The field hospital style model being built at the Javits center -- and many other places, including what used to be called Cobo Hall in Detroit -- has promise as a means of treating people.

But -- it is not being thought through anywhere near at a sufficient level of detail.

This is very much the TB Sanitarium model as a means of pandemic response, but it is missing one critical element: During those years when the Sanitariums were operating if you worked there you were someone who had TB and recovered -- and were thus immune.

And this leads back to what I was talking about yesterday: If you ignore one of what appears to be a major vector for this disease out of a sense of hero worship and then amplify it with field hospitals you will create an all-on disaster.

There is currently no mass-test available for antibodies.  We need one -- an OTC, anyone can buy it cassette style test.  We have them available for diabetics; they run them every day on multiple occasions.  There are even "home" A1c tests; same deal and those are even more-correlated as there is a reagent required with those as well (not just blood as with the routine sugar-level checks.)

This is critical for two groups: At risk Americans and health care workers.

Simply put with an antibody test those who have had the virus and recovered, and thus have antibodies, can safely work in those wards.  It then becomes a matter of routine decontamination before leaving (it may require a hot shower and soap, but that's reasonable) before departing for the day.  Other than direct transport of infectious material once immune you're "safe" in the general public even if exposed to sick individuals.

This is the key group, because one hospital worker can infect dozens of others.  Oh, I know, they'd neeeeevvvvveeerrr do that.  Except the data is that they are doing it right now.  It's either that or we've got a bunch of so-called "essential" folks doing the transmitting -- and we're fucked, because you cannot cut off the grocery stores and such.

For at-risk Americans however seropositive status isn't about getting other people sick -- it's about their personal life.  Just because you're at high risk it doesn't mean you didn't have an asymptomatic infection.  You might have.  For example it's implausible that the older couple on Diamond Princess who were quarantined in their cabin resulted in one infected and one not unless the individual who didn't get the virus seroconverted and was thus immune.

Further, if you know you're seroconverted then giving the finger immediately to President Trump, your Mayor, your Governor and everyone else in terms of your personal activity is not only appropriate -- it's a matter of civil and personal rights.  If you have seroconverted (that is, you were infected and are now immune) then there is absolutely no reason whatsoever to abide any restrictions or constraints -- not ethically, morally or legally.

Of course this is why nobody wants you to be able to go and buy one of these tests at the local store.  If you learn your seroconversion status then it renders all this "community" nonsense flat-out false since anyone can choose otherwise with absolute safety both on a personal and public basis.

Second, the facts on the ground are that only 10-15% of those who wind up on vents can be saved.  Everyone else dies anyway, so that's what we're talking about here.  If the facts are that 100,000 people are going to die then they are; we're now talking about a delta of 10,000 people or less than 1/5th of a moderate flu season in exchange for half the small businesses and an intentional economic depression being taken.

It is fine to urge people to "socially distance."  It is fine to urge the elderly to shelter in place. It's even ok to ban mass-gatherings; after all, if there was a shooting war on would you allow theaters to operate with their lit marquees as the bombers flew overhead -- would that not be literally painting a target on hundreds of Americans at once?

But when you force closed businesses you do something that was not done even during actual wars.  Businesses had their production diverted (those who lived through WWII were unable to buy tires for their cars as they were requisitioned for jeeps in battle) but actually forcing businesses closed?  No.  People went out, or not, as they deemed worth it during those times.  A bomber might come.  An air raid could happen with little or no warning.  People in Britain faced V2s that were launched from German territory on a daily basis.

Some people decided to wait out the war in a bunker, cowering in fear but others went to work, baked bread and went about their businesses.  The Allies won the war because we did not destroy our economy cowering in the corner at the point of a federal or state government gun.

Every time you claim some firm or operation or job is not "essential" that is someone who you destroy.  You do it on the claim that it will keep others from dying, but that's speculative.  You do not know -- you have a model, and it might be right or it might be wrong.  The facts are that even without an overloaded medical system in the US today the data is that roughly 9 out of 10 people who wind up on a vent with this virus die anyway.  That's the maximum size of the group you can save; everyone else has their path through this virus determined; if they're going to be ok, then they will, and if they would die on a vent they will still die without a vent.

Nothing changes for all but that tiny group of people.

Further, even if the system overloads and triage is appropriate or even necessary those who decide to operate their factory or go about their day knowing that a bomber might appear or a V2 might fall on their head made the decision.

They acted as adults, which is their right in any free society.

We no longer live in a free society.

Maybe you think that's worth it, but how many people will commit suicide?  How many people will decide to drug or drink themselves to death?  How many old people who are cooped up in the last year of their life die anyway without the social interaction and enjoyment of their friends?  Death comes to us all and why is it my right to tell you as an older person that you must live with no visitors for your last two months in a nursing home because everyone is barred from coming to see you?  What if you would choose to take the risk and enjoy time with your family members?

WHAT GIVES YOU THE RIGHT TO FORCE A SENIOR INTO ISOLATION AGAINST THEIR WILL?

Is this a free nation or a National Gulag?

THAT is what nobody is taking into account.

And, of course, we have Sweden.  A nation that has looked at the very same data and the same experts our government has and refused to lock down and has told their citizens that they are adults and are expected to act like one.  If they turn out to be right and we are wrong then whether this is a nation and people that deserves any respect, down to a single person, depends on whether one of the people involved in these decisions retains their jobs, their homes, their pensions, their jobs, even their underwear.

It will not be long before we know whether this was justified -- or whether Sweden was right and we were wrong.

It's simple folks.

If you want the whole story and why it has to be true then listen to the postcast.

It'll be up shortly.

Simply put, it's this -- R0 is likely around 3.0  We're intentionally undersampling, plus test error, so the original estimates around 3.0 look good.  Outside edge on that is likely 2.5 +/- 0.1

Social distancing and lockdowns have only reduced it by approximately 0.5 and even with the extremely aggressive "shelter in place" orders we're only getting another tenth -- that is, 0.6.  That's within the margin of error, so the difference between "shelter in place" and "slam closed all restaurants, bars, groups larger than 50, 10, 2 or whatever" is only 0.1 which is a statistical ZERO.

A reminder: It has to go below 1.0 to stop the spread.  It has to go below 1.3 or thereabouts to spread no more nastily than the seasonal flu.

Where's the rest coming from?

We've cut social interaction by 90%+ for nearly everyone in the country.

But we've increased the concentration of people with it (as the cases have gone up) in hospitals and that has to be where the spread into and through the community is coming from.

We know that's happening in nursing homes and such but it's happening in every hospital too and has been since this started.

THE PROTOCOL HAS TO CHANGE IN HOSPITALS EVERYWHERE AND ANYWHERE IN THE US RIGHT NOW TO THIS:

WASH YOUR FUCKING HANDS.

WASH THEM BEFORE AND AFTER EACH CONTACT WITH ANY SURFACE OR PERSON.

WITHOUT EXCEPTION, EVERY TIME, PERIOD.

NOT HAND SANITIZER, SOAP AND WATER.

EVERY TIME.

BEFORE AND AFTER.

ENFORCE THIS PROTOCOL LIKE DAMNED NAZIS AND ANYONE WHO BREAKS IT, EVEN ONCE, IS OUT, IS FIRED AND CANNOT RETURN.  PERIOD. I DON'T CARE WHO THEY ARE; NOTHING LESS THAN 100% COMPLIANCE IS ACCEPTABLE.  RIGHT NOW.

NO, GLOVES DO NOT CHANGE THIS.  NOR DO MASKS.

DOCTORS, NURSES, ORDERLIES AND OTHER WORKERS ARE TRANSPORTING THE VIRUS OUT OF THE HOSPITALS AND ONTO SURFACES AND PERSONS IN THE GENERAL POPULATION. 

THEY ARE THE VECTOR. THEY HAVE TO BE BECAUSE WE'VE SHUT DOWN VIRTUALLY EVERY OTHER POTENTIAL SOCIAL SOURCE OF CONTACT AND TRANSMISSION AND YET ALL WE GOT OUT OF IT IS AN 0.5 CHANGE IN R0.

IT CAN'T BE MOSQUITOES OR OTHER INSECTS, NOR OTHER VERMIN BECAUSE THE DENSITY OF THOSE FACTORS VARIES FROM PLACE TO PLACE AND YET NYC .VS. THE REST OF THE COUNTRY ONLY HAS A 0.1-0.2 DIFFERENCE IN MEASURED R0.

IT'S PEOPLE, AND THE ONLY PEOPLE WHO ARE INTERACTING WITH THE REST OF THE POPULATION RIGHT NOW THROUGH THEIR CONTACT WITH THE SURFACES WE ALL HAVE CONTACT WITH AND WHO ARE WHERE THE VIRUS IS CONCENTRATED ARE THOSE WHO WORK IN THE HOSPITALS.

AND BY THE WAY, THIS ALSO PROVES IT'S NOT PRIMARILY BEING TRANSMITTED IN VAPOR AND AEROSOLS FROM YOUR MOUTH.  IF IT WAS THEN "SOCIAL DISTANCING" WOULD HAVE SLASHED R0 BY WELL MORE THAN HALF.

IT DIDN'T.

THE VIRUS IS, TO A LARGE DEGREE, BEING SHED AND TRANSFERRED OUT YOUR ASS.

I hate it when I'm right.

Here's a Youtube from a doctor documenting what I suspected when it comes to actual transmission of this thing.

In other words it's nearly all shit-eating.

What was the protocol for presumptive interpersonal spread in a clinical setting where no physical contact had occurred?

30 minutes around said presumptive or actual positive person with no PPE.

How many times was this wrong?  Effectively zero.

So it's easy to spread interpersonally through aerosol, which is the entire argument for "social distancing"?  Bullfuckingshit!

So how is this thing being spread again?

What did Diamond Princess teach us?

What did I say when this started back in late January?

The same damn thing.

Of course nobody listened to that then and doesn't now.  "Social distancing" does nothing because almost none of the spread happens that way.  How's it spread nearly all of the time?

Shit-eating.

Wash your hands, you don't eat the shit and you don't get it.

Lock down the entire fucking country over this when it turns out the spreading is happening in the goddamned hospitals because the people there don't wash their fucking hands before and after each patient?  Then said person goes home to their family, spreads the shit and..... whoops!

Or, they get on the train, spread the shit and..... whoops!

Where do all the people with it concentrate?  In the fucking hospital!

And they didn't spread it by breathing -- they're spreading it with their hands.

They're shit-eating, to be blunt.

Oh by the way, NYC?  Full of shit-eating immigrants; people who were never incultated to even the routine washing of hands after using the bathroom!  Washington and CA?  Same deal.  Gee, sanctuary city politics anyone?

One of those people gets on a subway, now the railing on the escalator is contaminated and so is the train.  Someone else touches it and eats shit.

Political correctness, illegal invaders, third-world "imported asylees" and similar and hospital workers are the ones causing these hotspots.  Anyone wanna bet on the demographics of the nursing home workers at Kirkland?

Then there's more.

NY, of course, "shut down their economy."  I said that was stupid and they'd never figure out all the interconnections.  Well, that flying dickhead Cuomo can't even figure out the obvious ones.

No funerals.  They're unnecessary and promote social gathering, right?

Guess what?  The goddamned morgue is now nearly full!  Why that's an emergency for DHS even though that dickhead Cuomo directly caused it by shutting down funerals!  DHS ought to tell him to shove the dead bodies up his ass until he can taste them.

Naw, it'll all be good if we shut down the economy.  We can do this.  We can manage to figure out all the essential connections and we've exempted them.  It'll all be ok.

At least this one only hoses people who are already dead.

Wait until the next one where it turns live people into dead ones.

The shutdowns are madness and must be immediately reversed.

Cuomo says "we haven't flattened the curve."

That's because your city is full of imported shit-eaters and you have spent the last decade and more telling us that we must accept this, we must import more of them, we must keep doing it and it's all ok.

Nope.

Now you're eating the shit, literally.

"Social distancing" is not the answer nor are "lockdowns" because you can't enforce them, you can't support them as the infrastructure to do so doesn't exist in the US, you wouldn't get rid of the high-spread people before this happened, now its too late and you also can't maintain a lockdown, even if you're willing to go around shooting people who refuse to comply for the amount of time required without the health system collapsing due to lack of government revenue.

Isolating high risk people and offering them, at their own risk and choice, prophylaxis that may not be proved but is worth trying can at least blunt some of the impact.  It won't eliminate all of it.  You wrote the check in those areas of the country and now it's getting cashed.

Quarantining people who test positive and attempting to trace their contacts (and then testing those individuals) can be somewhat effective.  It's also sound public policy.  But that, for the most part, isn't being done and even that is not completely effective because this virus sheds before you become symptomatic.

The wages of bad public policy, "open borders", refusal to cooperate with removing illegal invaders, refusing to insist that employers actually verify every single employee and more is now coming back to bite all of these places hard.

No, NY is not what is coming everywhere else.  But it probably is what is coming to similar cities, towns and areas that also have a large number of shit-eaters and it is not the responsibility of those of us who did not countenance such policies and in fact advocate for them to bail your ass out when you freely made the choice and ignored those of us who said this was stupid and nothing more than an attempt to find ways to exploit people who would work without tax payments or benefits -- in other words, to suppress the employment of Americans and the money they earn.

AOC and her "squad" are in the middle of this and it's not a coincidence that AOC lives in NY!

Nor is it a coincidence that shit-eater advocate Nancy Pelosi and Diane FeinSWINE are from California.

Nor is it a coincidence that Inslee presides over yet another state with such "sanctuary" policies.

Nor is it a coincidence that Shitcago is going to be involved too -- and in fact already is and is perpetrating it by refusing to test.  I have inside baseball on it, and that's what they're doing to intentionally understate a problem they caused.

None of these are coincidences.  They're causal factors for the mess you now find yourselves in.

The fact of the matter is that public policies matter and quite frequently the stupidity you embrace has a lag time before you get fucked by it whether personal or throughout society.

If you believe "healthy at any size", a factual lie, and trust in medicine to give you a pill when you're fat, unable to climb 10 flights of stairs because your pulmonary capacity is fucked, you have high blood pressure and are diabetic, and thus pop pills to "control" this one of which is suspected to greatly increase mortality when you get this virus when the bug comes around it's too fucking late to change your mind.

You were wrong.  

You are NOT healthy at any size. 

Instead of a 0.05% risk of death from this virus your risk of death is one hundred times higher!

That's what the data out of Italy tells us.

0.5% of those who have died in Italy had none of cardiovascular disease, high blood pressure or diabetes.  Italy's death rate is quite high; last time I looked about 7% and change.  That sounds awful.

But if you do not have any of those co-morbidity factors your risk of death is not 7% it's 0.05%!  You can nearly count those deaths on your fingers and toes!

Not all of these factors are under your control.  Some people get high blood pressure, cardiovascular disease or diabetes without lifestyle choices.  But in nearly all cases these diseases are due to choices you make over a period of decades.  Not always, but most of the time.

Yet we hear how "this is all a personal choice and not anyone else's business."

Ok that's fine with me -- if this is your personal choice and not anyone else's business then it's not my responsibility when you get sick and die as a result of it and we must NOT destroy the economy because of the consequences stemming from your personal choices.

The facts are that the average age of someone in Italy who has died is something like 81.  This equals or exceeds the life expectancy for both men and women.  While that really sucks we all die of something and as we get older and more-frail the odds that something a younger person will not be terribly troubled by will kill us goes up.

We can dramatically increase that risk by doing things that are stupid and advocating that this is not only a civil right but that you're "healthy at any size" while making those demonstrably stupid decisions is criminally insane.

I have a "near son" (no actual blood or adoption relation, but we're very close) who's grandfather just passed.  The test came back this morning; positive for Covid.  That sucks.  I knew him and he was a great guy.  But he was also very old, well past the average expected age of death for a man born when he was, quite frail medically and his frailty wasn't due to doing stupid things -- it was due to simple good luck and nothing previously getting him.  This time he lost the bet and that blows but eventually something was going to get him.  It's inevitable.

If the government had, instead of demanding we all "social distance" at gunpoint by closing bars, restaurants and other events told him and his wife to stay the fuck away from everyone and have his groceries delivered with nobody coming or going from his house he might not have caught the bug. At least for now.  I don't know if he could have taken a prophylaxis with the anti-malarial or not; I don't know what sort of underlying conditions he had, or what medications he was using.  But if we had done that he might still be alive.

Instead of telling him a month ago to lock his ass in his house with his wife and do not open the goddamn door we tried to "lock down" the entire fucking nation and play "social distancing."  That strategy, which was not targeted at those especially at risk, failed for him.  He's dead.

That's not causative, of course.  He might have died anyway.  At that age it's always a risk.  So far his wife is not sick.  Maybe she actually was the one who got it, got a silent infection and give it to him.  We don't know because there's no antibody surveillance so we have no idea and at this point it doesn't matter, other than that his wife should bolt the door and shoot anyone who tries to come in.  In addition we owe her an antibody test (which we have but refuse to approve) so she knows if she needs to stay bolted in her house and shoot anyone who tries to come in that can't prove they're immune or whether it's safe for her to be out among the rest of us.

The policy of "everyone's welcome" is stupid.  The claim of "healthy at every size" and "pop a pill will fix it" is criminally insane and bankrupt as a matter of public policy.  You never know when a bug like this will come, some of them will be greatly potentiated via the mechanisms of action of various pharmaceuticals whether OTC or otherwise and viruses do not give a crap about your political and social justice bullshit.

This bug is known to spread in feces and personal sanitation protocol is not something you can enforce at gunpoint.  It's a cultural thing and as we are now, sadly, finding out there is a price that said "open borders" leftist screamers are going to inflict on everyone in those jurisdictions, like it or not.

I'm hearing anecdotal reports that material numbers of hospitals are starting to stockpile and use hydroxychloroquine as part of their Covid-19 response protocols.

Now theoretically it is now available on "compassionate use" and "right to try" sort of situations, but that's a one-off and someone has to request it.  These reports imply that these medical facilities either are now or are preparing to go much further than "one-offs" and start to use this as a front-line response to people coming in long before they get to the serious or critical stage, which is where the "right to try" stuff kicks in.

That is very important, because as I've noted once you get to the point where critical support is necessary in a given case the data we have from other places (e.g. Wuhan) says your survival odds are near zero.

This means that attempting to interdict case loads so as to not "overload" ICU and similar is stupid -- while it will feel good, and look good, it won't change outcomes.  If I'm 95% likely to die if I go on a vent with Covid-19 (and that is the data folks!) then whether I have a vent available or not is exactly the wrong place to give a wet crap.

The goal must be to stop that progression.  If you think I've been blowing smoke about this and calling those people arguing for cranking up beds and vent counts criminally insane and nothing more than criminal felons trying to jack up the cost of this thing and make money on people dying that table should shut you up right here and now.

Out of the 61 people who had "assisted breathing" by machine three survived.  That's a 4.9% survival rate.  

In fact free flow oxygen via nasal cannula didn't do well either.  Only one in five persons who had that intervention survived.  The other 80% are dead.

May I remind you that supplemental oxygen via cannula does not require a hospital; we do that all the time for people with COPD and such via either concentrator or bottle at lower levels.  Yet if you get there, 80% of the time you die.

The goal for mitigating death in this disease has to be on preventing compromise of the pulmonary system to the degree that those interventions are necessary.

This is why I've said that all of the focus on "overloads" is simply wrong-headed.  It's not that I don't want "inconvenience" or anything of the sort it is that such interventions do not work.  Nobody can seriously suggest that a path of action that fails 95% of the time is worth screaming about or arguing for irrespective of cost.  Shutting down the economy to accommodate a health system intervention approach that fails 95% of the time is criminally insane.

We must focus on paths of action that have better outcome profiles and the data out of both South Korea and the EU says that there are.

Fortunately it appears that a number of medical facilities have figured this out.  They may not be coming on TV to tell you that, but they have.  They're going after attempting on a front-line basis to attenuate the severity of the attack in individual cases and thus halt the progression to where the hospital itself is necessary.

That, rather than being primarily worried about whether we'll "overload" the hospitals, is the right course of action.

Not because I want people to go back to being able to run their bars and restaurants.

It's because I don't want people to die due to the stupidity of our elected officials.  Simply "accepting" that we must protect the hospital admit rate on the false hope that if there's a bed you'll be fine but if not you die, a premise that countless TV series over the decades have ingrained into the American consciousness (e.g. Marcus Welby, House, etc) is absolutely and completely, in the case of this virus, FALSE.

The only means forward that improves outcomes is to avoid the hospital requirement in the first place.  Dribbling people in to facilities with 95% treatment failure rates just means the same people die of the same thing, but slower.  Avoiding the hospital in the first place means they don't die at all.  We have what appears to be the means to greatly attenuate the need for the hospital in the first place.  While I'm sure that the alternatives are not completely effective almost anything beats that which fails 95% of the time and in terms of all-in costs doing nothing beats 95% failure rates because doing nothing avoids all the collateral damage including all the health care workers who will be sickened or killed by drawing this out for months or years.

Even a 50% failure rate of those alternative paths, which might well happen, radically beats a 95% failure rate.

PS: If you think China has had "zero" new cases and has stopped this in their nation -- that is, if you believe them -- you're nuts.  There is now leaked video coming out of Wuhan showing lines at 6' spacing out the door of their hospitals.  Again folks: China lies and if we allow their lies to dictate our policy and response our people will die too.