The key going forward will be the government's response. If they revert to type, we're very screwed. If they support the economy, then a sharp recovery is possible because the underlying production potential of the economy will be essentially unchanged. This is a vital point because unemployment and home losses cost far, far more in the long term than the cost of government borrowing. Especially when government borrowing is effectively at negative interest rates and the BoE is able to print money without generating inflation.
It's important to remember that there are two main factors currently depressing the economies of various nations. The first is a sharp reduction in productive capacity or output, as large sectors of the economy are shuttered. The second is a demand reduction because the people who worked in those now-shuttered portions of their country's economy are now without income and have to cut back on expenses, like food or rent or anything else they used to spend their now-decreased/eliminated income on. Since one person's spending is another person's income, this further depresses the economy.
The thing to remember is that the first of these (shuttering non-essential parts of the economy) is, if not exactly wanted at least necessary. Businesses shuttered because of a lockdown order are inconvenient but, from an economic point of view, not at all different from businesses shuttered because their workforce is hospitalized. From a human point of view (as opposed to an economic one) the former is much preferable to the latter.
It's the second factor (people cutting back consumption because they're broke) where government action can be most useful. Just give people enough money to spend on the still-open essential services still operating and pay their rent/mortgates/other obligations and the recession will be a lot less severe. Unfortunately a lot of politicians have reversed these priorities, pushing hard to "re-open the economy" (i.e. send the non-essential workforce back to work) while skimping on any aid to those out of work due to the shuttering of non-essential businesses.
Yesterday, New York City hospitals reported more coronavirus patients were discharged (ie sufficiently recovered to return home) than admitted (per CBS News).
The key going forward will be the government's response. If they revert to type, we're very screwed. If they support the economy, then a sharp recovery is possible because the underlying production potential of the economy will be essentially unchanged. This is a vital point because unemployment and home losses cost far, far more in the long term than the cost of government borrowing. Especially when government borrowing is effectively at negative interest rates and the BoE is able to print money without generating inflation.
It's important to remember that there are two main factors currently depressing the economies of various nations. The first is a sharp reduction in productive capacity or output, as large sectors of the economy are shuttered. The second is a demand reduction because the people who worked in those now-shuttered portions of their country's economy are now without income and have to cut back on expenses, like food or rent or anything else they used to spend their now-decreased/eliminated income on. Since one person's spending is another person's income, this further depresses the economy.
The thing to remember is that the first of these (shuttering non-essential parts of the economy) is, if not exactly wanted at least necessary. Businesses shuttered because of a lockdown order are inconvenient but, from an economic point of view, not at all different from businesses shuttered because their workforce is hospitalized. From a human point of view (as opposed to an economic one) the former is much preferable to the latter.
It's the second factor (people cutting back consumption because they're broke) where government action can be most useful. Just give people enough money to spend on the still-open essential services still operating and pay their rent/mortgates/other obligations and the recession will be a lot less severe. Unfortunately a lot of politicians have reversed these priorities, pushing hard to "re-open the economy" (i.e. send the non-essential workforce back to work) while skimping on any aid to those out of work due to the shuttering of non-essential businesses.
Completely agree.
The economic cost of the shutdown is manageable. I just fear it will be mismanaged.
This crisis is really a national security crisis and fighting the foe takes priority. However, the next step is also vital because (as always) it's the poorest who will pay the highest price.
The economic cost of the shutdown is manageable. I just fear it will be mismanaged.
This crisis is really a national security crisis and fighting the foe takes priority. However, the next step is also vital because (as always) it's the poorest who will pay the highest price.
AFZ
From an economic perspective (as opposed to a national security one) the kind of relief that's needed isn't stimulus, as the term is usually understood, it's more akin to disaster relief. It's not so much that we should be stimulating the economy to create jobs so everyone can go back to work (which would be counterproductive from an epidemiological point of view) but give people affected by disaster the means to survive until the disaster has passed.
It's not so much that we should be stimulating the economy to create jobs so everyone can go back to work (which would be counterproductive from an epidemiological point of view) but give people affected by disaster the means to survive until the disaster has passed.
Assuming they’ve got jobs to go back to afterwards, of course. That’s where the traditional stimulus comes in.
I see new and different jobs being created by a return to the new normal and some old ones passing away. Our governor has been talking of already training people to do testing when staying in place is eased. In my own small rural community I note that as people choose not to travel to the city for shopping where the virus is more active then the only 6 cases in our rural county, that our local smaller businesses are doing well. I expect many will continue to support local when things go back to normal. I see shaking hands coming to an end, and a bow of some sort become the new cultural norm. A fist bump or elbow bump always did feel a bit funny. No more hug greetings among casual friends for sure.
It's not so much that we should be stimulating the economy to create jobs so everyone can go back to work (which would be counterproductive from an epidemiological point of view) but give people affected by disaster the means to survive until the disaster has passed.
Assuming they’ve got jobs to go back to afterwards, of course. That’s where the traditional stimulus comes in.
Again, this is more akin to disaster relief (which usually covers stricken businesses as well as individuals) than economic stimulus as the term is usually understood.
Some expert or other on Twitter was saying that a very large number of people will be needed to do contact tracing, once we get a proper testing regime in place. Furloughed retail and hospitality workers would be perfect for the job - they're used to being on the phone with unhappy customers all the time.
Public Health England giving advice that if hospitals run out of PPE staff should wear - among other things - lab coats.
The idea that they should move towards reusable (with proper washing, of course) gowns has quite a lot of merit, as long as there are enough of them for everyone to change between patients. Or so it seems to me.
Yesterday, New York City hospitals reported more coronavirus patients were discharged (ie sufficiently recovered to return home) than admitted (per CBS News).
Public Health England giving advice that if hospitals run out of PPE staff should wear - among other things - lab coats.
The idea that they should move towards reusable (with proper washing, of course) gowns has quite a lot of merit, as long as there are enough of them for everyone to change between patients. Or so it seems to me.
Assuming there are enough - and they are suitable to be reused - the inclusion of the other things on that list suggest there are not.
Public Health England giving advice that if hospitals run out of PPE staff should wear - among other things - lab coats.
The idea that they should move towards reusable (with proper washing, of course) gowns has quite a lot of merit, as long as there are enough of them for everyone to change between patients. Or so it seems to me.
Assuming there are enough - and they are suitable to be reused - the inclusion of the other things on that list suggest there are not.
Related a question an engineer might be able to answer, could you not make a surgical gown out of silicone - because it could be steamed or boiled to disinfect ?
Related a question an engineer might be able to answer, could you not make a surgical gown out of silicone - because it could be steamed or boiled to disinfect ?
Cotton can be boiled. My mother had a wash tub back in the day where she boiled her white cotton laundry.
I doubt silicone is what you need - everything I've seen made of silicone has been rather heavy and clumsy - I'd think that would be a rather notable disadvantage in a hospital apron or surgical gown.
Part of me is now envisaging the surgical team striding down the corridor from theatre in full latex bondage gear, ready to be hosed down in the scrub room.
Part of me is now envisaging the surgical team striding down the corridor from theatre in full latex bondage gear, ready to be hosed down in the scrub room.
Part of me is now envisaging the surgical team striding down the corridor from theatre in full latex bondage gear, ready to be hosed down in the scrub room.
tbf, they donated actual medical equipment that they used as fetishwear. I'm talking about surgeons in black latex and a gimp mask.
.
.
.
I think it's finally started to get to me...
The short answer is yes, one would expect Hibiscrub (which I've just checked is 4% Chlorhexidine) to be effective against Coronaviruses.
The longer answer is that I would be very surprised if it has been directly tested (as yet) because of the newness of the virus and the set-up that's needed to do such a testing program. There is some data that agents with lower chlorhexidine (0.1%) are 'less effective' than alcohol-based agents with more than 60% alcohol.
Outside of the body, Coronaviruses (like most viruses) are actually quite easy to kill. Inside the body, viruses can be very tricky. The reason why antibiotics don't work against viruses is that they do not have their own biology in the way that bacteria do; they hijack the host's biology. If you look at bacteria, they have complete cells with the machinery to make more cells and do all the normal functioning of the cell. Key components of the cell (including the cell membrane and the mechanisms for DNA replication and protein synthesis) are sufficiently different to human cells that we can use chemicals that interrupt these processes in the bacteria (and thus kill the bacteria) without having a detrimental effect on the human cells. The problem with viruses is that they get into the human cells and hijack these mechanisms from the host cells. Thus any drug that stops the virus from replicating is likely to be very toxic to the host. The immune system attacks viruses by killing infected cells. Cytotoxic-T-Lymphocytes and Natural Killer Cells detect cells that are infected with a virus and kill them thus stopping the virus from replicating.
The fairly small number of antiviral agents we have all have to be clever in some specific way. In the case of HIV treatments, the relatively complex life-cycle of the retrovirus means there are a couple of steps that are completely different from the human cell biology and can be targetted. Similarly, the anti-flu drugs are designed to stop the influenza virus from getting into the cell. Aciclovir is my favourite. It is basically cytotoxic (i.e. it kills human cells). It is also inactive. It is activated by an enzyme. Said enzyme is only found in cells infected with herpes viruses.
Anyway, I digress, the point of this is that because a lot of people know that antibiotics don't work of viruses, you may hear people say that 'antibacterial agents won't work for hand-washing / surface cleaning.' This is wrong. They will work. Whether they're any better than soap is a different question. The coronaviruses are enveloped viruses. Essentially they are tiny (not quite) cells. The human cell has a membrane made up of a lipid bilayer - i.e. you can imagine a cell being a sphere with the skin of the sphere made up of fat. (That's a slight simplification but only a slight one). Enveloped viruses are made in the host cell and the new virus particles take part of the cell membrane with them to enclose the viral genome. Hence, like cells, these viral particles can be very easily disrupted by soap (or other agents). Once the viral RNA is exposed it will degrade pretty quickly. But more to the point the virus envelop also has a key protein in it known as the 'spike protein' in coronaviruses. This is the key to allowing the virus particle to enter and infect cells. Hence even if the virus genome survived after the envelope is disrupted, it would have no means to enter a cell.
Thus soap is very effective. Similarly, Hibiscrub should easily deactivate the virus.
As to reusable PPE. There are a number of factors here. One of the keys is safely removing PPE and without touching the outside of anything with your hands. The point of the gowns is to keep the virus off one's clothes and thus at risk of be transferred to the mucus membranes of the nose or mouth. In my hospital our visors are reusable - they go in a bucket of chemicals for 4 hours and are then ready to be used again. But our gowns, gloves hats and masks go in the bin. It really is a bit of an art, taking it all off safely. The reason why so much of what's used in hospitals is disposable is that it's often cheaper than reuse. For example, surgical gowns (used for any operation) can be either reusable or disposable. In the course of my career, most places I've worked have moved to disposable because the cost of production and cleaning the gowns is a lot more than the cost of single-use gowns. And when you factor in the energy costs of sterilisation as well, single-use is probably better for the environment. So switching to reusable gowns for PPE for coronavirus is possible but not necessarily an improvement because you need the gowns to be available in the first place. You need a system set up for safe collection and sterilisation of said gowns to get them ready to use again. That's not necessarily going to happen any quicker than the manufacture of single-use gowns. For our visors it works well because they are plastic and so easy to clean - we simply drop them in the right bucket and at the end of the day, the bucket is collected and the masks are ready to use the next day.
I doubt silicone is what you need - everything I've seen made of silicone has been rather heavy and clumsy - I'd think that would be a rather notable disadvantage in a hospital apron or surgical gown.
I'd expect heat overload would be a problem, if the op took at all long.
List of countries with at least 10,000 known COVID-19 cases.
United States - 710,021 (612,353 / 60,510 / 37,158)
Spain - 190,839 (96,040 / 74,797 / 20,002)
Italy - 172,434 (106,962 / 42,727 / 22,745)
France - 147,969 (94,868 / 34,420 / 18,681)
Germany - 141,397 (53,931 / 83,114 / 4,352)
United Kingdom - 108,692 (93,772 / 344 / 14,576)
China - 82,719 (1,058 / 77,029 / 4,632) 5.7%
Iran - 79,494 (20,472 / 54,064 / 4,958) 8.4%
Turkey - 78,546 (68,146 / 8,631 / 1,769)
Belgium - 36,138 (23,014 / 7,961 / 5,163)
Brazil - 34,221 (18,024 / 14,026 / 2,171)
Russia - 32,008 (29,145 / 2,590 / 273)
Canada - 31,927 (20,074 / 10,543 / 1,310)
Netherlands - 30,449 (26,740 / 250 / 3,459)
Switzerland - 27,078 (9,351 / 16,400 / 1,327)
Portugal - 19,022 (17,846 / 519 / 657)
Austria - 14,595 (4,460 / 9,704 / 431)
India - 14,352 (11,825 / 2,041 / 486)
Ireland - 13,980 (13,373 / 77 / 530)
Peru - 13,489 (6,648 / 6,541 / 300)
Sweden - 13,216 (11,266 / 550 / 1,400)
Israel - 12,982 (9,705 / 3,126 / 151)
South Korea - 10,653 (2,484 / 7,937 / 232) 2.8%
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries fifteen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3). New Jersey would be between Turkey and Belgium.
China admitted to a lot of previously unknown deaths since the last compilation, which is why their fatality rate jumped by more than a point.
I asked about hibiscrub specifically because it’s website blurb said it forms a barrier layer that sits on the skin for upto six hours (which soap definitely doesn’t). And strengthens with repeated applications.
I was thinking if the gown were silicone it could be sterilised in the same way as visors, or autoclaved in some way.
(Though this thing about protecting clothes, surely the point of scrubs is to take them off and dump them in the machine as soon as you leave the environment anyway ?)
I asked about hibiscrub specifically because it’s website blurb said it forms a barrier layer that sits on the skin for upto six hours (which soap definitely doesn’t). And strengthens with repeated applications.
I was thinking if the gown were silicone it could be sterilised in the same way as visors, or autoclaved in some way.
(Though this thing about protecting clothes, surely the point of scrubs is to take them off and dump them in the machine as soon as you leave the environment anyway ?)
Absolutely. That is the point of clothes. I suspect you knew a lot of what I posted but I was hoping it was useful for other people too. We use Hibiscrub a lot for prepping patients for surgery. It is very effective at reducing post-op infections and less irritating to the skin than iodine. I forgot to mention that there are versions with and without alcohol....
So why are you better off in gown over scrubs than scrubs + hibiscrub ? (+ gloves, masks & visors).
Also, I don’t get why wear a surgical mask, rather than a reusable visor.
It's mostly practical - gown comes off and goes in bin. Then change scrubs. That's the protocol. I.e. minimising the chance that you're carrying the virus anywhere - the two layer thing - especially as the gowns are waterproof - is the key.
The fairly small number of antiviral agents we have all have to be clever in some specific way. In the case of HIV treatments, the relatively complex life-cycle of the retrovirus means there are a couple of steps that are completely different from the human cell biology and can be targetted. Similarly, the anti-flu drugs are designed to stop the influenza virus from getting into the cell. Aciclovir is my favourite. It is basically cytotoxic (i.e. it kills human cells). It is also inactive. It is activated by an enzyme. Said enzyme is only found in cells infected with herpes viruses.
AFZ
I was a Sister in an ophthalmic HIV clinic in the mid 1990s in London. Our patients had a life expectancy of 9 months and our task was to stop them going blind (generally from cytomegalovirus) before they died. It was like a miracle when appropriate antivirals arrived.
So why are you better off in gown over scrubs than scrubs + hibiscrub ? (+ gloves, masks & visors).
Also, I don’t get why wear a surgical mask, rather than a reusable visor.
It's mostly practical - gown comes off and goes in bin. Then change scrubs. That's the protocol. I.e. minimising the chance that you're carrying the virus anywhere - the two layer thing - especially as the gowns are waterproof - is the key.
So why are you better off in gown over scrubs than scrubs + hibiscrub ? (+ gloves, masks & visors).
Also, I don’t get why wear a surgical mask, rather than a reusable visor.
It's mostly practical - gown comes off and goes in bin. Then change scrubs. That's the protocol. I.e. minimising the chance that you're carrying the virus anywhere - the two layer thing - especially as the gowns are waterproof - is the key.
The use of a phone app is coming to the fore now, as through Bluetooth, contacts of an infected person can be identified, and then tested . Traditionally, this would be done via personal interview, using local health teams. It's unclear whether the phone app would work, since presumably a lot of people have to download the app, and then reveal their infected status. It looks as if Hancock is keen on it, as it could provide an exit from lockdown.
I doubt silicone is what you need - everything I've seen made of silicone has been rather heavy and clumsy - I'd think that would be a rather notable disadvantage in a hospital apron or surgical gown.
Yeah I think most of the constraints are driven by the physical requirements for the various pieces of protective equipment.
Gowns need to be flexible, light and thin to allow for freedom of movement - so aren't going to hold up very well to the kind of disinfection that would be required to keep them safe while remaining leak-proof - visors otoh are rigid and can be made of tougher material so reuse is a viable option there.
Basic material science being insufficiently enthusiastic about government policy there.
The use of a phone app is coming to the fore now, as through Bluetooth, contacts of an infected person can be identified, and then tested . Traditionally, this would be done via personal interview, using local health teams. It's unclear whether the phone app would work, since presumably a lot of people have to download the app, and then reveal their infected status. It looks as if Hancock is keen on it, as it could provide an exit from lockdown.
Here is a summary of different electronic contract tracing methods used in various east Asian countries.
Bloomberg News is reporting the Oxford vaccine may be ready for full-scale production by this Autumn. I certainly hope so.
Apparently they had a jump start in their development because they had previously worked on another type of SARS coronavirus and a MARS coronavirus.
The New York Times is also reporting the drug Remdesivir is showing promising results in the treatment of COVID 19.
The University of Washington models predict Washington State should be able to lift its stay at home order by May 18 provided we can get the new cases down to 0 for at least two weeks.
There is a light at the end of this tunnel. (I hope.)
I've asked this before, I think, but what about those of us who do NOT possess, or use, a mobile/smart phone?
(I do have an Auncient and Venerable mobile, purchased for the vast sum of £5 some mumble mumble years ago, and which I keep in the car for emergency use).
I've asked this before, I think, but what about those of us who do NOT possess, or use, a mobile/smart phone?
(I do have an Auncient and Venerable mobile, purchased for the vast sum of £5 some mumble mumble years ago, and which I keep in the car for emergency use).
I think the idea is that it doesn't need everyone to use the app, just enough that you can keep the infection rate below 1 without having everyone stuck at home all the time.
Bloomberg News is reporting the Oxford vaccine may be ready for full-scale production by this Autumn. I certainly hope so.
Apparently they had a jump start in their development because they had previously worked on another type of SARS coronavirus and a MARS coronavirus.
The New York Times is also reporting the drug Remdesivir is showing promising results in the treatment of COVID 19.
The University of Washington models predict Washington State should be able to lift its stay at home order by May 18 provided we can get the new cases down to 0 for at least two weeks.
There is a light at the end of this tunnel. (I hope.)
Re vaccine. As far as we're informed, the various labs working on vaccines conference every week. News sources looking for stories like to push stories which give optimism. When they're not doing pessimistic stories. Local lab here has done animal testing. It's university affiliated so releases less news stories designed to increase investment and stock prices. This link of one month ago and says testing. https://www.narcity.com/news/ca/sk/coronavirus-vaccine-made-in-saskatchewan-is-now-in-the-testing-stages
So I'm taking stories like the Bloomberg link lightly.
Re lifting of lockdown. We're at about 1 per day. But that's not the reason enough to release lockdown if your jurisdiction isn't testing hundreds of thousands a day.
I've asked this before, I think, but what about those of us who do NOT possess, or use, a mobile/smart phone?
(I do have an Auncient and Venerable mobile, purchased for the vast sum of £5 some mumble mumble years ago, and which I keep in the car for emergency use).
I think the idea is that it doesn't need everyone to use the app, just enough that you can keep the infection rate below 1 without having everyone stuck at home all the time.
Yes, I see. Thx.
(OTOH, if the guvverment wants to buy me a new phone... ).
what about those of us who do NOT possess, or use, a mobile/smart phone?
There is a special corner of heaven reserved for you. (Not that I'm suggesting that you make haste to get there, mind.)
I've long felt that the telephone is the single worst invention ever to have occurred to the imagination of mankind. And the second (the smartphone) is like unto it. But this is a topic for another thread.
The New York Times is also reporting the drug Remdesivir is showing promising results in the treatment of COVID 19.
The New York Times is reporting that the manufacturer of Remdesivir claims promising results. Nowhere in the article was there mention of some of the deficiencies of the test, such as the lack of a control group.
The New York Times is also reporting the drug Remdesivir is showing promising results in the treatment of COVID 19.
The New York Times is reporting that the manufacturer of Remdesivir claims promising results. Nowhere in the article was there mention of some of the deficiencies of the test, such as the lack of a control group.
That's not NYTimes reporting, it's an opinion piece referring to an article in Statnews describing comments in a discussion among University of Chicago faculty, not claims by Gilead.
Both the NYTimes opinion piece and the StatNews article note the limitations of the study, including the absence of a control group.
FT reporting preliminary estimates of up to 6000 covid related deaths inside UK care homes, based on the above trend number:
"The Office for National Statistics has said the jump in deaths is highly unusual and has started work with the Care Quality Commission, the industry regulator, and Public Health England to reveal whether doctors are failing to mention coronavirus on death certificates in large numbers."
Matt Hancock, the health secretary, admitted on Friday that he had a “high degree of confidence” that the number and proportion of Covid-19 deaths in care homes was higher than reported.
That has to be true. And the numbers of the dead (15,464 according to worldometer) are distressingly high without that. I think it was Chris Whitty who observed that 20,000 deaths in this epidemic wave would be a "good, if horrifying result" based on how bad things might have been. It's increasingly likely that we will exceed that total even without including the care homes deaths.
Both the Express and Sunday Times running stories about Johnson missing multiple Cobra meetings during the early part of the crisis. Meanwhile a number of people have pointed to a speech given back in Feb:
"And in that context, we are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases such as coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then at that moment humanity needs some government somewhere that is willing at least to make the case powerfully for freedom of exchange, some country ready to take off its Clark Kent spectacles and leap into the phone booth and emerge with its cloak flowing as the supercharged champion, of the right of the populations of the earth to buy and sell freely among each other."
Which if nothing else indicates a certain set of ideological presuppositions that may lead to playing the maverick.
I've asked this before, I think, but what about those of us who do NOT possess, or use, a mobile/smart phone?
Bishop's Finger The idea of an app on smartphones was considered here, but the report said that even in one of the more tech savvy countries (can't remember, but I think it was Hong Kong) people were having difficulties with it. So another suggestion was having a card, the size of a bank card that was blue tooth enabled and you could just put into your wallet. I'm a bit vague on the details as I am a *technopeasant*, but it seemed a better idea to me as a wider range of people could use it.
It also appealed because my usual smart phone died, and now the back up can only be used for texts - the phone may be smart, but this user definitely isn't.
AFZ, thank you so much for the long post you made about how viruses work. I didn't really understand that before and I find it fascinating.
And acyclovir is da bomb! My doc prescribed it for an outbreak of colds sores on my lips that kept bouncing back despite all those expensive topical gels, it worked like scientific magic.
Comments
It's important to remember that there are two main factors currently depressing the economies of various nations. The first is a sharp reduction in productive capacity or output, as large sectors of the economy are shuttered. The second is a demand reduction because the people who worked in those now-shuttered portions of their country's economy are now without income and have to cut back on expenses, like food or rent or anything else they used to spend their now-decreased/eliminated income on. Since one person's spending is another person's income, this further depresses the economy.
The thing to remember is that the first of these (shuttering non-essential parts of the economy) is, if not exactly wanted at least necessary. Businesses shuttered because of a lockdown order are inconvenient but, from an economic point of view, not at all different from businesses shuttered because their workforce is hospitalized. From a human point of view (as opposed to an economic one) the former is much preferable to the latter.
It's the second factor (people cutting back consumption because they're broke) where government action can be most useful. Just give people enough money to spend on the still-open essential services still operating and pay their rent/mortgates/other obligations and the recession will be a lot less severe. Unfortunately a lot of politicians have reversed these priorities, pushing hard to "re-open the economy" (i.e. send the non-essential workforce back to work) while skimping on any aid to those out of work due to the shuttering of non-essential businesses.
Yesterday, New York City hospitals reported more coronavirus patients were discharged (ie sufficiently recovered to return home) than admitted (per CBS News).
Ah, memories! The inimitable Brendan Grace aka Fr. Fintan Stack.
Completely agree.
The economic cost of the shutdown is manageable. I just fear it will be mismanaged.
This crisis is really a national security crisis and fighting the foe takes priority. However, the next step is also vital because (as always) it's the poorest who will pay the highest price.
AFZ
From an economic perspective (as opposed to a national security one) the kind of relief that's needed isn't stimulus, as the term is usually understood, it's more akin to disaster relief. It's not so much that we should be stimulating the economy to create jobs so everyone can go back to work (which would be counterproductive from an epidemiological point of view) but give people affected by disaster the means to survive until the disaster has passed.
Assuming they’ve got jobs to go back to afterwards, of course. That’s where the traditional stimulus comes in.
Again, this is more akin to disaster relief (which usually covers stricken businesses as well as individuals) than economic stimulus as the term is usually understood.
The idea that they should move towards reusable (with proper washing, of course) gowns has quite a lot of merit, as long as there are enough of them for everyone to change between patients. Or so it seems to me.
May this trend continue!
Assuming there are enough - and they are suitable to be reused - the inclusion of the other things on that list suggest there are not.
Hence the “as long as” in my post.
Didn't we have that timeline already?
tbf, they donated actual medical equipment that they used as fetishwear. I'm talking about surgeons in black latex and a gimp mask.
.
.
.
I think it's finally started to get to me...
The short answer is yes, one would expect Hibiscrub (which I've just checked is 4% Chlorhexidine) to be effective against Coronaviruses.
The longer answer is that I would be very surprised if it has been directly tested (as yet) because of the newness of the virus and the set-up that's needed to do such a testing program. There is some data that agents with lower chlorhexidine (0.1%) are 'less effective' than alcohol-based agents with more than 60% alcohol.
Outside of the body, Coronaviruses (like most viruses) are actually quite easy to kill. Inside the body, viruses can be very tricky. The reason why antibiotics don't work against viruses is that they do not have their own biology in the way that bacteria do; they hijack the host's biology. If you look at bacteria, they have complete cells with the machinery to make more cells and do all the normal functioning of the cell. Key components of the cell (including the cell membrane and the mechanisms for DNA replication and protein synthesis) are sufficiently different to human cells that we can use chemicals that interrupt these processes in the bacteria (and thus kill the bacteria) without having a detrimental effect on the human cells. The problem with viruses is that they get into the human cells and hijack these mechanisms from the host cells. Thus any drug that stops the virus from replicating is likely to be very toxic to the host. The immune system attacks viruses by killing infected cells. Cytotoxic-T-Lymphocytes and Natural Killer Cells detect cells that are infected with a virus and kill them thus stopping the virus from replicating.
The fairly small number of antiviral agents we have all have to be clever in some specific way. In the case of HIV treatments, the relatively complex life-cycle of the retrovirus means there are a couple of steps that are completely different from the human cell biology and can be targetted. Similarly, the anti-flu drugs are designed to stop the influenza virus from getting into the cell. Aciclovir is my favourite. It is basically cytotoxic (i.e. it kills human cells). It is also inactive. It is activated by an enzyme. Said enzyme is only found in cells infected with herpes viruses.
Anyway, I digress, the point of this is that because a lot of people know that antibiotics don't work of viruses, you may hear people say that 'antibacterial agents won't work for hand-washing / surface cleaning.' This is wrong. They will work. Whether they're any better than soap is a different question. The coronaviruses are enveloped viruses. Essentially they are tiny (not quite) cells. The human cell has a membrane made up of a lipid bilayer - i.e. you can imagine a cell being a sphere with the skin of the sphere made up of fat. (That's a slight simplification but only a slight one). Enveloped viruses are made in the host cell and the new virus particles take part of the cell membrane with them to enclose the viral genome. Hence, like cells, these viral particles can be very easily disrupted by soap (or other agents). Once the viral RNA is exposed it will degrade pretty quickly. But more to the point the virus envelop also has a key protein in it known as the 'spike protein' in coronaviruses. This is the key to allowing the virus particle to enter and infect cells. Hence even if the virus genome survived after the envelope is disrupted, it would have no means to enter a cell.
Thus soap is very effective. Similarly, Hibiscrub should easily deactivate the virus.
As to reusable PPE. There are a number of factors here. One of the keys is safely removing PPE and without touching the outside of anything with your hands. The point of the gowns is to keep the virus off one's clothes and thus at risk of be transferred to the mucus membranes of the nose or mouth. In my hospital our visors are reusable - they go in a bucket of chemicals for 4 hours and are then ready to be used again. But our gowns, gloves hats and masks go in the bin. It really is a bit of an art, taking it all off safely. The reason why so much of what's used in hospitals is disposable is that it's often cheaper than reuse. For example, surgical gowns (used for any operation) can be either reusable or disposable. In the course of my career, most places I've worked have moved to disposable because the cost of production and cleaning the gowns is a lot more than the cost of single-use gowns. And when you factor in the energy costs of sterilisation as well, single-use is probably better for the environment. So switching to reusable gowns for PPE for coronavirus is possible but not necessarily an improvement because you need the gowns to be available in the first place. You need a system set up for safe collection and sterilisation of said gowns to get them ready to use again. That's not necessarily going to happen any quicker than the manufacture of single-use gowns. For our visors it works well because they are plastic and so easy to clean - we simply drop them in the right bucket and at the end of the day, the bucket is collected and the masks are ready to use the next day.
AFZ
I'd expect heat overload would be a problem, if the op took at all long.
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries fifteen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3). New Jersey would be between Turkey and Belgium.
China admitted to a lot of previously unknown deaths since the last compilation, which is why their fatality rate jumped by more than a point.
I was thinking if the gown were silicone it could be sterilised in the same way as visors, or autoclaved in some way.
(Though this thing about protecting clothes, surely the point of scrubs is to take them off and dump them in the machine as soon as you leave the environment anyway ?)
Absolutely. That is the point of clothes. I suspect you knew a lot of what I posted but I was hoping it was useful for other people too. We use Hibiscrub a lot for prepping patients for surgery. It is very effective at reducing post-op infections and less irritating to the skin than iodine. I forgot to mention that there are versions with and without alcohol....
Also, I don’t get why wear a surgical mask, rather than a reusable visor.
It's mostly practical - gown comes off and goes in bin. Then change scrubs. That's the protocol. I.e. minimising the chance that you're carrying the virus anywhere - the two layer thing - especially as the gowns are waterproof - is the key.
We have fitted masks plus visor. Like this!
AFZ
Very fetching
🤣🤣
Yeah I think most of the constraints are driven by the physical requirements for the various pieces of protective equipment.
Gowns need to be flexible, light and thin to allow for freedom of movement - so aren't going to hold up very well to the kind of disinfection that would be required to keep them safe while remaining leak-proof - visors otoh are rigid and can be made of tougher material so reuse is a viable option there.
Basic material science being insufficiently enthusiastic about government policy there.
Here is a summary of different electronic contract tracing methods used in various east Asian countries.
Apparently they had a jump start in their development because they had previously worked on another type of SARS coronavirus and a MARS coronavirus.
The New York Times is also reporting the drug Remdesivir is showing promising results in the treatment of COVID 19.
The University of Washington models predict Washington State should be able to lift its stay at home order by May 18 provided we can get the new cases down to 0 for at least two weeks.
There is a light at the end of this tunnel. (I hope.)
(I do have an Auncient and Venerable mobile, purchased for the vast sum of £5 some mumble mumble years ago, and which I keep in the car for emergency use).
I think the idea is that it doesn't need everyone to use the app, just enough that you can keep the infection rate below 1 without having everyone stuck at home all the time.
Re vaccine. As far as we're informed, the various labs working on vaccines conference every week. News sources looking for stories like to push stories which give optimism. When they're not doing pessimistic stories. Local lab here has done animal testing. It's university affiliated so releases less news stories designed to increase investment and stock prices. This link of one month ago and says testing. https://www.narcity.com/news/ca/sk/coronavirus-vaccine-made-in-saskatchewan-is-now-in-the-testing-stages
So I'm taking stories like the Bloomberg link lightly.
Re lifting of lockdown. We're at about 1 per day. But that's not the reason enough to release lockdown if your jurisdiction isn't testing hundreds of thousands a day.
Yes, I see. Thx.
(OTOH, if the guvverment wants to buy me a new phone...
There is a special corner of heaven reserved for you. (Not that I'm suggesting that you make haste to get there, mind.)
I've long felt that the telephone is the single worst invention ever to have occurred to the imagination of mankind. And the second (the smartphone) is like unto it. But this is a topic for another thread.
The New York Times is reporting that the manufacturer of Remdesivir claims promising results. Nowhere in the article was there mention of some of the deficiencies of the test, such as the lack of a control group.
Both the NYTimes opinion piece and the StatNews article note the limitations of the study, including the absence of a control group.
"The Office for National Statistics has said the jump in deaths is highly unusual and has started work with the Care Quality Commission, the industry regulator, and Public Health England to reveal whether doctors are failing to mention coronavirus on death certificates in large numbers."
That has to be true. And the numbers of the dead (15,464 according to worldometer) are distressingly high without that. I think it was Chris Whitty who observed that 20,000 deaths in this epidemic wave would be a "good, if horrifying result" based on how bad things might have been. It's increasingly likely that we will exceed that total even without including the care homes deaths.
"And in that context, we are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases such as coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then at that moment humanity needs some government somewhere that is willing at least to make the case powerfully for freedom of exchange, some country ready to take off its Clark Kent spectacles and leap into the phone booth and emerge with its cloak flowing as the supercharged champion, of the right of the populations of the earth to buy and sell freely among each other."
Which if nothing else indicates a certain set of ideological presuppositions that may lead to playing the maverick.
It also appealed because my usual smart phone died, and now the back up can only be used for texts - the phone may be smart, but this user definitely isn't.
AFZ, thank you so much for the long post you made about how viruses work. I didn't really understand that before and I find it fascinating.
And acyclovir is da bomb! My doc prescribed it for an outbreak of colds sores on my lips that kept bouncing back despite all those expensive topical gels, it worked like scientific magic.
*Thanks to the late Uncle Pete for this word*