Covid-19, A quick look at the numbers

As the coronavirus pandemic rages on in the U.S., a lot of claims get tossed out with very uncertain evidence to back them up. I saw a screenshot clip from one of my Facebook friends. I couldn’t find the source for that, but a search on the name I saw lead me to a website where I found this claim.

STUDY DISCOVERS THAT STATES WITH FEWER RESTRICTIONS HAD LOWER Covid DEATH RATES – In a rebuke to the “experts,” a study from the Sentinel, a Kansas non-profit, found that the eight states that didn’t fully lock down – North and South Dakota, Nebraska, Iowa, Arkansas, Oklahoma, Wyoming, and Utah – witnessed a 75% lower death rate per capita than the 42 states that enacted the strictest lockdowns.

On the face of it, that sounds impressive. Did staying open actually save people’s lives? I had to look into it. For starters, I already knew that meat plants in South Dakota, Nebraska, and Iowa were hard hit by Covid-19 cases. Meat plants in Texas and Pennsylvania were similarly hard hit. So this was no magic protection. But I decided to dig up the current numbers and see if this difference is still holding up. I came up with this table as of July 31, 2020.

State comparison
casesdeathspopulationCFRPFRcases/100k
North Dakota6937111762,0620.0160010.000146910.2934
South Dakota9079136884,6590.014980.0001541026.271
Nebraska270273391,934,4080.0125430.0001751397.172
Iowa460458873,155,0700.0192640.0002811459.397
Arkansas453814903,017,8040.0107970.0001621503.776
Oklahoma394525663,956,9710.0143470.000143997.0252
Wyoming288427578,7590.0093624.67E-05498.3076
Utah420153243,205,9580.0077120.0001011310.529
8 states218820288017,495,6910.0131620.0001651250.708
Texas470,000789028,995,8810.0167870.0002721620.92
New Mexico213406582,096,8290.0308340.0003141017.727
California525,000962039,512,2230.0183240.0002431328.703
Florida497,000740121,477,7370.0148910.0003452314.024
Georgia182,000383510,617,4230.0210710.0003611714.164
5 states1,695,34029,404102,700,0930.0173440.0002861650.768
New York182,0003,83519,453,5610.0210710.000197935.5614
Louisiana125,0004,0514,648,7940.0324080.0008712688.869
U.S.4,850,000159,000328,239,5230.0327840.0004841477.58
other 424,631,180156,120310,743,8320.0337110.0005021490.353
All But NY4,668,000155,165308,785,9620.033240.0005031511.727

So those 8 states, with a combined population of about 17.5 million, had 218,820 cases and 2880 deaths. The population fatality rate was .0165% for those states.

The other 42 states in the U.S. with a combined population of over 310 million had 4,631,180 cases and 156,120 deaths for a population fatality rate of .0502%.

So, as of July 31, that 75% discrepancy was down to 66%.

And for five comparison states that I was interested in (Texas, New Mexico, California, Florida, and Georgia), the population fatality rate was .0286%. So those 8 states are only 42% less than my arbitrary selection of 5 states. And my set is 43% less than the U.S. average.

If fact, the Case Fatality Rate for my set of 5 states with almost 1/3 of the U.S. population is barely half (1.7% vs 3.3%) that of the U.S. as a whole. The 8 state set had a slightly lower CFR (1.3%) and slightly lower rate of cases (1250 per 100K people vs 1650 in my set and 1477 in the U.S. overall.)

So, Louisiana’s experience has been about average for the U.S. and states like Michigan that were hit hard early and have a CFR almost 7% make my set of 5 states look good by comparison.

https://coronavirus.jhu.edu/data/new-cases-50-states

The Johns Hopkins website has excellent graphics for tracking this disease in the U.S. and around the world. You can check on your state’s progress there. I’m happy to note that Texas, where cases soared by a factor of 6 in June and July after businesses opened up, is starting to get the disease back under control with a combination of mask wearing, social distancing, limiting restaurant capacity to 50% and closing the bars. Those measures have cut the case rate in half over the last 2 weeks or so.

Another factor is that the overall death rate is declining for a few reasons. The hospitals in New York and Michigan that were hit so hard back in March and April have learned how to treat this disease better. Some of it is just managing patients better. And treatments like remdesivir, corticosteroids, and blood thinners are beneficial when used at the right stage in the course of the disease. Also, there is a rise in younger patients in their 20’s and 30’s who still get sick, but are less likely to die from Covid-19.

So, Utah may look safer than Texas with regard to this disease, but I wouldn’t want to get it in either state.

The Media are the messages, Part 1

It’s hard to believe but, even though Marshall McLuhan and Quentin Fiore’s influential book https://smile.amazon.com/Medium-Massage-Marshall-McLuhan/dp/1584230703/ref=sr_1_3?dchild=1&keywords=marshall+mcluhan&qid=1591467817&s=books&sr=1-3 was published in 1969 when I was still in high school, I’ve been getting its name wrong all this time! I thought it was The Medium is the Message, but it’s actually The Medium is the Massage. I guess I should break down and get around to reading it.

In any case, it has been very influential by planting the concept that how we receive information affects us and changes how we perceive and understand that information. And, as someone who studied Latin in school, it continually irks me when I see someone say that “the media is the message.”

So, of course it came back to me when one of my Facebook friends shared a meme about “Anybody notice how fast the Covid conversation disappeared when the nation’s attention was turned elsewhere? Notice how media controls (sic) you “.

Memes are everywhere and it’s a losing battle to try to refute them all. But I’ve started writing this blog because I think I have a bit more to say than can be expressed in a simple meme.

Nevertheless, it planted an idea and I thought I would start a series of examples of various media that I found particularly interesting and that I personally read or watched (if perhaps not in the current week).

So here is my first list.

Books

A couple years ago we celebrated the centenary of the end of the First World War. I have recently been learning about some of my relatives who served in the American Expeditionary Force in 1918. So, I decided to do some serious research and started reading The First World War by John Keegan. https://smile.amazon.com/The-First-World-War-John-Keegan-audiobook/dp/B07SLKPV3M/ref=sr_1_5?dchild=1&keywords=John+Keegan&qid=1591469179&s=books&sr=1-5

The war began with what was essentially a domestic incident in a country (the Austro-Hungarian Empire) that was led by a minority of Germans and Magyars. Perhaps there is a lesson to be learned as our country which once had a majority of White Anglo-Saxon Protestants (WASPs) is looking at a future where Caucasians will be less than 50% of the population?

Magazines

The National Geographic is one of the oldest American magazines and has been greatly influential in shaping our view of our world and ourselves. So I found this article about racism and the coronavirus to be particularly interesting.

<blockquote>George Floyd’s death is no different from that of Eric Garner, Sandra Bland, Ahmaud Arbery, or Mike Brown. And their deaths are no different from Emmett Till’s. The years change, but nothing else does. The conversations I hear at protests are full of anger and frustration, but they lack substance and history. I understand the rage and that it needs a release. The rage eventually dies. The fire is put out. What are we left with then? (Related: Read how the violent history of lynching reflects a brutal American legacy.)</blockquote>

I barely remember Emmet Till. He was lynched as a 14 year old boy just before I started kindergarten. https://en.wikipedia.org/wiki/Emmett_Till

But he was mentioned by one of the people interviewed by the New York Times last week about why they had decided to protest the death of George Floyd.

Newspapers

Many of my Facebook friends decry the liberal bent of our leading national newspapers like the New York Times and Washington Post. As a former newspaper boy, I still have a fondness for this medium which is hanging on mainly through a blending of the World Wide Web internet sites with local print publication. So, I decided to subscribe to the Dallas Morning News, which published this article a few days ago.

https://www.dallasnews.com/news/crime/2020/06/02/dallas-police-chief-renee-hall-says-demonstrators-broke-law-when-they-walked-onto-margaret-hunt-hill-bridge/

I frequently drive across that bridge working the local gig economy. I wasn’t working Monday night when this happened but I thought about it a few days later when I did drive downtown.

Fortunately, the decision was made not to prosecute the demonstrators. So, I was able to discuss it more calmly with a black man I met while jogging this morning in Kiest Park. I even kidded that perhaps the police were trying to keep the protesters from getting into Oak Cliff (the area south of the Trinity River) which has large Hispanic and Black neighborhoods.

But there has been a lot of discussion about how police can allow protesters to exercise their right to assemble and freedom of speech in a peaceful manner. And the technique of kettling is one of several ways in which police tactics can escalate rather than calm a situation.

New Media

There are a lot of sources of information that have arisen in the last 20 years since the dawning of the information age. Some of them like the Huffington Post aspire to newspaper status. Others like Breitbart are little more than a cover for one-sided political advocacy. But since it has a lot of useful information about my home state, I tend to follow the New Mexico Political Report.

They recently posted an article titled Health officials: Data shows masks, social distancing works.

<blockquote>While cloth masks aren’t suitable for use in healthcare settings, Scrase said they are still useful at preventing the spread of the illness among the general public. A review published in May that analyzed 21 studies found that mask use provided a “significant protective effect,” and reduced the risk of infection significantly, ranging from 80 percent among healthcare workers to 47 percent among the general public.  </blockquote>

Podcasts

I started downloading and viewing or listening to audio and video podcasts about 14 years ago after my sons talked me into helping them build a new computer and we got direct (not dial-up) internet that would support web browsing.

Since my gig work gives a lot of time to listen while I drive around, I have returned to following some old favorites and learned about some new ones. microbe.tv has several good ones, but my personal favorite is This Week in Virology (TWiV). It has been enormously informative as the new coronavirus spreads around the world.

And this interview with Peter Daszak of the Eco Health Alliance is particularly interesting. He was working with the Chinese to identify potentially hazardous viruses in bat populations until the NIH cut his funding.

https://www.sciencemag.org/news/2020/04/nih-s-axing-bat-coronavirus-grant-horrible-precedent-and-might-break-rules-critics-say

So, perhaps you’ll also find this podcast informative.

YouTube

YouTube has exploded from just people sharing their home movies to become the medium for sharing anything video or audio. I stumbled across this blast from the past the other night.

Many of the top hits of the 1960’s and 70’s were recorded in studios in Los Angeles. And a group of highly skilled session musicians informally known as the Wrecking Crew performed backing up Brian Wilson and the Beach Boys, Phil Spector’s Wall of Sound recordings and many others.

Movies

It’s been a few years since I watched it, but since today is the anniversary of D-Day, I have to mention Saving Private Ryan. It’s still one of the best war movies of all time.

https://www.imdb.com/title/tt0120815/

Music

Since I also like Lady Gaga, I’ll defer to my son Eric’s recommendation for this and wish you all some Fun Tonight.

I should definitely add a television section and perhaps some others, but I think this will do for now.

Wishing you all a good wake and hoping you stay safe and healthy.

Lies, Damned Lies, and covid-19

There is a well-known saying which Mark Twain popularized in Chapters from My Autobiography, published in the North American Review in 1907. “Figures often beguile me,” he wrote, “particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: ‘There are three kinds of lies: lies, damned lies, and statistics.’

Apparently Twain’s attribution to Disraeli was incorrect, but the saying was in common use by the 1890’s including a letter to the British newspaper National Observer on 8 June 1891, published 13 June 1891, where it was written: “Sir, —It has been wittily remarked that there are three kinds of falsehood: the first is a ‘fib,’ the second is a downright lie, and the third and most aggravated is statistics.”

My interpretation of these three categories is something like this. The first category consists of simple falsehoods. These can be merely incorrect but spoken in the conviction that they are true. Other times they are spoken knowingly to cover up information that is inconvenient or embarrassing. The second category is spoken knowingly and with intent to deceive or perhaps malign someone. The third category, which I see often in my perusing of various blogs about science and medicine in particular, uses a convenient statistic as a magic talisman to deflect criticism and give the appearance of truth to what is fundamentally a lie.

Many of the statistics I see cited repeatedly are only preliminary estimates based on a limited sample of data. In other cases, the user will find one number in a large report that supports the argument they wish to make while ignoring the rest of the report which disagrees with their argument. In the process of science, researchers will do repeated studies on matters of importance like the effectiveness of various treatments or the safety of vaccines. Thus information which may have been current 20 or 30 years ago will often have been superseded by newer and more accurate results.

In the middle of a global pandemic like COVID-19 which is caused by the SARS-CoV-2 virus, the statistics about it change as often as the weather. And even the definition of what we are counting changes as we become more aware of the nature and extent of this disease. So I would like to discuss the important statistics about this disease and how they compare with more familiar diseases like influenza and measles. Specifically, I want to discuss the uncertainty in some of the key statistics, how some people twist those statistics to mislead us and imply the disease is less harmful or widespread than it actually is, and how even in the face of that uncertainty those statistics can help us learn about this disease and guide us to control it and minimize the harm to ourselves and those we care about.

On December 31, 2019, the Wuhan Municipal Health Committee informed the World Health Organization (WHO) of 27 “cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan.” This was the first public announcement about COVID-19.

On January 7, 2020, scientists of the National Institute of Viral Disease Control and Prevention (IVDC) confirmed the novel coronavirus isolated on 3 January was the pathogenic cause of the viral pneumonia of unknown etiology (VPUE) cluster, and the disease has been designated novel coronavirus-infected pneumonia (NCIP).

On January 8, South Korea announced the first possible case of the virus coming from China.

On January 14, WHO sent a tweet which said “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus (2019-nCoV) identified in Wuhan, China”.[61] According to Reuters in Geneva, WHO said there may have been limited human-to-human transmission of a new coronavirus in China within families, and it is possible there could be a wider outbreak.

On January 15, the first known travel-related case of 2019 novel coronavirus entered the United States: “The patient from Washington with confirmed 2019-nCoV infection returned to the United States from Wuhan on January 15, 2020. The patient sought care at a medical facility in the state of Washington, where the patient was treated for the illness. Based on the patient’s travel history and symptoms, healthcare professionals suspected this new coronavirus. A clinical specimen was collected and sent to CDC overnight, where laboratory testing yesterday confirmed the diagnosis via CDC’s Real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test.”

At this point it was clear to anyone concerned with diseases that this was a significant new disease. And doctors and public health people were asking questions like:

How bad is it? / What are the symptoms? / What is the case fatality/death rate?

How contagious is it? / Does it spread from humans to humans like the H1N1 or just from animals to humans like the so-called avian or bird flu’s? How much does it spread? / What is the replication number?

If it spreads from humans to humans, does it spread only after symptoms are evident like the first SARS virus or could it spread before people are aware they are sick? (which has turned out to be the case)

Who is vulnerable? Does it affect mainly the elderly or can anyone get it? Can children spread the disease? What are the long-term effects?

We can get clues to the answers from simple observations. For instance, there were several cases in China of families where one member of the family got sick, then over subsequent days the rest of the family also got sick. That is clear evidence of spreading from human to human, not a common source like exposure to the same animal at a live market.

There was also a case where a woman from China visited someone in Europe. After she returned to China, both people got sick with Covid-19. That was pretty clear evidence of pre-symptomatic spread.

But to really understand those answers and compare a disease like Covid-19 with other diseases like the H1N1 influenza or the more familiar measles, we need measurements in numbers, i.e. statistics. And to use those statistics intelligently, we need an awareness of just how accurate or uncertain they are.

So what are those key numbers?

Johns Hopkins University has put a wonderful website online to gather and share those numbers.

<a href="https://coronavirus.jhu.edu">Coronavirus Resource Center</a>

The top level emphasizes maps and graphs rather than specific numbers, but these <a href=”https://coronavirus.jhu.edu/data/new-cases“>Critical Trends</a> show the difference between a very slow downward trend in the U.S. overall and how other countries like Italy, Spain and Germany have reduced their overall cases by a factor of 3 or more.

As of May 8, 2020, <blockquote>The first case of COVID-19 in US was reported … on 1/22/2020. Since then, the country has reported 1,228,603 cases, and 73,431 deaths.</blockquote>

For analyzing and comparing different diseases, the key statistics involve <a href=”https://www.health.ny.gov/diseases/chronic/basicstat.htm“>Incidence, Prevalence, Morbidity, and Mortality</a>.

<blockquote>Incidence is the number of newly diagnosed cases of a disease. An incidence rate is the number of new cases of a disease divided by the number of persons at risk for the disease.</blockquote>

For instance, on May 7, Texas (where I currently reside with a population of 28,995,881) reported 968 new cases of Covid-19 for a total of 35,390. There were 25 deaths for a total of 973. New Mexico (where I used to live with a population of 2,096,829) reported 202 new cases for a total of 4493 and 3 deaths for a total of 172. New York (population 19,453,561) reported 2786 new cases for a total of 323,978 and 242 deaths for a total of 19,887. So the incidence rate in Texas yesterday was 1 in 29,954. New Mexico was 1 in 10,380. New York was 1 in 6983. But on Monday May 4 in New Mexico, 2 counties in the northwest (San Juan and McKinley) with a combined population of 201,864 reported 136 of the 186 new cases in the state. That gives those two counties an incidence rate of 1 in 1484, 5 times as high as the state of New York.

<blockquote>Prevalence is a measure of disease that allows us to determine a person’s likelihood of having a disease. Therefore, the number of prevalent cases is the total number of cases of disease existing in a population.</blockquote>

Prevalence tends to be used more for persistent diseases like Hepatitis or diabetes. For instance, the CDC estimates that nearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016. At the same time, 34.2 million people in the U.S. have diabetes (10.5% of the US population). So far, most people who get sick with Covid-19 recover and many of them have symptoms that are barely detectable. But many of the seriously ill suffer from <a href=”https://www.sciencemag.org/news/2020/04/survivors-severe-covid-19-beating-virus-just-beginning#“> Post-ICU Syndrome</a>. And a few children are turning up with an <a href=”https://www.washingtonpost.com/health/2020/05/06/kawasaki-disease-coronavirus/“> inflammatory shock syndrome.</a> So, it may be important to track the prevalence of those conditions in the future.

<blockquote>
Morbidity is another term for illness. A person can have several co-morbidities simultaneously. So, morbidities can range from Alzheimer’s disease to cancer to traumatic brain injury. Morbidities are NOT deaths. Prevalence is a measure often used to determine the level of morbidity in a population.</blockquote>

A search on morbidity for measles in the U.S. will lead you to the CDC Pinkbook, which tells us

<blockquote>Before 1963, approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually. More than 50% of persons had measles by age 6, and more than 90% had measles by age 15. The highest incidence was among 5–9-year-olds, who generally accounted for more than 50% of reported cases.</blockquote>

<blockquote>Mortality is another term for death. A mortality rate is the number of deaths due to a disease divided by the total population</blockquote>

So in the 50’s there were about 500 deaths per year in a population that was increasing from 150 to 180 milion. That works out to about 3 deaths per 100,000. But the case fatality rate was about 1 in 1000 and we have seen similar numbers in recent outbreaks in France, Romania and other countries. And there were also 48-53 deaths per 100,000 population from influenza and pneumonia. Since pneumonia is often a secondary infection in patients with measles, some of those deaths may have been a result of a measles infection.

One other important number is called the <a href=”https://www.healthline.com/health/r-nought-reproduction-number#how-its-calculated“>reproduction number</a>, often designated as R or R0 . The distinction is that R is the actual reproduction number in the current population and can be location specific. R0 is the basic reproduction number. R0 tells you the average number of people who will contract a contagious disease from one person with that disease. It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated. The higher the reproduction number, the more people will catch the disease if they are not immune.

R can be lowered from R0 when some of the population become immune to the disease, if people are widely scattered, or if artificial constraints on contact are instituted such as social distancing and shelter-in-place orders. And in some cases R can be higher than R0 when one person is especially contagious or in cramped quarters like a nursing home, military barracks, or prison. For the rest of this article, I have used R0 to refer to the calculated or estimated reproduction number.

For the 1918 flu pandemic, the R0 value of the 1918 pandemic was estimated to be between 1.4 and 2.8.

The R0 for COVID-19 is a median of 5.7, according to a study published online in Emerging Infectious Diseases. That’s about double an earlier R0 estimate of 2.2 to 2.7. There is a lot of uncertainty about the reproduction number for the <a href=”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323341/“>2003 SARS virus</a>, which was relatively well controlled by isolation and quarantine measures.

For the 2009 H1N1 pandemic, <blockquote>Rt declined from around 1.4–1.5 at the start of the local epidemic to around 1.1–1.2 later in the summer, suggesting changes in transmissibility perhaps related to school vacations or seasonality. Estimates of Rt based on hospitalizations of confirmed H1N1 cases closely matched estimates based on case notifications.</blockquote>

The reproduction number is important because it tells us how rapidly a disease can grow and spread if people are not protected against it. And it tells us how much we need to be protected against the disease to keep it under control. If you multiply the reproduction number times the fraction of the population that are not protected, (1 minus the fraction that are protected) i.e. immune, you will see if the disease will grow or decline with each generation. So if the reproduction number is 2 and 55% are protected. 1 x (1-0.55) = 0.9. Thus the number of people infected declines by 10% with each cycle and eventually the disease will die out. The best way to achieve that is by vaccination which doesn’t require each person to get the disease first. But we don’t have a vaccine for Covid-19 yet.

And so far we don’t know how well protected the people who do get the disease will be. An early study shows that even people who get a mild form of the disease <a href=”https://directorsblog.nih.gov/2020/05/07/study-finds-nearly-everyone-who-recovers-from-covid-19-makes-coronavirus-antibodies/“>develop antibodies.</a> But, we won’t find out for some time how strong or long-lasting this protection will be. And immunity to coronaviruses doesn’t seem to last very long. Immunity to the first <a href=”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/“> SARS virus</a> only lasted an average of two years. We can hope for better, but we will have to wait and see.

So now that I’ve laid out a basis for discussion, let’s look at the ways in which people can use statistics to mislead the reader/listener to distort or minimize the danger of this disease. The first is a variation on a classic fallacy called the argument from ignorance. The basic form of this is to say that since you don’t understand how something can happen, then it can’t happen. But what we have seen especially in January and February when we were just learning about this disease was a tendency to assume that the cases we had identified were all there were. This especially showed up in political pronouncements, but it also affected the perception in rural states that hadn’t seen the disease yet while it was building up in Washington, California, New York and Louisiana.

And we still see this thinking in the comments that spring up on news story sites and blogs that cover politics and medicine. I read one commenter arguing yesterday that the SARS-CoV-2 wasn’t a problem because no cases had been diagnosed in his county. And even though Texas continues to report about 1000 new cases a day and deaths have almost doubled from 663 to 1100 in the last two weeks, there are still many counties in western Texas that have yet to see their first case of this disease.

But at the political level, this is turning into willful ignorance. I always thought that knowledge was power, but our president doesn’t want to know how many people are sick because it will make us (or perhaps him?) <a href=”https://www.businessinsider.com/trump-says-too-much-coronavirus-testing-makes-us-look-bad-2020-5“>look bad</a> And even though Dallas County tied its single day high yesterday and “Texas ranks last in coronavirus testing in the country”, <a href=”https://www.dallasnews.com/news/public-health/2020/05/11/dallas-county-reports-253-new-coronavirus-cases-tying-its-single-day-high/>the federal government plans to pull COVID-19 tests from two Dallas sites</a> which can test up to 500 people a day.

Two other ways to argue against the evidence take advantage of the fact that several key statistics are actually ratios, one number divided by another number.

<blockquote>A mortality rate — often confused with a CFR — is a measure of the number of deaths (in general, or due to a specific cause) in a population scaled to the size of that population per unit of time. A CFR, in contrast, is the number of dead among the number of diagnosed cases. The term infection fatality rate (IFR) also applies to infectious disease outbreaks, and represents the proportion of deaths among all the infected individuals. It is closely related to the CFR, but attempts to additionally account for all asymptomatic and undiagnosed infections.</blockquote>

So, for instance, in Texas with 39,869 cases and 1100 deaths, the CFR is 2.76% but the mortality rate is only .00379% since most of the population has still not been exposed to and been infected with this virus. So one argumentative technique is to argue that the disease is not that dangerous because the mortality rate is so low (so far). This is a way of inflating the denominator.

But to see how dangerous Covid-19 really is, we need to compare it with other diseases like influenza or measles. <a href=”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/“>Wong et al </a> did a systematic review of the 2009 H1N1 influenza pandemic and came up with a CFR upper bound of “10 deaths per 100,000 infections” or about 0.1%. The CFR for measles varies widely from <a href=”https://www.who.int/immunization/sage/Review%20article%20of%20measles%20CFRs.pdf“>country to country</a>. But typical estimates hover around 1 in 1000 or 2000 cases, similar to influenza. For comparison, death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992. So, Covid-19 is clearly a much more serious disease than influenza or measles. And we can’t yet vaccinate to protect ourselves.

Another common technique is to deprecate the numerator by making it seem smaller than it really is. We can see this is Senator Scott Jensen’s <a href=”https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/“>TV claim</a> that “hospitals get paid more if Medicare patients are listed as having COVID-19 and get three times as much money if they need a ventilator”. The implication which was widely shared on Facebook is that the reported number of Covid-19 cases is less than reported. But Senator Jensen himself said that he thinks the overall number of COVID-19 cases have been undercounted based on limitations in the number of tests available..

And if you look at total deaths <a href=”https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html“>regardless of cause</a>, you can see a huge increase beyond what is accounted for in the official coronavirus death counts. Some of those deaths are undoubtedly from other causes and might have been saved if hospitals hadn’t been so swamped with Covid-19 cases. But many are likely people who didn’t test positive or were advised to stay at home because their symptoms were mild.

A final way to argue against the data is to quote an outlier or irrelevant statistic. For instance, on one day last week New York City reported a high percentage of new Covid-19 cases were people who were sheltering at home. The implication was that sheltering at home didn’t help. But the 75% reduction in the city’s daily case rate belies that implication. And many of those cases were in nursing homes or senior living facilities which can easily become hotspots for an outbreak.

So where do we go from here? There is a broad consensus among medical and epidemiology experts that we need to do three things.

First, we should continue shelter-in-place, social distancing and other infection limitation measures until we achieve a steady reduction in cases over a 14 day period. The target level is usually stated at about 1 new case per day per 100,000 population. For Texas, that would be about 300 cases. So at 1000 cases per day which is not going down, we still have a lot of work to do.

Second, we also need to increase the level of testing to locate outbreaks. A prominent <a href=”https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing“>Harvard study</a> found that we need to increase the level of testing to about 150 tests per day per 100,000 people. This can vary depending on how common and widespread the disease is in a specific state or city. This model shows that Texas needs to do about 27,000 tests a day while it is averaging only about 17,000. New Mexico is doing about 3,000 tests a day and needs to do about 5,000.

At that point, we can control the oubreak and limit its spread with <a href=”https://time.com/5825140/what-is-contact-tracing-coronavirus/“>contact tracing</a>. This worked to control the 2003 SARS outbreak and the 2014 Ebola virus epidemic. But it is a laborious process of sending trained people out to identify recent contacts of people who test positive and advise them to quarantine themselves. The goal of 1 new case per 100,000 is primarily based on this workload. Even then, managing new outbreaks can be tricky.

But right now, the different states in the U.S. and other countries around the world are doing a vast experiment adopting varying strategies in how to limit this new disease, support their population and try to get their economies and life in general back to a semblance of normal or whatever the new normal turns out to be.

Final note: I’m not an expert in these subjects so I try to base my thoughts on those who know and understand better than I do. I welcome comments and critiques. But for now, they go to moderation so I can filter out any profanity or obvious spam.

ADDENDUM

May 19, 2020

It’s been about a week and I decided to give this a quick read-over and did a little minor editing. I’ll probably revisit the subject in about a month.

One persistent argument that I see online is a version of deprecating the numerator. The idea is that people who die with other co-morbidities should be counted as deaths from those and not from Covid-19. Thus our estimates of the CFR are too high and the SARS-CoV-2 virus is not as dangerous as claimed. But this is pointless and misleading for a couple reasons.

First, it doesn’t save anyone’s life. It just shifts the blame. And, as the excess death statistics show, a lot more people are dying this year in the U.S. and other countries than died last year. And the one major difference this year is Covid-19. Future scientists will sort out the overall effects of this new virus. But until then, we should track and count all cases that test positive as we are now doing.

And second, if anything, counting only the positive cases understates the devastating effect of this disease. As Dr. Jeremy Samuel Faust points out, https://news.yahoo.com/flu-deaths-were-counted-covid-053449918.html the official estimates for influenza cases and deaths include many cases based on symptom-based diagnoses even without viral confirmation. If we used the same method for counting influenza that we are now using for Covid-19, the official influenza counts would be much lower.

<blockquote>The 25,000 to 69,000 numbers that Trump cited do not represent counted flu deaths per year; they are estimates that the CDC produces by multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms. These coefficients are based on assumptions of how many cases, hospitalizations, and deaths they believe went unreported. In the last six flu seasons, the CDC’s reported number of actual confirmed flu deaths — that is, counting flu deaths the way we are currently counting deaths from the coronavirus — has ranged from 3,448 to 15,620. [Jeremy Faust, Scientific American]</blockquote>

Another argument I have seen is the irrelevant comparison, such as the number of people dying each year from tobacco. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm If cigarette smoking causes 480,000 deaths every year and Covid-19 “only” causes 60,000 or 80,000 or now more than 90,000, why are we getting so concerned about this virus?

Of course we have taken action about the damage from tobacco in the last 30-40 years. During that time, cigarette use has declined substantially. If we hadn’t done those things, there would be a lot more people dying from tobacco. But this argument also ignores the difference in the two conditions. Tobacco deaths are a sort of sunk cost, the result of years of behavior. Even if every smoker in the U.S. stopped tomorrow, many of those deaths would happen anyway because of the damage their bodies have already suffered. Also, most tobacco use is voluntary although some of the damage is from secondary smoke. It’s not easy, but people can choose not to smoke. No one can just choose not to get infected by a virus in the air they breathe. It requires caution and cooperation.

Whereas, Covid-19 is a contagious disease. If we cooperate and work together to limit its spread, we can minimize the harm and greatly reduce the number of people who suffer this disease and give ourselves time to find a useful treatment and develop and produce an effective vaccine to finally control it.

USEFUL REFERENCES

This Week in Virology is a podcast available on Google, Apple, Spotify and other podcast apps. It offers a fascinating discussion of ongoing subjects in virology even though much of it is way above my limited biology training. Episode 607 featured an interview with Dr Jeffrey Shaman of Columbia University https://datascience.columbia.edu/jeffrey-shaman.

<blockquote>to explain why more SARS-CoV-2 testing and contact tracing is needed to stop the pandemic, and provide insights on immunity and reinfection from seasonal CoVs, the problems with antibody tests, and what to expect in the coming months</blockquote>

There was a special interview episode on March 26 featuring Dr Mark Denison of Vanderbilt University who discussed COVID-19 and SARS-CoV-2 with an emphasis on antiviral therapeutics.

https://www.vumc.org/viiii/person/mark-r-denison-md

Another useful source was the Explore the Space podcast Episode 181. That episode featured Jeremy Konyndyk, who is a Senior Policy Fellow at the Center for Global Development & a recognized expert on global outbreak preparedness. They discussed the unsettling response to the Covid-19 pandemic from the US government thus far, the disruptive impact of magical thinking, & what a fierce sense of urgency looks like..

https://www.cgdev.org/expert/jeremy-konyndyk

Donald trump and the challenge of leadership

I have wondered for some time whether the American political landscape was drifting to a system which favored an amateur over an experienced participant. The growth of negative campaign advertising makes it easy to spread the message of any mistake a candidate has made. Whereas someone new to the system has a clean slate and relatively little for opponents to focus on. I think that helped Barack Obama who, although a U.S. Senator, had a relatively limited political record. But we saw that in clear focus in 2016, when one candidate with direct or indirect participation in national and international affairs for 24 years faced another who had never held a political office. So I was disappointed and even appalled when Donald Trump, the amateur politician, won the election.

I had many complaints about Mr Trump, but I remember thinking on the day of his inauguration that I didn’t think he was a very good leader, but I hoped he would somehow elevate his performance as, for instance, Ronald Reagan and George W. Bush had done. I was quickly disappointed, but somehow the nation has managed to muddle through until this year with the coronavirus (SARS-CoV-2) pandemic spreading throughout the country. And so increasingly in the last few weeks, I have seen the topic of leadership brought into articles about how the President is handling this crisis. Here are a few: https://www.cnn.com/2020/03/19/politics/donald-trump-leadership-coronavirus/index.html Trump’s new strategy on coronavirus is already being undermined by his own actions

https://www.cnn.com/2020/03/21/politics/donald-trump-leadership-coronavirus/index.html As Trump’s leadership is tested, he turns to states and the private sector

https://www.nytimes.com/2020/03/23/opinion/letters/us-coronavirus-trump.html Trump’s Leadership in the Coronavirus Crisis

https://www.theatlantic.com/ideas/archive/2020/03/presidents-character-unequal-task/608743/ The President Is Trapped

And so I have decided to take this time to discuss the qualities of a good leader and describe how I feel Donald Trump meets or fails to meet these standards. You might ask who am I to criticize the President of the United States? After all, since I retired from the U.S. Air Force as a regular officer, I am technically still a member of the armed forces and he is therefore my commander-in-chief! But I write this strictly as a private U.S. citizen and my opinion in no wait reflects any official or unofficial policy of the U.S. Air Force or its organizations.

My training as a leader began when I joined the Boy Scouts of America in 1961, or perhaps as a Cub Scout before that. The Boy Scouts teach many qualities such as being trustworthy and loyal, or being courteous and kind. And you learn to work with a group of your peers. So, in the Boy Scouts I learned to be a Senior Patrol Leader, the member/leader of the boys in our troop.

Donald Trump is 4 years older than I am. So in May 1968 when he graduated with a B.S. in economics, I was preparing to graduate from high school and go to college. In October 1968, when he was medically deferred and classified 1-Y, I was enrolled in my first class of the Air Force R.O.T.C. program at Michigan State University. And that began my training to be an officer, a military leader. In 1972, when he was reclassified 4-F, I graduated With Honor from MSU and was commissioned as a 2nd Lieutenant in the Air Force. During my service, I completed two professional military training programs, Squadron Officer School and Air Command and Staff College. I also received training on how to avoid both racial discrimination and sexual harassment.

In 1992, when Trump’s Plaza Hotel filed for bankruptcy and a reorganization plan was approved, I retired from the Air Force and entered private life. After a year and a half of focusing on my family, I realized I needed to earn some money and entered an off-and-on 30 year career in the fast food industry, which Donald Trump is fond of. During that time, I was trained to be a manager at KFC and rose to be an Assistant Manager, cross-trained to be a Restaurant General Manager at Pizza Hut, where I ran restaurants for about five years. I then trained as an Assistant Manager at Whataburger and worked there for several months. So I received manager training from three different business organizations. I got to work with some really good managers and some really bad ones. I had to try to find good employees to train as managers (not an easy task in the minimum wage economy) and tell some bad ones “You’re fired!”

So, while my career is not nearly as distinguished as his in many ways, I am not coming completely out of left field (actually I was a substitute right fielder in Little League) when I discuss his qualities as a leader and a manager.

And what are those qualities? There is are many discussions of leadership and lots of lists of various qualities, but I’ll pick this list of https://www.ccl.org/blog/characteristics-good-leader/ Core Leadership Skills from the Center for Creative Leadership as a starting point.

Integrity

Ability to delegate

Communication

Self-awareness

Gratitude

Learning agility

Influence

Empathy

Courage

Respect

  1. Integrity is “the quality of being honest and having strong moral principles; moral uprightness”. It’s part of what the Boy Scouts talk about when they say “A Scout is Trustworthy.” As an officer, I was given access to some of the most sensitive classified information available so I could use it to do my work. I helped construct a special network to allow my office to work with that information without risking compromise by electronic surveillance. And I observed the construction of a Secure Classified Information Facility (SCIF) with extra protections to allow people to work with SCI information while protecting it. I also managed some funds appropriated by Congress to ensure they were spent as intended to meet the needs of our organization. Later as a restaurant manager, I was responsible for an inventory of valuable equipment, as well as the supplies we ordered to run the restaurant and the funds from our sales. And I took pride in keeping inventory losses low and the stores earning a profit.
    1. So I was not impressed when Donald Trump couldn’t make money running a casino and had to declare bankruptcy. But I was especially upset that he used that as a justification to negotiate reduced payments to local contractors who had been hired to help build the casinos and install musical equipment. https://www.nytimes.com/2016/06/12/nyregion/donald-trump-atlantic-city.html How Donald Trump Bankrupted His Atlantic City Casinos, but Still Earned Millions
    2. And I was extremely upset when I learned about https://www.independent.co.uk/news/world/americas/us-politics/donald-trump-russia-israel-intelligence-share-isis-mossad-spies-sergei-lavrov-kislyak-us-a8071086.html The highly sensitive Israeli intelligence on Isis that Donald Trump gave away to Russia.
  2. Ability to delegate is especially important in running even a small organization. One of my maxims has been that authority and responsibility have to be commensurate. That is, if you tell someone they are responsible for doing a job, you need to give them the authority to act on it. When you tell them they are responsible for the work, but don’t do anything until you get my approval, you are taking over that responsibility and sending the message that you don’t think they can really do the job (which may be true in some cases, but that’s a training issue.) And you increase your own workload, reduce the organization’s work-flow, and give your employees the sense that you don’t value their skills.
    1. One example of this under Donald Trump was his relationship with https://www.nbcnews.com/politics/politics-news/former-ambassador-ukraine-marie-yovanovitch-retires-state-department-n1128126 Marie Yovanovitch. The ambassador is the President’s personally selected and confirmed representative to the country they are appointed for. They are supposed to represent and speak for the President and the U.S. in matters concerning that country. So it bypassed her responsibility and undercut her authority when https://www.cnn.com/2020/02/13/politics/trump-rudy-giuliani-ukraine-interview/index.html he sent Rudy Giuliani to the Ukraine.
    2. Another example is his appointment of Vice President Mike Pence to head the https://www.theguardian.com/us-news/2020/mar/21/mike-pence-coronavirus-crisis Coronavirus Task Force Apparently this has worked better than might have been expected given Pence’s generally anti-science background, but I have wondered why it is always President Trump speaking at the podium while Pence stands stolidly in the background. There may be a selection factor involved since VP Pence does https://www.c-span.org/video/?470389-1/vice-president-pence-coronavirus-task-force-press-briefing&start=1234> lead some press conferences . But even then I noticed he started his speech with “Thank you Mr President”!
  3. Communication is a critical skill for a leader. In order to get people to do what you want them to do, you have to be able to tell them what you want them to do. And you will often need to persuade or cajole those who disagree with you to get their cooperation. It is also hard to explain difficult concepts or convince people that you understand them when you are https://blog.factba.se/2018/01/08/stable-genius-lets-go-to-the-data/ communicating at a 4th or 5th grade level. But it is especially difficult to persuade people when your own press secretary is continually have to convince the press that you really did mean what you said today even though it directly contradicted what you had said just the day before.
  4. Self-awareness is “conscious knowledge of one’s own character, feelings, motives, and desires.” This one is tricky to evaluate without seeing inside the President’s mind. But there are https://blog.hubspot.com/marketing/self-awareness Benefits of self-awareness. These include:
    1. Improve skills by recognizing what you do well and what you need to improve … President Trump practically never shows an awareness that he needs to improve in anything.
    2. Become a better leader by understanding how employees perceive your behavior … Referring to the ordinary rank-and-file employees trying to do their job as the “deep state” that are somehow conspiring against him may show a minimal awareness of this perception but not in a good way.
    3. Strengthen work and personal relationships by managing emotions … Donald Trump’s Thin Skin https://www.bostonglobe.com/opinion/2019/08/29/trump-problem/0k7JDsaA6b7jQKZmgsMUYP/story.html has become legendary and both an international and a domestic liability.
  5. Gratitude is a key leadership skill because communicating to your subordinates and co-workers that you value their work builds their self-esteem, reinforces their work ethic, and makes it more likely that they will support you and work better in the future. Gratitude can even be a tool for persuading people to change their ideas and behavior, as https://www.bostonglobe.com/opinion/2019/08/29/trump-problem/0k7JDsaA6b7jQKZmgsMUYP/story.html FDR showed. Whereas Trump used it to give himself a pat on the back, saying he was thankful that he had “made a tremendous difference in this country.”
  6. Learning agility is critical and one of the President’s biggest weaknesses. Every holder of the office has much to learn. Harry Truman, who wasn’t even privy to the Manhattan Project, certainly found that out. But coming from a private business background, Donald Trump had a lot more to learn about the business of governance. So I was especially disappointed when I learned that the President had asked to have the daily intelligence briefings reduced in length. And even the briefings he did receive were difficult because he https://www.huffpost.com/entry/trump-intelligence-briefings_n_5de7b0f5e4b0d50f32abf5b8 had no foundational framework to understand what the limits of intelligence are, what the purpose of it was, and the way that we discuss it. It is also hard for someone to learn when he https://medium.com/@therealgabblog/from-lincolns-brilliance-to-the-stable-genius-a-comparison-to-presidents-of-yesteryear-1ffe9125c3ea thinks he knows more about basically everything than anybody else.
  7. Influence is “the capacity to have an effect on the character, development, or behavior of someone or something”. The United States has great influence in world affairs simply by our strong economy and military power. The previous president, Barack Obama, enhanced that influence by getting the U.S. to participate in the Paris Accord to face the threat of global warming and by getting Iran to sign an agreement to drop a nuclear weapons development program. And he enhanced the influence of the presidency in https://coiski.com/barack-obama-influence-last-forever/ domestic culture and sports </a>. National sports teams were honored and happy to visit the White House to celebrate their success under Obama, while they have openly refused to do so under President Trump. On the other hand, Trump’s influence seems mainly to be https://www.cnn.com/2019/08/10/opinions/trumps-influence-is-spreading-like-a-virus-dantonio/index.html setting a template for hostility and aggression. And his abandoning those agreements sends a message that any deal with the U.S. is only good until the next President, which will undercut the influence of future U.S. presidents as well.
  8. Empathy is one of his biggest failings. President Trump seems to almost completely lack “the ability to understand and share the feelings of another.” This particularly shows when he characterizes people who make a long trek to the U.S. border seeking asylum to escape from violence in their home countries as “in many cases, criminals, drug dealers, rapists, etc.”
    And he shows little empathy for the countries themselves and even their best citizens when he refers to them as “shit-hole countries”. Perhaps it is because he was born into a wealthy family and never had to suffer the hardships so many of us face in life. But even if he is tested by such crises, will he https://www.minnpost.com/community-voices/2019/09/empathy-its-lack-is-what-most-disqualifies-donald-trump-for-the-presidency/ suddenly learn humility?
  9. Courage. Donald Trump may have https://www.washingtontimes.com/news/2017/jan/12/donald-trumps-old-school-courage-to-come-in-handy-/ old-school courage But, he doesn’t have the courage to accept criticism or even https://theintercept.com/2020/03/19/republican-operative-press-corps-helps-trump-use-briefing-pandemic-attack-critics/ difficult questions .
  10. Respect goes both ways. Political leaders have earned a certain amount of respect, even if you don’t like them, by their success in getting elected and their performance in their office. And they can add to that by treating even their opponents with respect. “Treating people with respect on a daily basis is one of the most important things a leader can do. It will ease tensions and conflict, create trust, and improve effectiveness. Respect is more than the absence of disrespect, and it can be shown in many different ways.” And demeaning them with insults diminishes your own level as well as theirs.

In conclusion, President Trump’s performance during the coronavirus crisis probably won’t change whether many people support him or not, except perhaps for a few right-leaning middle-roaders. But perhaps if we as citizens and voters can look past the immediate questions of “Does he support policy X?” or “Is she in my political party?” and consider leadership skills as a broader qualification, we can elect better leaders and have a better country.

And I will be watching the campaign of Mr Biden in the coming months to see how he fits these qualities.

/postscript

Thanks to all who have read this far. I apologize for my limits with WordPress formatting. Any comments are much appreciated.

Fact-Checking the INF Withdrawal

This evening I watched President Trump’s State of the Union address with doubts and concern mixed with curiosity about just what he would choose to address. Major news organizations with far more time and resources than I have will be reviewing in detail over the next few days. However, I thought I would comment on an area he mentioned in which I have some experience and knowledge, the Intermediate Range Nuclear Force Treaty of 1987.

https://en.wikipedia.org/wiki/Intermediate-Range_Nuclear_Forces_Treaty

There have been complaints for the last few years of Russian violations of this treaty. But, rather than pursue a resolution using the mechanism setup in the treaty itself or addressing those concerns by negotiations with Russia (who had threatened to withdraw before) and other affected countries like China (whose missile developments are of concern to the Russians), President Trump chose to withdraw from the treaty first, and was followed by a Russian withdrawal. This followed the pattern of Iran and North Korea, where he complained about the nuclear treaty with Iran but rather than negotiate a better one with North Korea and then negotiate matching changes to the Iran treaty, he unilaterally withdrew from the treaty with Iran and merely shook hands with the leader of North Korea.

Since the treaty was ratified in 1988 and the destruction of weapons was completed in 1991, many of us have forgotten about this whole class of nuclear weapons systems although some of North Korea’s missiles fall into this class. But in the 1970’s they were a major threat to our NATO allies and U.S. forces deployed in Europe.

In March 1976, while I was still serving on a Titan II missile crew, the Soviet Union began deploying its new RSD-10 Pioneer (or SS-20 Saber) with a range of 4700-5000 kilometers, just below the 5500 kilometer minimum for intercontinental weapons set by the SALT treaties. And, unlike their predecessors, the SS-4 and SS-5 which were launched from a fixed site, the SS-20 was a mobile and concealable system that also featured 3 independently targetable RV nuclear weapons. To counter these, the U.S. and NATO only had a small number of shorter range Pershing 1 missiles. So, the U.S. and NATO responded with a planned deployment of 100 Pershing 2 missiles to West Germany and the deployment in several countries of the BGM-109G Ground Launched Cruise Missile (GLCM).

My first thought on hearing this in the SOTU address was “are we going to send the GLCM launchers back to Sicily?” In fact, I really don’t know what President Trump plans do in the absence of the treaty other than to give Russia an excuse to do what they had been threatening for some time. But, I do have some peripheral knowledge of the GLCM, so let us discuss that.

In the early 1980’s, I worked on some technical analyses of various nuclear forces. A big concern was the ongoing replacement of older, less accurate Soviet ICBM’s with newer and more accurate systems like the SS-18 and SS-19. These had sufficient accuracy to threaten our land based missiles in their hardened silos and more warheads as well. Part of the U.S. response was the development of a land-based version of the Navy’s Tomahawk cruise missile system, the BGM-109G. For more information on the history of the GLCM, I suggest this article from Air Force Magazine.

http://www.airforcemag.com/MagazineArchive/Pages/2002/July%202002/0702glcm.aspx

In its own way, the GLCM may have been the most successful weapons system in history. By spending money on building a new base in Sicily and beginning training and deployment of the system, the U.S. gained leverage to talk the Soviets into withdrawing an entire class of nuclear weapons and eventually destroying 1846 weapons systems in exchange for 846 by the U.S./NATO. And it established a basis for transitioning from limiting strategic arms to reducing them.

So where do we go now? As Bob Dylan would say, “things have changed”.

First, although the U.S. and Russia still dominate the strategic arms field, we are no longer in a bilateral situation. The Soviet Union has split up into several successor states with nuclear forces and not all of them have signed onto the INF.

Second, China was never a signatory and their nuclear forces and missile capabilities are much greater than they were in the 1980’s as evidenced by their current lunar exploration activity.

Third, smaller nuclear or nuclear-potential states like North Korea and Iran are a very real threat with the ability to threaten our allies or friendly nations like South Korea and Japan, Iraq and Israel. Part of our response has been to develop defensive systems. But these also threaten the stability of the INF agreement, even if it were still in place.

So, what is clearly needed is ongoing serious negotiations among the many involved parties on a framework for a stable and safer agreement.

But, will any of the leaders involved step up to the plate and accept the challenge?

Green Chile Potato Enchilada Casserole

Baked Casserole

Ingredients

5-6 medium russet potatoes, cut into ¼-1/2 inch cubes

½ tsp salt

½ medium onion, diced

½ Tbsp green chile powder (use other ground red chile if you can’t find this)

½ Tbsp ground garlic powder

1 can Hatch Green Chile Enchilada Sauce

1 cup grated smoked cheddar cheese

1 cup grated white cheddar cheese

Diced green onions

Sour cream

Procedure

  1. Preheat oven to 400F.
  2. Spray 9 x 13” Corning or Pyrex baking pan with cooking spray.
  3. Wash and cut potatoes. Cover with water, add salt and heat to boil. Lower to rolling simmer and boil for 15 minutes.
  4. Drain potatoes and place in the baking pan.
  5. Add diced onion and sprinkle with green chile and garlic powders. Stir thoroughly.
  6. Sprinkle grated smoked cheddar over the potatoes
  7. Pour green chile enchilada sauce over the potatoes and cheese.
  8. Sprinkle white cheddar on top.
  9. Place in oven and bake for 15 minutes.
  10. Sprinkle green onions on top and serve with sour cream.
Serve with diced green onions and sour cream

The difficulties that get overlooked when your autistic child is verbal

I read this and found it interesting for a couple reasons.  My grandson has a cousin who is also autistic and may be similar to this girl.

Also, we are starting to learn there may be many more autistic females than have generally been counted. Because women socialize differently from men, their autistic behaviors may ho unrecognized.

 

via The difficulties that get overlooked when your autistic child is verbal

My thoughts about Ebola

I follow some of the ongoing discussions about medical science, vaccination, cancer treatments and related areas and occasionally offer a comment.

I’m too busy with studying and job-searching to devote the continual effort needed to comment and reply regularly on the many sites where these topics are discussed. But, once in a while I will toss my hat into the ring and offer my thoughts on the topic at hand.

So, when Carol A Hoernlein PE wrote a blog a few days ago (http://www.theepochtimes.com/n3/blog/ebola-on-my-mind/), I made a comment. She responded and after a few days, I decided to take the time to express my ideas and reasoning in more detail. After spending a fair amount of time writing them up, I chose to reblog my reply here in toto.

Carol,

Thanks for your reply(s).

Primarily I was responding to the overall tone of your article, but let me discuss some specifics and explain further.

The Fear Factor

Personally, I’m worried more about someone with a ski mask and a gun coming in to rob a restaurant or bank where I was than I am about my personal risk of Ebola. But, if I were in one of the nations in Africa where the current outbreak is occurring, I would definitely be highly concerned. I am certainly glad that many scientists have been working for many years to develop a vaccine against this horrible disease.

Modern Medicine

I was in college in 1970 and remember a talk given to incoming students about the limitations of existing antibiotics and developing resistance to them and the challenge of developing future antibiotics that might work in a different manner. Unfortunately, this strategy has been very difficult to implement.  And only a few years later, President Nixon announced a war on cancer. This has helped fund research and resulted in enormous improvements in survival from many of the worst cancers, such as childhood leukemia. So while things were hopeful then, my view as a science student wasn’t nearly as Panglossian as you describe it.

So, although vaccines may not have been the perfect solution for all diseases, they have mainly born out the promise of their early success. Thanks to the MMR, which was introduced in 1971 and some changes in vaccination requirements, we fought off a rise in measles incidence from 13,000 cases in 1980 to 26,000 cases in 1990. As a result, measles was pronounced eradicated in the U.S. about 10 years ago.

Profit

Since we don’t want to pay huge taxes for the government to support massive research into vaccines and drugs, we have to rely on the potential for profit from the one treatment that proves successful to fund the necessary research into the dozen or more alternatives that wind up not working or having too many problems to be useable.

But, science researchers are motivated by many factors in addition to profit. There is the challenge of solving a difficult problem. There is the satisfaction of discovering something new about the world. There is the desire to do something important during your life that will help others and that you can remember with pride and satisfaction. I consider that to be a humanitarian endeavor.

I don’t think the Belgian nurses who died from the disease or the Belgian researchers who identified it considered it to be Africa’s private hell.

Vaccines

I don’t think Bill Gates is donating all the money he has contributed (for which he regularly gets castigated by the anti-vaccination crowd) towards a world-wide vaccination program out of an expectation of future profit.

And, while GSK is manufacturing thousands of doses of their vaccine to have available for emergency use and the trials are being fast-tracked, we are doing the necessary testing to ensure the vaccine is both safe for humans like Ruth Atkins (http://uk.reuters.com/article/2014/09/17/uk-health-ebola-vaccine-idUKKBN0HC17K20140917) and effective against Ebola.

As for your three links later, we’ll see how the Merck case plays out in court. While they may have oversold how well and how long their vaccine protects against mumps, the competitors weren’t that much better. Mumps and pertussis have both proven to be difficult to develop a vaccine that provides the high level and long lasting immunity we really want.

I’ve been following the Thompson case and read his statement. He never uses the word fraud. My perception is that he was concerned about one statistical outlier (black boys vaccinated between 2 and 3 years age) which was not emphasized in the published paper. No data were “manipulated” because the exact same data were used by Hooker with incorrect statistical methods to generate this whole flap. And, since their analysis showed this blip was due to other confounding factors and none of the many studies of vaccination and autism have shown a particular sensitivity by Africans or African-Americans, there doesn’t seem to be a real problem except in the minds of people like Hooker who are looking for somewhere to point their finger.

Tools in the Medicine Chest

Until the GSK vaccine is shown to be safe and effective, those are all we have. And, regrettably for Thomas Eric Duncan, they were too little too late.

The Fear Meter

The great thing about vaccines is that they work even in countries with poor sanitation, lack of clean drinking water and poor access to nutritious food. And, the U.S. had none of those problems in the 1950’s when hundreds of thousands of children (including me and my siblings) got measles every year and hundreds died from it. Measles is a mild illness compared to smallpox or polio, but it is still deadly. I am curious where you got the idea that doctors “convinced folks the only way to deal with an infectious disease is a vaccine”.

The perception described by the comedy writers on The Brady Bunch was certainly not the perception of the thousands of people who suffered side effects of the disease. And it certainly wasn’t the perception of Roald Dahl, for instance. We put up with these diseases because we had to, not because they were a laughing matter.

Ebola is certainly more deadly than measles. But, fortunately it is not nearly as contagious. For the moment, it is only spread by direct contact. By comparison, you can get measles by walking into an elevator two hours after someone sick with the measles left it. So, keeping a patient in facilities designed to contain some of the nastiest diseases known to man is not the threat to people on the streets of Dallas that you seem to describe.

Moving Target

Rapid mutations in diseases are certainly a problem. We will find out when an Ebola vaccine is demonstrated safe enough for field testing whether it is effective enough to contain the disease and eliminate a relatively local outbreak (and I emphasize the term relatively). Unlike the H1N1 strain of influenza, which quickly spread to all continents around the world, Ebola (except for a handful of cases) is still confined to a few countries in Africa.

So there is hope that the current strategies will eventually succeed. But, the development of an effective vaccine would be a huge benefit in this struggle.


Addition on 9 Oct 2014

I checked in on Carol’s post at Epoch Times this morning and discovered my comment last night failed to post or was deleted. I’m fairly certain I saw it displaying on the screen.

Instead, I noticed she had closed comments on the thread.

Comments closed on Epoch Times after my comment failed to post.
Comments closed on Epoch Times after my comment failed to post.

I find this especially ironic, because in one of her comments to Dorit Reiss, she stated:

. I blog at a paper that was created to fight the worst types of censorship from the Chinese Government. I am not afraid of you. I will refute your points because I believe in debate

Actions speak louder than words, Carol!