[johnu]

Anti-malarial drug touted by Trump was subject of CIA warning to employees

Quote

The CIA has privately advised its workforce that taking an anti-malarial drug touted by President Trump and some of his supporters as a promising treatment for the novel coronavirus has potentially dangerous side effects, including sudden death.

The warning, featured on a website for CIA employees with questions related to the spread of covid-19, came in late March after public discussion — and promotion by the president — that hydroxychloroquine, administered in concert with the antibiotic azithromycin, might prove effective against the disease.

Quote

Experts have cautioned about side effects, such as heart arrhythmia, which can be fatal.

A recent study in Brazil of chloroquine, which is similar to hydroxychloroquine, was halted early because a number of test subjects developed dangerous heart problems.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, has said the data on hydroxychloroquine’s effectiveness against the virus is “really just at best suggestive.”

[FelicityR]

As we all have, I have had plenty of time to think over this coronavirus pandemic, and whilst many people have, and in some cases surprisingly, shown their altruistic sides, it seems (to me) that the whole world seems so geared to the economy, or perhaps more accurately, an individual country's economy, that beyond the medical and ethical questions raised by this pandemic, we should also be asking why the world cannot work together so that an economy, any economy, is not disadvantaged in any way?

I am truly surprised that both Spain and Italy have effectively fast-forwarded an opening up of restrictions, even in a small way, when there are still people dying, and more importantly perhaps, people still out there who can pass on the virus and cause further deaths. I acknowledge that even if lockdowns were extended further - and even just these three weeks in the UK have been problematic for many, and without any shadow of a doubt we'll be seeing an extension to that this week - there will still be some deaths because until everyone is tested (an impossibility) we will never know who has or hasn't had the virus.

Whilst not welcoming a further lockdown myself, like so many others, surely the priority of any government is to protect its citizens. However does money and resurrecting the economy take preference over people's lives? My father used to say 'money doesn't grow on trees' but billions have seems to be able to generated out of thin air to prop up the economy. People are substantial, tangible, material. That's the difference.

[cherdano]

Felicity - my first reaction about Spain was the same. But then I looked at what exactly they did. It seems really very careful and proportionate. E.g. it seems completely possible to work on a construction project at 80% speed and have essentially no risk of transmission.

If it was just about another month, then sure, why risk anything. But covid-19 won't go away until we have a vaccine produced at scale, which might be 18-24 months. We can't do what we are currently doing for 24 months. So we will have to explore what we can do where the risk is proportionate to the benefit of everyone - in terms of the economy, of everyone's health, and mental health.

[pilowsky]

When you don't know something it is easy to have an opinion about it. Recently I asked a Director "why do I have to announce my 1♣ bid" his response was "because it's in the rules". This person is in charge of training Club Directors in NSW but was unable to give an intelligent answer to a simple question from a Beginner. The same lack of knowledge about medicine and clinical trials seems to be leading people astray here. My very first clinical scientific study was on the topic of neural tube defects - spina bifida and anencephaly - devastating birth defects that used to be extremely common. They are much rarer now because of improvements in antenatal diagnosis and because of a randomised controlled clinical trial (RCT): not that I had much to do with it. Without the statistical methods that underpin RCT many bridge players would not be alive today to be worrying about COVID19. They would be dead from end-organ damage caused by hypertension (heart attack, stroke etc) or they would have died from curable cancers. None of these disease would be treatable without RCT or the preceding trials to establish safety.
Without statistical evidence you know nothing: opinion is completely worthless. Any pharmacologist will tell you that: any drug can be toxic at the wrong dose or in the wrong individual - even water. Opinion based thinking works fine at the bridge table but not when dealing with human lives. You cannot just shuffle the deck and get a new grandmother. It doesn't work like that.

[barmar]

 johnu, on 2020-April-13, 20:23, said:

Anti-malarial drug touted by Trump was subject of CIA warning to employees

Now we have the answer to Trump's "What do you have to lose?" question: your heartbeat.

[pescetom]

Today's statistics in Italy: positive 104291 (+1%), dead 21067 (+3%), no longer infected 37130 (+4%). Intensive care 3186 (-2%). Fatality rate 16.8%.
So more comforting news about diffusion and intensive care, but still 600 reported deaths a day and probably at least another 1000 not reported as Covid.

[Cyberyeti]

"A recent study in Brazil of chloroquine, which is similar to hydroxychloroquine, was halted early because a number of test subjects developed dangerous heart problems."

The reason they were using hydroxychloroquine was that while not quite as effective as chloroquine, it was a fair bit safer (although still not safe).

[y66]

 FelicityR, on 2020-April-14, 01:59, said:

As we all have, I have had plenty of time to think over this coronavirus pandemic, and whilst many people have, and in some cases surprisingly, shown their altruistic sides, it seems (to me) that the whole world seems so geared to the economy, or perhaps more accurately, an individual country's economy, that beyond the medical and ethical questions raised by this pandemic, we should also be asking why the world cannot work together so that an economy, any economy, is not disadvantaged in any way?

In his Reith Lectures (1974), Ralf Dahrendorf talks at length about the problem of organizing ourselves to prepare for the gigantic turbulences ahead.

He begins with this suggestion:

Quote

the alternative to expansion is not stagnation. In fact, the new subject of history is not an alternative in the ordinary sense at all. In its substance, it is neither more of the same thing nor the opposite of it. It is different. The motive force of the political economy of liberty in the 1970s is no longer expansion, but what I shall call improvement, qualitative rather than quantitative development. While the life-chances of men remain the subject-matter of politics and thus of history, their growth must become a question of better rather than more.

and ends with

Quote

One of the urgent needs of contemporary politics is to supplement, and correct, the pragmatism of the operators by awareness of medium-term perspectives. Somebody has to look beyond the rim of the saucer in which most politicians are huddled together, and tell
them what happens beyond their local or even national constituency, their term of elective office, their necessarily—and at times unnecessarily—restricted horizon.

Quote

Boredom with international affairs is, in effect, boredom with survival, and men may, unfortunately, die because they were too bored to bother about their lives. Let us, by all means, make international organisations more responsible, more answerable, to elected bodies of whatever kind. Let us make sure, also, that the solution of problems is not left to the idiosyncrasies of personal diplomacy, but embodied in general rules. Let us realise that, in this field, we do not start from scratch, but have the experience of remarkable achievements by many organisations to use. But unless we do all this soon, we shall find ourselves in a war of all against all, in which nobody can win, and in which those will be the first to lose who continue to indulge in the luxury of sweet dreams about sovereignty and autarchy.

Quote

Many of the steps in the right direction which I have proposed in this lecture are political steps. They have to be taken by governments, by those who elect them or by those with whom they share their sovereign power. This may sound promising, but the sound is deceptive. Paradoxically, the demand for political action grows as modern societies become more ungovernable, because power has slipped away from governments, let alone parliaments. The most important step in the direction of a viable liberal order today may therefore be the restoration of governability by the creation of a new political public. This involves several things. Parliament first, which is going to maintain its pivotal position, and to which all other developments must be geared. Then there is the immediate representation of the general public, by political organisations, possibly, by referenda or direct elections of officeholders perhaps, but, above all, by the media. Every time a broadcaster is fired because the governing body is displeased with his views, or a journalist is prevented from writing because he refuses to join a union, liberty has lost a battle. Every time a newspaper is forced to close down, or a broadcasting station is placed under government tutelage, liberty has lost a campaign. A media policy—that is, the establishment of legal rules and economic mechanisms to maintain a pluralist structure of published opinion—is not a notion which John Stuart Mill would have entertained gladly, but it is one which is necessary today in the light of his own concerns.

But the creation of a general public involves on thing above all, and that is the recognition of organisation. Confrontation with the mighty organisations of the day, whether they are intra- or international, is bound to lead to the defeat of national governments and parliaments. People are, in fact, both citizens, individual voters, and members, a part of larger organisations. However distasteful the idea may seem to the classical liberal, we need a second level of organised interest, which is both independent from, and related to, parliament. In this body, the social contract might find its organised expression; an Economic and Social Council, perhaps, which brings organisations into a structure of general responsibility and makes it, therefore, impossible to ignore them, and unnecessary to fight them. To be governable we have to organise organisation, as well as give the individual his chance.

The first test of our ability to cope will come soon, probably in the two years immediately ahead. The advanced societies, and especially the more liberal ones, are passing through a gigantic turbulence. It differs in impact on different countries, but everywhere it is a combination of factors. Prima facie, the turbulence is economic, that mixture of unfounded growth expectations called inflation, a changing international balance of power, and a general slump in activity. In the first place, the solutions will have to be economic, too: a comprehensive social contract committing all partners to a period of standstill, if not some cutback; international arrangements which re-establish stable expectations at a cost to national sovereignty. But let us not be misled into believing that we can afford to tackle this vast set of problems by itself, and ignore the purposes for which we seek more tranquil economic waters. Coping with the immediate issues is a necessary condition of survival, but no guarantee of survival in liberty; solving the economic problems ahead is a prerequisite -of justice, but in order to give it a liberal meaning we have to be sure not only that we solve them but how we solve them.

It is conceivable that the turbulence ahead will overtax the nerves of the crew, or the resilience of the equipment and that the ship in which we are travelling will break up and go down. Inability to cope in the years ahead means wars and mass starvation, the death of millions of people and the impoverishment of many more. There are those, already, who advise us to change our course by 180 degrees and try to escape the turbulence by a return to more familiar waters. They forget that it was the course set in these familiar waters which got us where we are today, quite apart from the fact that those waters, while familiar, were by no means undisturbed. If we try to return to allegedly good old values, and begin to abandon the social achievements of the last decades, full employment and educational opportunities, pensions and medical care and the rest, we shall have to start afresh in the early 1930s; and there are many who remember the horrible risks which that involves. It is more than likely that a number of people will get hurt before we leave the turbulence. But we can get through, and it is worth trying. The other aspect of our current problems is the enormous potential of human life- chances which the advanced societies have developed, and the opportunities, therefore, of a brighter future in the direction of which our halting steps of today and tomorrow lead us.

What matters most in this world is liberty: that is, human life-chances. They are threatened today by the consequences of our own actions; they are also capable of great new development. To meet the threat, and to realise the potential, we do not need a doctrine of salvation. We have the weapons we need: our minds. Reasoned analysis, imaginative designing, and an experimental approach to action, form a rational, or, at any rate, reasonable, triptych which has served men well. This is the method of liberty. Its substance is defined by the new conditions in which we live today. The new liberty means that we have to change our attitudes in order to pass through the turbulence ahead in a manner which enhances human life-chances. This is what I mean when I say that the subject of history is changing; and the change in approach is reflected in the words which we use—new words: improvement instead of expansion, good husbandry instead of affluence, human activity instead of work, and, of course, one word which is quite old, liberty.

[y66]

What reopening might look like on the west coast of the US:

Quote

On April 13, Oregon Gov. Kate Brown joined her counterparts in Washington and California to form a West Coast pact in which they agreed to cooperate on how to rescind their states' stay-home orders.

Their announcement came after President Donald Trump falsely claimed he had "total authority" to end such orders—even after he left it to the states to halt the spread of the virus. And it was a striking rebuke to the failed federal response.

Each state is still developing its own plan for easing the restrictions that have sent residents indoors. Brown went before cameras April 14 with few specifics—but offered a broad framework for understanding how she'll decide when to reopen Oregon. Her conditions include adequate protective gear for medical providers, a decline in COVID-19 cases, adequate testing (around 15,000 tests a week), and an effective system for tracing cases and isolating people when cases are identified. (She added that restrictions may be lifted earlier in parts of the state that are less impacted by the virus.)

Want more details? So did we.

With Brown hinting that Oregon may look to our larger neighbor to the south for guidance, WW flipped over to the April 14 announcement by California Gov. Gavin Newsom about how he'll open his state.

He offered a similar framework to Brown's—but with the added criteria that the state's health and tech institutions must develop therapies to address the virus. He also offered vivid specifics about what life in the near future will look like.

Here are five things Oregonians may need to know about Newsom's outlook for his "nation-state," as he calls California, as orders for social distancing are lifted.

"Normal it will not be," Newsom cautioned, "at least until we have herd immunity or a vaccine."

Time frame: Wait two weeks. At that time, Newsom expects to be able to announce a larger timeline, if hospitalizations and use of intensive care beds are down.

Masks are here to stay. "Face coverings are likely to be common in public," the California public health PowerPoint presentation stated.

Going to restaurants will be different. "You may be having dinner with a waiter wearing gloves, maybe a face mask," Newsom said. "Dinner where the menu is disposable, where half the tables in that restaurant no longer appear, where your temperature is checked before walking in. These are likely scenarios."

Schools may look different too, with the possibility of fewer students in a building at a time. "Can you stagger the times our students come in?" Newsom asked. He said that's a question he and other officials are asking, along with figuring out how to handle PE, recess and lunch in ways that keep kids apart.

Big events like conventions, graduations and concerts may not return for at least a year. "The prospects of mass gatherings are negligible at best until we get to herd immunity," Newsom said—meaning such gatherings aren't going to happen until half the people in the state have had the virus or a vaccine has been developed, which isn't expected for more than a year.

Source: Rachel Monahan at Willamette Week

[y66]

Hannah Kuchler at FT:

Quote

The Gates Foundation is more than doubling its donation to the fight against the coronavirus pandemic, making new grants of $150m to partners to create vaccines, drugs and diagnostics and to help countries in south Asia and Africa cope with the crisis. 

The philanthropic organisation also called for more global co-operation after US President Donald Trump on Tuesday said he would suspend payments to the WHO temporarily. 

Mark Suzman, chief executive of the Bill & Melinda Gates Foundation, said it opposes the US decision to suspend funding to the World Health Organization. If the US withdraws permanently, the Gates Foundation would be the largest donor to the body charged with co-ordinating global action against the pandemic. 

“In the worst global crisis of our lifetime, we need a strong and fully funded WHO. The United States has traditionally played a strong leadership and supportive role in that and we certainly believe that it should and needs to continue,” Mr Suzman said. “We would strongly oppose any efforts to withhold funding from the World Health Organization.”

The Gates Foundation’s latest commitment brings its total contribution up to $255m, which will be split between funding the development of vaccines, diagnostics and treatments. 

European allies and the leadership of the WHO have condemned Mr Trump’s decision to suspend hundreds of millions of dollars in funding while the US conducts a review to assess the organisation’s “role in severely mismanaging and covering up the spread of the coronavirus”.

Mr Suzman said philanthropy cannot be used to supplant contributions from the public and private sectors. He called on companies and governments across the world to co-operate more, including funding organisations such as the Coalition for Epidemic Preparedness Innovations, a group funded by governments and non-governmental organisations launched at the World Economic Forum in Davos in 2017, which has yet to meet its funding target for the development of vaccines. 

“Even though it’s appropriate for governments to look after their own citizens, we all need to look at the global level,” he said. “We need to come together to address this crisis.” 

The Gates Foundation already teamed up with the Wellcome Trust, a UK-based medical research charity, and the payments company Mastercard to establish the Covid-19 therapeutics accelerator, to hunt for drugs to treat the disease.

Even before the crisis, the foundation supported biotech companies developing platforms for creating vaccines more quickly, including German start-up CureVac and Boston-based Moderna, which are now working on vaccines for Covid-19. The foundation now wants governments to pool resources to create manufacturing facilities ready to help scale up any successful vaccine.

As well as direct donations, the Gates Foundation is using some of its $2.5bn strategic investment fund to take equity in companies, give loans and establish contracts committing to purchasing certain volumes of products for manufacturers. These could help low and middle-income countries get access to essential supplies such as personal protective equipment and ventilators. 

“There are hospitals in New York that have more ventilators than some African countries,” Mr Suzman said. 

Cooperation is hard.

[pescetom]

Today's statistics in Italy: positive 106607 (+2%), dead 22170 (+5%), no longer infected 40164 (+8%). Intensive care 2936 (-9%). Fatality rate 17.2%.
So back to over 1100 dead per day, but the number in intensive care is still dropping at a good rate.

[shyams]

I fear the UK is not doing well as per published statistics.

* Number of cases are still growing at a rate of 5%-6%. This is despite a total lockdown that has lasted longer than the incubation period for the virus!
* Number of deaths (in the hospitals) is still around 750-950 per day. And as we recently discovered, the death figures do not include those dying in old age homes who were never moved to hospitals.
* The administration is already falling short of committed tests and committed PPE supplies to hospitals and care homes. It appears that a large number of nurses/doctors/care home workers are catching the infection and some of them are sadly dying.

This is tragic mismanagement by the bureaucracy.

[Cyberyeti]

 shyams, on 2020-April-16, 14:54, said:

I fear the UK is not doing well as per published statistics.

* Number of cases are still growing at a rate of 5%-6%. This is despite a total lockdown that has lasted longer than the incubation period for the virus!
* Number of deaths (in the hospitals) is still around 750-950 per day. And as we recently discovered, the death figures do not include those dying in old age homes who were never moved to hospitals.
* The administration is already falling short of committed tests and committed PPE supplies to hospitals and care homes. It appears that a large number of nurses/doctors/care home workers are catching the infection and some of them are sadly dying.

This is tragic mismanagement by the bureaucracy.

It depends which statistics you look at. The death rate is of course MUCH lower than that calculated, because there are very few tests, so a lot of people are positive but untested. Overall there are more deaths than shown in the figures, but I believe these are all deaths where the patient has coronavirus in hospital, so if you come in following a heart attack or stroke, have confirmed coronavirus and die of the original ailment, this is counted. A figure was bandied about that 90% of deaths were of people with underlying conditions but I'm not sure where it came from.

A more real overall death figure does exist but is published once a week and lags a week or so behind because it takes time to calculate.

Because the virus takes about 3 weeks to kill somebody, we should only now start to see the effects of the lockdown.

[cherdano]

 shyams, on 2020-April-16, 14:54, said:

* Number of cases are still growing at a rate of 5%-6%. This is despite a total lockdown that has lasted longer than the incubation period for the virus!

One reason the effect of the lockdown on the growth rate takes longer than the incubation period is transmission within the household. So I hope the number of new cases will keep going down, though I am not sure how much below 1 our R0 is.

[shyams]

 Cyberyeti, on 2020-April-16, 15:47, said:

It depends which statistics you look at. The death rate is of course MUCH lower than that calculated, because there are very few tests, so a lot of people are positive but untested. Overall there are more deaths than shown in the figures, but I believe these are all deaths where the patient has coronavirus in hospital, so if you come in following a heart attack or stroke, have confirmed coronavirus and die of the original ailment, this is counted. A figure was bandied about that 90% of deaths were of people with underlying conditions but I'm not sure where it came from.

A more real overall death figure does exist but is published once a week and lags a week or so behind because it takes time to calculate.

Because the virus takes about 3 weeks to kill somebody, we should only now start to see the effects of the lockdown.

My point was not about death rates (i.e. % of some denominator) but about the absolute numbers of deaths from coronavirus.

The reason for my assertion is that the Govt. had previously said something like "we would have done a good job if the epidemic results in 20k deaths". We are at 13,729 (hospital) Covid deaths and are reporting some 700-900 per day. At this rate, we will cross 20k within a week! I do realise that models tend to specify range of outcomes and that holding the Govt. to account on one fixed number is not exactly fair. However, they quoted the number; and it is acceptable to criticise the Govt. for doing much worse.

Note, as per ONS (link), "the provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average". The absolute numbers have risen by 6k per week from mid-March onward.

[Winstonm]

The Atlantic is one of the more reliable information sources in the U.S. media, and they have removed their paywall for coronavirus coverage so their latest article is available and important:

Quote

Because the number of Americans tested for COVID-19 has changed over time, the U.S. test-positivity rate can’t yet provide much detailed information about the contagiousness or fatality rate of the disease. But the statistic can still give a rough sense of how bad a particular outbreak is by distinguishing between places undergoing very different sizes of epidemics, Andrews said. A country with a 25 percent positivity rate and one with a 2 percent positivity rate are facing “vastly different epidemics,” he said, and the 2 percent country is better off.

In that light, America’s 20 percent positivity rate is disquieting. The U.S. did almost 25 times as many tests on April 15 as on March 15, yet both the daily positive rate and the overall positive rate went up in that month. If the U.S. were a jar of 330 million jelly beans, then over the course of the outbreak, the health-care system has reached in with a bigger and bigger scoop. But every day, 20 percent of the beans it pulls out are positive for COVID-19. If the outbreak were indeed under control, then we would expect more testing—that is, a larger scoop—to yield a smaller and smaller proportion of positives. So far, that hasn’t happened.

[helene_t]

 Winstonm, on 2020-April-16, 21:51, said:

The Atlantic is one of the more reliable information sources in the U.S. media, and they have removed their paywall for coronavirus coverage so their latest article is available and important:

20% positive rate? Yesterday New Zealand tested more than 2000 people. Two were positive. So <0.1%.

But of course you will get a higher rate if the testing is targeted (people with symptoms who have had contact with a known case) than if it's a lottery (people who have money // can afford to be quarantined // live in an area that hasn't run out of swaps).

[johnu]

 helene_t, on 2020-April-16, 22:29, said:

20% positive rate? Yesterday New Zealand tested more than 2000 people. Two were positive. So <0.1%.

But of course you will get a higher rate if the testing is targeted (people with symptoms who have had contact with a known case) than if it's a lottery (people who have money // can afford to be quarantined // live in an area that hasn't run out of swaps).

In almost all areas of the US, you usually only get a COVID-19 test if you are sick enough to go to hospital and actually get admitted as a patient. Otherwise, hospitals tell you to go home and self isolate. There have been a few popup drive through testing clinics, and a few popup walk in test clinics but they are few and far between. And of course, high ranking members of the government can get tested, no questions asked.

Testing in the US has flattened in the past week or so (wrong curve being flattened ) due to shortages of test kits, test swabs, reagents, so as more testing is required, the US is testing less.

Also, we don't in general do contact testing because we don't have the tests available unless the contact is sick enough to go to the hospital. Fortunately the US has the greatest and most beautiful health care system in the world or we would be in real trouble. MAGA

[o__nikos]

I am new in the discussion. Do you know if the attached page from the Chinese author Cixin Liu book "The Dark Forest" (edited 2008) has anything related to Coronavirus? Is it a coincidence?

[Cyberyeti]

 shyams, on 2020-April-16, 18:16, said:

My point was not about death rates (i.e. % of some denominator) but about the absolute numbers of deaths from coronavirus.

The reason for my assertion is that the Govt. had previously said something like "we would have done a good job if the epidemic results in 20k deaths". We are at 13,729 (hospital) Covid deaths and are reporting some 700-900 per day. At this rate, we will cross 20k within a week! I do realise that models tend to specify range of outcomes and that holding the Govt. to account on one fixed number is not exactly fair. However, they quoted the number; and it is acceptable to criticise the Govt. for doing much worse.

Note, as per ONS (link), "the provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average". The absolute numbers have risen by 6k per week from mid-March onward.

I'd be interested what death figure they would consider for them to have done a decent job rather than a good one, but I'm sure they won't publish that.

Also you will need to look at the post virus death numbers for a couple of years, it may well be that a good proportion of the excess deaths are people who would have died in the next 3-6 months anyway, in which case that should be visible in the figures.