog.blogspot.com/2020/04/peter-tsai-and-electrostatic-filter-mask.html
“Prof. Tsai's innovation was to find a way to take a cold pre-fabricated mat of non-woven material and subject it to two electric discharges of opposite polarity, one after the other. Under the right conditions, this process embedded quasi-permanent electric charges into the plastic fibers and made them very attractive to even sub-micron particles, like the 100-nanometer-diameter SARS-CoV-2 virus that causes COVID-19. The charge is durable and will persist even if the masks are sterilized with steam, according to a new article that Prof. Tsai just put up on a University of Tennessee website.'
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The retired inventor of N95 masks is back at work, mostly for free, to fight covid-19
https://www.washingtonpost.com/lifestyle/2020/07/07/peter-tsai-n95-mask-covid/
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More technical information for those curious enough:
https://aim.autm.net/public/project/53844/
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Finally, let's dispense with a couple of other oh-so-popular misconceptions:
“Q: Do face masks cause oxygen deficiency?
“A: The prolonged use of medical masks when properly worn, does not cause oxygen deficiency nor CO2 intoxication, according to WHO. Make sure your face covering fits properly and that it is tight enough to allow you to breathe normally.
“ 'This is a common misconception being perpetuated that has no evidence behind it,' said Krutika Kuppalli, a Palo Alto infectious disease doctor and a biosecurity fellow with the Johns Hopkins Center for Health Security.
“Q: Does wearing a face covering put you at risk for carbon dioxide poisoning?
“A: No. CO2 molecules diffuse easily through everything from bandannas to medical masks to N95 respirators, allowing for normal breathing.”
Aidin Vaziri. San Francisco Chronicle
Posted by: AntiSpin | Jul 30 2020 19:55 utc | 6
Thanks B. for your stance on Covid. You stay loyal to yourself and to the truth despite those here in their black and white worldview.
People like Roberto using arguments against your Covid coverage which you have already disproved beyond reasonable doubt time and time again. I guess while this could be cured by reading, some here are beyond even that.
At this point to spread that Covid is just a "fake" shows how a major part of Alt. Media is even more stupid and close minded that a huge part of MSM. How ironic.
Posted by: DontBelieveEitherPr | Jul 30 2020 20:16 utc | 8
Posted by: Roberto | Jul 30 2020 19:00 utc | 1
" Please stop spreading panic. ...Lockdown are destroying economy, mask are useless and potentially dangerous."
You said your piece. Now STFU
Posted by: JC | Jul 30 2020 20:22 utc | 9
@ Posted by: Fog of War | Jul 30 2020 19:15 utc | 2
The problem with your hypothesis is in the fact that doctors and nurses have been using N95 masks for decades. Other workers from the construction sector have also been using it.
If the N95 mask was the culprit, then we would've already seen enough data showing an epidemic of heart attacks among nurses, doctors and construction workers.
N95 masks do impair saturation - but only in low-oxygenated environments (i.e. you can't do too much physical work with one for too much time). But hospitals are projected to be easy on the body for nurses and doctors (elevators everywhere, relatively few floors, well connected system of corridors etc. etc.), so they can dislocate easily (with minimum physical effort) while doing their jobs. Construction workers who need to use the N95 have already developed specific labor journeys so that they have regular resting periods after each 90 min or even less. You'll never be able to run a marathon with an N95, but, with the correct culture, you can do productive labor with it without any significant risks to your heart and brain.
And even nurses and doctors (even surgeons) do not always use N95, but simple surgical masks made of cloth. Those kind of masks do not affect saturation at all, and you can even do exercises with them. Those are the masks the vast portion of the population of the USA is using, so we're not talking about risks to them, too.
The flattening and decrease of daily new cases in the US is a positive sign, but I am concerned there will be more to come in September - associated with return to school.
According to US dept of Education, there are nearly 20 million college and graduate students, and 50 million "k-12" students. If even half of them return to in-person classes before the epidemic has been suppressed in general, as is the case, they will certainly be getting sick in large numbers.
Although the health risks are low for student age, they can of course infect others, starting with parents and teachers.
More troubling is the impact on testing. The school calendar is synchronized within a month, meaning that students would at once consume all the testing resources now existing in the US, simply by attempting preventarive testing. If the obvious result takes place, this will continue to consume all the new planned test capacity for the remainder of the year. This is known but not widely discussed. The CDC does not recommend universal testing of students currently, I think because the resources don't even exist. But what is the consequence?
This situation is not unique to the US, and many other countries have even fewer testing resources.
Posted by: ptb | Jul 30 2020 20:32 utc | 11
b, as a pulmonologist, I could not agree more with your recommendation to upgrade air-conditioning systems to HEPA filters. This is why the cruise ships turned into disaster ships.
Posted by: Tiger | Jul 30 2020 20:34 utc | 12
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"b" is Moon of Alabama's founding (and chief) editor. This site's purpose is to discuss politics, economics, philosophy and blogger Billmon's Whiskey Bar writings. Moon Of Alabama was opened as an independent, open forum for members of the Whiskey Bar community. Bernhard )"b") started and still runs the site. Once in a while you will also find posts and art from regular commentators. You can reach the current administrator of this site by emailing Bernhard at MoonofA@aol.com. 
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Her heart attack might have been triggered by her constant mask wearing, decreased amounts of oxygen intake, and re-breathing carbon dioxide from her own breath. Add in potential pharmaceuticals she might have been on, her lifestyle ( was she overweight ?) , her diet, and she might have been a smoker.
Posted by: Fog of War | Jul 30 2020 19:15 utc | 1