Plus c’est la même chose

Excerpts from an extensive article at the National Institute of Health (Because this is an extended quote, I’ve chosen to italicize it rather than indent for readability.).

Citations omitted:

THE SARS EPIDEMIC AND ITS AFTERMATH IN CHINA: A POLITICAL PERSPECTIVE

This “strange disease” alerted Chinese health personnel as early as mid-December. On January 2, a team of health experts was sent to Heyuan and diagnosed the disease as an infection caused by a certain virus… A Chinese physician, who was in charge of treating a patient from Heyuan in a hospital in Guangzhou, quickly reported the disease to a local anti-epidemic station… We have reason to believe that the local anti-epidemic station alerted the provincial health bureau about the disease,

On January 27, the report was sent to the provincial health bureau and, presumably, to the Ministry of Health in Beijing. The report was marked “top secret,” which meant that only top provincial health officials could open it.

Further government reaction to the emerging disease, however, was delayed by the problems of information flow within the Chinese hierarchy. For 3 days, there were no authorized provincial health officials available to open the document. After the document was finally read, the provincial bureau distributed a bulletin to hospitals across the province. However, few health workers were alerted by the bulletin because most were on vacation for the Chinese New Year. In the meantime, the public was kept uninformed about the disease.

[U]ntil such time as the Ministry chose to make information about the disease public, any physician or journalist who reported on the disease would risk being persecuted for leaking state secrets. A virtual news blackout about SARS thus continued well into February.

On February 11, Guangdong health officials finally broke the silence by holding press conferences about the disease.

From then on, information about the disease was reported to the public through the news media. Yet in the meantime, the government played down the risk of the illness. Guangzhou city government on February 11 went so far as to announce the illness was “comprehensively” under effective control. As a result, while the panic was temporarily allayed, the public also lost vigilance about the disease. When some reports began to question the government’s handling of the outbreak, the provincial propaganda bureau again halted reporting on the disease on February 23. This news blackout continued during the run-up to the National People’s Congress in March, and government authorities shared little information with the World Health Organization until early April.

In fact, the Chinese Center for Disease Control and Prevention did not issue a nationwide bulletin to hospitals on how to prevent the ailment from spreading until April 3, and it was not until mid-April that the government formally listed SARS as a disease to be closely monitored and reported on a daily basis under the Law of Prevention and Treatment of Infectious Diseases.

[T]here is no doubt that [CCP] government inaction paralleled by the absence of an effective response to the initial outbreak resulted in a crisis.

On May 12, the very same day that Premier Wen Jiabao released the new regulations to promote openness, the Beijing Morning News carried an article on how people who spread “rumors” about SARS could be jailed for up to 5 years.

You will have noted a few minor discrepancies in this account from our current situation. Locations, precise dates, leadership names. That’s because this 2004 article describes events that took place during the SARS outbreak in 2003. The players change, but the game remains the same.

Given the CCP’s track record, the World Health Organization’s deference regarding the 2019 virus is unconscionable. If you read the whole article, you’ll likely come away with the impression it was better handled in 2003.

Stop it!

Harvard researchers say social distancing may be needed into 2022
Detailed models suggest the coronavirus that causes COVID-19 could resurge as late as 2024.

The worst secondary effect of the CCP virus pandemic is the press coverage. CNET should be ashamed and so should Harvard. The idea that CCP virus will come back is intuitively obvious, but the article hawks it as unexpected.

A couple of snippets that tell you the model and the article were unnecessary:

[S]ome social distancing methods, like avoiding hugs and handshakes, could persist beyond the end of the pandemic

“The authors are aware that prolonged distancing, even if intermittent, is likely to have profoundly negative economic, social and educational consequences,”

Maintaining ‘no hugs nor handshakes’ would surprise precisely no one as a natural public response.

This behavior will not be intermittent, it’s going to be a fact of life, like more hand-washing. The lack of “hugs and handshakes” will not have “profound” effects. If they’d mentioned the six feet distancing rule, they might have made a case for “irritating effects.”

Harvard bases this on a “detailed model.” OOOh! Models. Harvard. Scientists. Changes in public behavior after a world historical pandemic. Run!

The CCP virus modeling has been wildly wrong – as bad as CAGW models. They specify 2024. Because putting a number on it makes the model seem more precise and insightful, but it is a WAG generated by a spreadsheet. Why not 2028 and 2035? People wouldn’t worry so much, and wouldn’t click on it.

A 2024 resurgence would be tempered by a vaccine, likely by effective drug treatment, likely (and sadly) acceptance of cell-phone-based contact tracing apps by those who care nothing for privacy, and by handy, 5 minute, inexpensive self-testing kits available at CVS and Walmart. If the FDA gets out of the way.

I question whether they factored those changes into their model. If they did, I’d call BS on the values they used.

To help determine the way forward, the researchers say a better understanding of immunity to the virus is key, as is epidemiological surveillance of the disease, which can be done through widespread testing and contact tracing.

They had to have a model to reach that insipid conclusion? While admitting the key element of their model, immunity, is not understood?

A plea for funding, and a quest for clicks.

Fumble Delay Abet

This is scandalous.

Brian H. Shirts, M.D., is a molecular pathologist at the University of Washington. He writes: We’ll see more shortages of diagnostic tests if the FDA has its way

“February was a frustrating month for my laboratory. We wanted to make tests to detect the virus that causes Covid-19. My virology colleagues had great ideas and solid testing platforms. The Food and Drug Administration told us to stop. [That link is worth reading!]

Why? Because of a quirk in FDA regulations. Diagnostic tests are currently regulated in one of two ways, and there’s no clear rule to determine which one applies to coronavirus tests. This uncertainty is a big part of why test shortages have caused a national crisis.

This uncertainty is no accident. James Bovard, at Mises Institute:

“Dr. David Kessler, who became FDA commissioner in 1990, quickly sought to intimidate the companies that his agency regulates. A laudatory Washington Post article concluded, “What he cannot accomplish with ordinary regulation, Kessler hopes to accomplish with fear.” Kenneth Feather of the FDA’s drug advertising surveillance branch boasted: “We want to say to these companies that you don’t know when or how we’ll strike. We want to eliminate predictability.”

See the notes at the end of this post.

Now, back to Dr. Shirts:

“The VALID Act, introduced in Congress in early March, aims to address the confusion about who regulates diagnostic testing, but it would make the situation worse. If the VALID Act passes, we would see shortages in diagnostic tests for even more diseases than Covid-19, including cancers.

Under one system of regulation, laboratory directors are licensed by their states to develop tests through a set of rules called the Clinical Laboratory Improvement Amendments (CLIA). When a CLIA-licensed lab creates a test and documents that it works, doctors can order that test.

Diagnostic testing, and interpreting those tests, is considered the practice of medicine. The FDA is not allowed to regulate the practice of medicine. Yet it is responsible for regulating medical devices. Diagnostic tests use machines, sample tubes, and other tools that are clearly medical devices.

Here’s where the second system comes in: The FDA approves devices — not the lab that produces it — on a case-by-case basis. So which diagnostic tests are devices regulated by the FDA and which are laboratory-developed tests regulated through CLIA?

The FDA gets to choose…

The VALID Act will give the FDA power to create more monopolies on diagnostic tests. CLIA-licensed labs will be shut out of producing new tests that perform as well as FDA-approved versions — or better than them. The result will be higher costs and periodic shortages…

The VALID Act was created because large pharmaceutical companies wanted to have monopolies on cancer tests…”

If you recall, the FDA granted a monopoly to the CDC for CCP virus test kits. The kits were quite late, few, and didn’t work.

With the VALID Act, the FDA is going to be able to create a public/pirate partnership – making private industry more like the CDC.

Notes. Thoughts on complex and uncertain ‘law’ in the hands of unaccountable bureaucrats.

“After having thus successively taken each member of the community in its powerful grasp and fashioned him at will, the supreme power then extends its arm over the whole community. It covers the surface of society with a network of small, complicated rules, minute and uniform, through which the most original minds and the most energetic characters cannot penetrate, to rise above the crowd. The will of man is not shattered, but softened, bent, and guided; men seldom forced by it to act, but they are constantly restrained from acting. Such a power does not destroy, but it prevents existence; it does not tyrannize, but it compresses, enervates, extinguishes, and stupefies a people, till each nation is reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd.”
-Alexis de Tocqueville

“We’re after power and we mean it… There’s no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren’t enough criminals one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws. Who wants a nation of law-abiding citizens? What’s there in that for anyone? But just pass the kind of laws that can neither be observed nor enforced or objectively interpreted – and you create a nation of law-breakers – and then you cash in on guilt. Now that’s the system, Mr. Reardon, that’s the game, and once you understand it, you’ll be much easier to deal with.”
-Ayn Rand.

On masks

Updated for clarity, typos – some links added. 11:10 April 5th.

My opinion on this question has undergone a 160 degree shift in the last month. Not a full 180, because I did think wearing a mask would help in preventing community transmission and would remind the wearer not to touch their face. Still, I accepted the ‘idea from authority’ that face coverings, even N95 masks, would not offer much protection to the general public against the CCP virus. Those authorities, I’ve concluded, can’t distinguish absence of evidence from evidence of absence.

I’ve been working on this for several days while also tending to time critical spring gardening tasks. It’s still timely, even as the CDC has finally seen fit to slightly modify their advice on the wearing of masks as protection from the CCP virus.

I think they did not go far enough.

First, here’s the advice we’ve been given until yesterday:

CDC

CDC does not recommend that people who are well [is asymptomatic ‘well’?] wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms [The asymptomatic are not, of course.]. This is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with COVID-19 in close settings (at home or in a health care facility).

FDA

The Centers for Disease Control and Prevention (CDC) does not recommend that the general public wear N95 respirators [No. CDC said “facemasks.” As to N95s? The FDA is blocking their importation.] to protect themselves from respiratory diseases, including coronavirus (COVID-19). The best way to prevent illness is to avoid being exposed [Yes. Including everybody wearing a mask.] to this virus. However, as a reminder, CDC always recommends everyday preventive actions, such as hand washing, to help prevent the spread of respiratory diseases.

For the general American public, there is no added health benefit to wear a respiratory protective device (such as an N95 respirator), and the immediate health risk from COVID-19 is considered low.

Low? That’s why I can’t leave my house without a damn good reason? The FDA is as slow to update their website as they are on everything else.

New CDC:

In light of new [?] data about how COVID-19 spreads, along with evidence of widespread COVID-19 illness [“evidence of?” Yeah, I guess there’s some evidence.] in communities across the country, CDC recommends that people wear a cloth face covering to cover their nose and mouth in the community setting. This is to protect people around you if you are infected but do not have symptoms [Aha! They do know you may be asymptomatically infectious.].

It’s actually more than just protecting others, and face coverings should have been a general recommendation much earlier. Even a tiny percent success rate in preventing community transmission has non-trivial benefits.

Second, there is substantial evidence that using even less than perfect nose/mouth covering reduces potential virus ‘load.*’ The CDC is still not admitting this. If they had, it might encourage “hot spots” of infection to consider making wearing masks in public mandatory. (Laredo, Texas has done so.)

The biggest barrier to mask wearing may well be psychological – and the CDC reinforced Americans’ perception that only people with symptoms wear them. People who are considered incompetent to fit and wear an N95 mask are the same people expected to diagnose CCP virus symptoms – when many will be asymptomatic.

I get protecting the N95 supply for health care workers. I don’t get minimizing the protective value of even a scarf in order to do so.

It’s Time to Face Facts, America: Masks Work

That whole article is recommended, but I want to emphasize part of it as point 4, below. I’ve heard it said that even N95 masks aren’t that good against the CCP virus because the virus particle size is far below 0.3 microns. Four things about that,

    1) They’re the best, affordable protection we have, or we wouldn’t be trying to preserve the supply for health care workers.

    2) The virus is unlikely to be floating around as naked particles, it will be in a larger droplet. Even a scarf or bandana can help. Though see the Israeli Ministry of Health advice, linked below.

    3) There has always been general agreement that masks cut down on infecting others; important because of some evidence that many** of those who contract the CCP virus are asymptomatic, yet still infectious. That means the amount of virus they might expel would not have to be reduced as much – by any sort of mask – to be protective for the wearer. Dose matters.

    Reducing the virus load is protective.

    4) In any case, N95s do filter particles smaller than .3 microns:

    N95s are so-named because they filter out 95 percent of particles with a diameter of 0.3 microns, which are the most difficult particles to trap. Think of the filter in a mask not as a sieve but as a thicket—a dense tangle of minuscule filaments. To make it through, particles must flow seamlessly with air currents, weaving around every obstruction. Large particles are too heavy to pivot quickly, so they crash. Extremely tiny particles are buffeted by individual air molecules, bouncing about like pinballs and colliding with filaments. Particles 0.3 microns wide are just the right size to ride a stream of air through a filter’s fibrous maze, but it is still possible to thwart them with enough twists and turns.

    Because N95s block the vast majority of particles that try to pass through them, they are formidable barriers against microbes. For context, the bacterium that causes anthrax is 0.8 microns wide and 1.4 microns long, whereas influenza viruses and coronaviruses are usually between 0.08 and 0.12 microns. But microbes expelled from someone’s respiratory tract are rarely naked: the droplets they travel in range in size from 0.6 to more than 1,000 microns.

It is not unreasonable to suspect that a mandatory mask policy would have cut down transmission at Mardi Gras in New Orleans, and the subways and Lunar New Year Parade in New York City. CDC knew this even as Bill de Blasio was encouraging people to assemble in parks via subway, and Nancy Pelosi was inviting people to the Lunar New Year parade in NYC.

Could it be as effective to mandate mask wearing in New York City, or Detroit, as it is to lock people in their houses – given high levels of non-compliance? It is easier to enforce than guessing whether some citizen is on their way to an essential job.

Because the general public is untrained in N95 mask fitting and use, they won’t get the same benefit a diligent health care worker does. Does that mean any mask is a waste of time? If it does flatten the curve, even if not as much as the lockdowns. If it does improve compliance. If it’s easier to enforce. If it got a few more back to work. Then, no, it’s not a waste of time. But everybody has to do it.

If we’re willing to put 10 million out of work, shouldn’t we have tried mandated masks? To the obvious objection, I’ll let Arnold Kling respond. Here:

[UPDATE: You want to object, “We can’t experiment with people’s lives in a crisis!” My response is that we are doing exactly that. We are experimenting with various lockdown policies, but not in a way that allows us to learn from the results.]

and here,

I do not like the way that the experts are dealing with this crisis. I am at the point where I don’t care about being charitable toward them. Nassim Taleb, who is never charitable to those who disagree with him, has a shorthand that I will modify for this purpose. Expert Yet Idiot, or EYI. [ASK is Kling’s askblog]

What should we rely on to make decisions?
ASK: rigorous studies and experiments
EYI: noisy data and models
What should we use to reduce the spread rate of the virus?
ASK: masks and scarves
EYI: lockdowns
What should government do to relieve individuals and small businesses?
ASK: provide backing for credit lines from banks
EYI: Massive intervention by the Fed and deficit spending

Other resources on the topic:

Slate Star Codex
Face Masks: Much More Than You Wanted To Know
Good overview. It’s comprehensive enough to justify the title. It does examine the question dispassionately, citing studies positive and negative.

New York Post
Experts say face masks can help slow COVID-19, despite previous claims

Washington Post
Face mask shortage prompts CDC to loosen coronavirus guidance
This pretty much confirms surgical masks (which are not N95) provide some protection against the CCP virus. But, the public still shouldn’t be buying them, because health care workers should get them first, and there’s a shortage.

Lancet
Rational use of face masks in the COVID-19 pandemic

New York Times
More Americans Should Probably Wear Masks for Protection

Reuters
Masks do reduce spread of flu and some coronaviruses, study finds

Israeli Ministry of Health
Wearing a mask that covers your mouth and nose in public in order to minimize the chance of infection
Mask protocols ad including instructions on fabricating homemade masks.

Meanwhile the FDA and CDC are getting in the way,
Marginal Revolution
Barriers to masks
FDA Prevents Import of Masks

Reason
Health Care Workers Need Masks (and the Rest of Us Need Them, Too)

As are some hospitals,
New York Times
Frightened Doctors Face Off With Hospitals Over Rules on Protective Gear

* Virus load is simply the quantity of viral particles. Exposure to fewer particles may still cause infection, but eventual symptoms seem to be proportional to the number of particles.

Science
Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing page 2

Mild cases have been found to have viral loads 60-fold less than severe cases (19) and it is likely that the viral loads of asymptomatic individuals are lower still, with possible implications for infectiousness and diagnosis.

New York Times
These Coronavirus Exposures Might Be the Most Dangerous

Both small and large amounts of virus can replicate within our cells and cause severe disease in vulnerable individuals such as the immunocompromised. In healthy people, however, immune systems respond as soon as they sense a virus growing inside. Recovery depends on which wins the race: viral spread or immune activation.

Virus experts know that viral dose affects illness severity. In the lab, mice receiving a low dose of virus clear it and recover, while the same virus at a higher dose kills them. Dose sensitivity has been observed for every common acute viral infection that has been studied in lab animals, including coronaviruses.

** Percent of asymptomatic people in 2 cases. Iceland’s testing has been rigorous. The Diamond Princess can be considered a petri dish test where humans were the agar.

50% were asymptomatic in Iceland. Note: this is an antigen test which reveals the presence of the virus. From the evidence that 50% of people who had an active case were asymptomatic we can infer there are people who have fully recovered who did not even know they were infected, and no longer host the virus. To identify them, a different test (for SARS-COV2 antibodies) is needed. If we knew who those recovered people are they could go back to work.

On the Diamond Princess cruise ship, “slightly less than half the passengers (48.6% ± 2.0%) who got the disease showed NO symptoms.”

CDC says it might be 25%:
As many as 1 in 4 people with coronavirus may not show symptoms, the CDC director warns

Masque of the Red Death II

The Federalist:
China Is Lashing Out Because Wuhan Flu Has Unmasked It To The World

Real Clear Investigations:
Unpacking China’s Viral Propaganda War

Wall Street Journal:
China’s Count Excluded Infected People With No Symptoms

China said more than 1,500 people who were infected with the coronavirus but haven’t shown symptoms weren’t included in its tally of confirmed cases.

That Wall Street Journal number of 1,500 is odd since the South China Morning Post is reporting:

Classified government data seen by the Post showed more than 43,000 people in China had tested positive for Covid-19 by the end of February but had no immediate symptoms. They were quarantined but not included in the official tally of confirmed cases.

One wonders why “infected with” and “tested positive” do not equate with “confirmed” in Mandarin. And whether the rest of the world might have been interested in that information a little earlier.

Elsewhere in that SCMP article, Lu Jinxing, party secretary of China’s National Institute for Communicable Disease Control and Prevention, is quoted:

A top Chinese health official sought to allay growing fears over asymptomatic coronavirus carriers on Monday, saying there was “no evidence” they could spread the illness…

Lu told the state broadcaster: “We have observed a great number of asymptomatic cases and found that people had a relatively long duration of viral shedding,” referring to the rate at which an infected person “sheds” the virus.

“In terms of whether they are infectious, we have not done detailed studies so far,” Lu said.

There is “”no evidence” asymptomatic carriers” with “a relatively long duration of viral shedding” are contagious? Well, yes, you won’t find evidence you haven’t looked for.

Someone should remind Mr. Lu that absence of evidence is not evidence of absence. Then again, there is evidence:

Public fears were heightened on Sunday after officials disclosed the case of a 59-year-old woman in Henan province who contracted Covid-19 after she had contact with a doctor who was an asymptomatic carrier.

Maybe the WSJ is wrong about the 1,500. Maybe the SCMP is wrong about 43,000. Maybe all but 1,500 of those 43,000 later became symptomatic. Maybe that woman was infected by someone other than the asymptomatic doctor, and the Chinese surveillance system missed the contact. Maybe word of that transmission hadn’t reached the party secretary.

Maybe the party secretary is lying.

Witless

Gretchen Witless (my nickname for Michigan’s Governor predates, and is better than Trump’s “half Whitmer”) is threatening to lift the licenses of doctors and pharmacists over prescriptions of chloroquine.

She wants to prevent hoarding, so she makes sure no CCP virus patient can get it.

She implies doctors are making sure their families have it. Well, they certainly should.

The doctors are hoarding? I bet there are some unethical doctors of which this is true. I bet two other things:

For the vast majority of docs –
1) If they are prescribing it off label, it isn’t so the general public can add it to their toilet paper storage facility.

2) If they are doing it for their families and other health care workers at extreme exposure risk, isn’t that just like donating some N95 masks? Who more needs the drug than those exposed to CCP virus in the trenches?

Here’s a situation where that might matter…

Our small city has no centralized site for COVID testing. As such, any feeling need to be tested, have to drive to the larger center of Edmonton to get in line at a drive through testing site. Out nurses out here have met and are discussion setting up a testing site here and are looking for volunteer Dr’s to lead. I was asked. Here it is. One of those moments. I’m 59 and have a 40’s wife a 13 y old and 10 y old son and an 89 year old (sure to die if he gets the virus) father in law living with us on oxygen and home care. I want to do the right thing and need to make a decision. “Decision” from the latin root scisserae. Meaning to cut. “Decision” to cut away all things blocking one from the truth and the answer is there to see. Gonna sleep on it. I did a parking lot nasal swab on one of my patients just an hour ago, and looking at her, she was unwell and a high likelihood positive. But doing it 20?30?50 times in a day? Not sure if I want to take the risk. I know if I was a 59 year old bachelor, I would.

For God sake Gretchen. What you should have done is placed an order for Michigan to stockpile it.

Update, 03/31/20 12:30PM,
Another example from a friend:

I have talked about my daughter, ____, from time to time. She made an interesting comment the other day, about her role as a nurse practitioner, in an emergency room setting. Her concern was not about her own participation in serving patients, but she is very concerned about returning back to the house. When we talked, she still was not comfortable with the data on how it spreads, and what she may be carrying back to her family. Her pattern is entering through the “laundry room entrance”, disrobing there with her clothes going directly to the washing machine, putting on fresh garments, and then entering the house. She returns to disinfect everything she might have touched in the process, and then goes on. And her concern is, is this enough? I could tell from her voice that this unresolved question was creating stress.

I think there’s an argument here for prophylactic use.

From Michigan Capitol Confidential:
March 27 – Michigan Licensing Bureau Vs. Dr. Fauci On Off-Label Coronavirus Treatment
March 31 – Feds Permit Malaria Drugs For Coronavirus Patients, State Has Not Rescinded Threat Of Sanctions

The Masque of the Red Death

Gatestone Institute:
The West Needs to Wake Up to China’s Duplicity

National Review:
The Comprehensive Timeline of China’s COVID-19 Lies

Real Clear Politics:
Has the U.S.-China Cold War Now Begun?

The CCP hides their totalitarianism behind a “state capitalism” mask.

Market Leninism is more like it.