Thursday, May 28, 2020

Why Covid-19 Is Such A Killer

It's May 28 and the first summer holiday came and went, giving Americans an excuse to take back the outdoors (???) then appear on TV answering questions from incredulous local reporters such as "Did you know there were going to be 1500 people asses to elbows in the pool?" and "When you SAW 1500 people assses to elbows in the pool not wearing masks, why didn't you leave?"

How Did Americans do answering those questions?

Not well, I'm afraid. When you listen to the answers, it becomes very apparent that Covid-19 may be the perfect disease for 2020 America.

Here are the answers from one such 'Murican interviewed on a local station.

DID YOU KNOW THERE WERE GOING TO BE 1500 PEOPLE AT THAT ESTABLISHMENT? Heck no, I thought we was gonna show up and there'd be like fifty people there. When we got there and saw all the people, I was like, "wow..."

WHEN YOU SAW SO MANY PEOPLE THERE, WHY DIDN'T YOU LEAVE? Well, they took all of our temperatures when we arrived before they let us in and there was signs all around and the waiters and bartenders all wore masks. And it wasn't like anybody was doing anything bad, ya know. It was a good time.

Wasn't like anybody was doing anything bad, huh?

Okay, Jonas (Dude) Salk Jr., what exactly would constitute doing something "bad" vis a vis coronavirus? What would cross your line of pandemic safety? How about a bunch of drunken hoosier men standing three deep waiting for drinks at the pool bar? How about a bunch of 45+ year old women trying to act like 20-somethings in bikinis while attempting to line dance in the pool?

The biggest concern from "Dude's" answers was his plan for "staying safe" after his possible exposure. "I'll just stay home until I can get tested."

What he was really saying was after Day 0 of known possible exposure, he can just get tested and if the test is negative, he's in the clear and doesn't have to worry.

None of these stories ever STOP the narrative right there and perform a true public service and instantly debunk all of the sloppy thinking about the entire life cycle of this virus and corresponding disease. What's missing is an easy to follow diagram to depict all of the overlapping intervals reflecting critical stages in the disease and an explanation about how those overlaps produce so much ambiguity that results in complacency.

Here is the diagram I've had in my head since March that I thought should be obvious to anyone reading stories about the spread and the progression of the disease for its patients and victims.

It would look a lot better rendered graphically but this is the best I can do in a text-oriented forum. Think of each line as a horizontal bar and the horizontal dimension as time in days.

COVID-19 DISEASE TIMELINE

                                         ????AAAAAAAAAAAAAAAAAA
           ???SSSSSSSSSSSSS--------------SSSS???
        ???DDDDDDDDDDDDDDDD--------------DDDD????
     ???IIIIIIIIIIIIIIIIIII--------------IIII???
XXXXXXXXXXXXXXXXXXXXXXXXXXX--------------XXXXXXXXXXXXXXXXXXXXXX

Legend:
X = point of exposure
I = point of infectiousness to others
D = point where detection of the disease is possible via testing
S = point where symptoms are detectable in SOME patients (some remain asymptomatic)
A = point where antibodies of immune response can be accurately spotted
- = variable period of actual disease at home or hospital
? = statistical uncertainty before or after each stage

The point of this bar chart time-lapse visualization is to highlight a few things:

  • no science has established the typical interval between exposure and infectiousness
  • no science has established the typical interval between exposure and detectability
  • no science has established the typical interval between infectiousness and detectability
  • no science has established the typical interval between the end of symptoms and the presence of antibodies
  • no science has established the typical interval between the end of testability and the end of infectiousness
  • there isn't a fixed "true" day interval for any of these because every immune system differs

You have to stop and really think about what each of those uncertainties mean in relation to the different stages of the disease's progression.

Those uncertainties produce the following problems:

If you KNOW you were in the presence of a COVID-19 case on Day 0, you can’t get a test on Day 1, get a NEGATIVE result and assume you escaped infection. No one can accurately predict how long the exposure will take to reach the point of being visible via a test. Also, it is now clear that some of the tests for active disease detection have a confirmed false-negative rate of at least FIFTEEN PERCENT.

If you DON’T somehow know exactly when you were exposed, you can’t use the date of a positive test and work backwards to find a likely date when you WERE exposed to narrow down the search of contacts.

If you come down with COVID-19, it isn’t clear if infectiousness stops before symptoms stop or vice versa. More precisely, how long should a "recovered" asymptomatic patient continue to isolate to avoid infecting others? No one knows for sure.

If you come down with COVID-19, it isn’t clear when you will test CLEAR of the disease in relationship to when you stop being infectious to others.

Will the disease continue to exhibit more or less this same proportionate timeline over time, once public health officials think they have more statistical precision on these intervals? It isn't clear at all. Doctors believe a spike in cases of a condition with children is actually tied to original spikes in COVID-19 cases in adults FIVE weeks earlier. One theory is that early childhood immune systems are more flexible at fending off the never-seen-before coronavirus but they still can't overcome it every time so by the time it overwhelms a young immune system, it has stressed the body in different ways producing vastly different symptoms.

And one giant final caveat. No one has confirmed how much immunity to a future infection of the same SARS-CoV-2 strain or a mutation of it will be provided by having antibodies. Remember, some of the sailors aboard the Theodore Roosevelt who were originally infected and diagnosed with COVID-19 then cleared returned to the ship only to test positive for the disease a second time.

So there it is. A witch's brew of science, complexity, uncertainty and statistics combined with the need for public accommodation and basic courtesy. And a nation where 10-20 percent think being asked to wear a cloth mask is "stupid" and amounts to an infringement of their Constitutional rights.


WTH