Monday, March 23, 2020

UPDATED - Latest Thoughts from @pdxsag on WuFlu

[Our correspondent @pdxsag shares his latest thoughts below. I'm not as optimistic as he is and I'm planning to write up my thoughts separately.]

In the two weeks since my last piece, the WuFlu has hit the United States head-on. I expect the coming week will be the climax of the epidemic as far as the new-case growth rate is concerned. Total cases are a lagging indicator, as are mortality rates.

As for the oft remarked conundrum I believe I've figured out its source.

Among highly rational thinkers the Covid virus, in isolation, would not be a cause for a Societal Reset. Comparing it to recent flu epidemics it's remarkable only for its speed, not its total magnitude. Even a 10% CFR, if it's entirely among the oldest and least healthy population is not an existential threat to the economic health of functional society. The cold, rational fact is that these are not productive members being lost. It is a psychological toll only.

Among highly empathetic thinkers, however, the speed and intensity that makes the Covid virus such a headline grabber means it will elicit a societal response. If the social contract is such that there already exists a state of “frayed nerves” and institutional instability, the societal response will necessarily have significant consequences.

Global economic imbalances today are at such a scale they can no longer be maintained. The Fed Reserve in tandem with the Political Establishment has doubled-down on the status quo in 1994 (Mexican Peso Crisis), 1998 (LTCM Crisis), 2001 (Dot-com equity bubble followed by WTC and Gulf War II), and 2008 (GFC, biggest of them all). They have reached the limit of their Martingale Strategy. A reset is inevitable.

As for the current events, the three states with the most liberal and dysfunctional governments (as measured by budget deficit and pension obligation ratios to GDP), California, Illinois, and New York, were the first under official state-wide quarantine orders by their respective governors.
 
(I'm sure that's only a coincidence. As is the fact each of those three states has the country's largest three metros, and those metros have the largest foreign-born populations. It's just another coincidence. That New York, whose Governor Cuomo was highly critical of President Trump's early travel ban, had their 'patient zero' be a healthcare worker that had been infected on a visit to Iran is another total coincidence. Globalism is not to blame for the unfortunate events, any more than China is to blame. It's all an unavoidable coincidence that could happen to any country. There is no causality here. The most highly credentialed experts in the respective fields of economics and public health have studied it carefully and assured us this is the case. /sarc)

The question at hand with the outbreak raging across the United States is: how bad is this disease really? In one sentence my hypothesis is: SARS-CoV-2 causes metabolic disease to transition from a chronic health condition to an acute one.

The most damning study might be the one from Italy that looked at a random sample of nearly 18% of the death certificates where Covid19 was implicated. Only 0.8% were negative for any other comorbidity. 47% were positive for 3 or more.

It is reminiscent of what low-carb advocates say about diabetes: no carbohydrate overload, no diabetes. Similarly, no metabolic disease, no WuFlu. (Note, I am referring to the illness, distinct from the virus, same as health policy experts refer to AIDS distinctly from HIV.)

A close second is the following morbidity table from Spain. Nearly 19,000 cases are divided into age cohorts. The hospitalization, ICU, and mortality rates for each cohort are computed. While hospitalizations are high to be sure, they grow at a linear rate with each age cohort. In contrast, the mortality rate is nearly flat until turning exponential at the 40-49 year old cohort. (Hockey stick curve, anyone.) I stand by my judgement that reasonably fit people under the age 50 have nothing to worry about, and exceptionally fit people in their 50's and 60's while taking prudent cautions, do not need to self-isolate.

The following is a miscellany of threads I've seen and thought about over the last two weeks:

Corona viruses originate from bats. This is often stated in the media, but never developed. It means corona viruses evolved to be spread under the environmental conditions of bat caves, which is to say aerosolized fecal matter. The ramifications for nursing homes, hospices, and hospitals are profound. (It is no coincidence they are Covid19 hot-spots, and it goes beyond the fact they service those people with the worst health.) As for the home environment, mortality among family clusters is very common. Should one member in the family fall ill you must treat it like you would a norovirus in the home. If you have the ability to segregate bathrooms, do so immediately. Bathroom hygiene is paramount. Toothbrush heads should be kept submerged in a glass or cup of diluted lysol. Towels should be changed frequently, and in the middle of an outbreak removed from the bathroom itself. Hang them up outside the bathroom and change daily. Always close the lid on the toilet before flushing. Clean daily and use a tank disinfectant. (see this and this)

The first statement I recall President Trump having on WuFlu was in late January. He said that by April the weather would be warming up and it would all be fine. Of course he was widely derided for such a flippant statement. Among the complaints the "intellectual yet idiot" class charged was that he had no way of knowing a wholly new virus would exhibit seasonality. While the IYI's are technically correct, there's a multitude of factors that contribute to the phenomenon. With so many factors contributing, it actually makes the effect more robust since the WuFlu virus would have to overcome all of them, rather than just one or two. Among the factors:

  • increased UV intensity kills the virus (it evolved under the conditions found in a bat cave)
  • increased UV exposure increases endogenous vitamin D and nitric oxide (see)
  • April showers clean the air of particulates
  • warmer weather increases humidity which is good for mucus membranes
  • naturally occurring ozone in outdoor air also has anti-viral and anti-microbial properties, milder weather will result in more open windows in their homes bringing in fresh outdoor air (@mangan150)
  • while numerous cases of WuFlu have been reported in tropical and sub-tropical countries, they've all been from infected travelers bring it into the country. There have not been any community-spread clusters in Singapore, India, Thailand, Laos, or Vietnam, all of which (excepting India) are popular Chinese tourist destinations.
  • sauna therapy, of course lacking a sauna, hot and humid summer days will suffice
An anti-malaria treatment was first reported being used to good success in China. It then began making rounds among “autistic-nationalistâ€twitter (high-IQ Trump supporters). It then began getting attacked by progressive-liberal twitter. Finally, it was acknowledged by President Trump both in a press conference, and in a tweet directly putting the FDA on the spot. Whether the hydroxychloroquine and azithromycin combo is as efficacious as the initial study suggested (1), there are doubts (2), or some other off-label, generic combination presents itself, the glacial bureaucrats in the NIH, CDC, and FDA are on notice that the world is watching and suspicious of their gatekeeping. Good times.

There may be a genetic component to Italy's high mortality rate, beyond the age component and the large number of Chinese sweatshops, er... visa holders working there in the garment trade so that designer bags can overcharge for a Made in Italy label (see). The ACE gene allele rs4343 gives an increased risk for hypertension, diabetes, and all the usual metabolic diseases. Italians in Tuscany have a 41% preponderance of haplotype D/D (1). Utah, the proxy for NW Europeans were next highest at 26% for D/D. ACE2 is also a sex-linked gene on the X-chromosome. Much has been made of the male-female disparity. It could well be a function of heterozygosity, such as color-blindness or sickle cell trait, where in females the two X chromosomes give them better fitness against the virus (2). Also apropos, Italy has 4X the seasonal flu deaths as the world-wide per-capita average (3).

I have a real, live, nearly first-hand to my own ears report to share. My wife's friend has a brother that lives in Seattle. The brother was feeling really unwell the week before last (2ndweek of March) and went to the hospital figuring he had a case of WuFlu. The hospital didn't have a WuFlu test at the time, but he tested negative for all the usual suspects, seasonal flu, etc. The hospital told him you probably have coronavirus, go home, don't go anywhere else for two weeks, and don't come back to the hospital unless your condition severely deteriorates. It took him 3 days to recover at home. He ended up also giving it to his wife, but it was not as bad for her as for him. All in all, it was a really bad flu, but... still just the flu. They're in their lower to mid 40's. They are reasonably fit, ie. typical of Seattle and the Pacific NW, but are not athletes or anything of that nature.

Billions in opportunity cost - foregone taxes, lost wages and revenues, unemployment insurance, small business bankruptcies, etc. - are being spent by governors imposing state-wide quarantines, but 1/1000th the amount is not available for random community-wide testing to get a handle on how broad the virus really is. The frightening CFR's (case fatality rates) are based upon a restricted range for the denominator: we are counting only the cases severe enough to present at a hospital, not the 10, 100, 1000, times the number of cases, such as the brother of my wife's friend, that do not get tested. Again, as we've seen in South Korea and the Diamond Princess, asymptomatic cases may be 2 to 10 times the total number of cases. The CFR among the active, work-age population may well be 0.01% instead of 0.1% that it appears to be. A few private individuals have noticed and are responding (Sailer).

Likewise, just as the government was caught flat-footed with regard to testing, they were, and remain flat-footed on masks. There has been a huge disinformation campaign on the efficacy of masks, despite the obvious benefit our lying eyes are seeing in the mask-wearing countries of Japan, S. Korea, and Taiwan. (Sailer) Why has this obvious lie received such little critical push-back?

WuFlu is a political lightning rod on social media. A novel virus is about as close to a real-life case of Reagan's quip about an alien invasion of Earth. Yet, it seems to be having the opposite effect. It's as politicized as a Presidential campaign. For those familiar with Scott Adam's concept of "Two movies, one screen," WuFlu checks all the boxes.

What does it all mean?

First, sadly, the public health threat is real. About 10 million Americans fit the high-risk profile of being severely obese and over 60 years old. The CFR of that cohort is in the 3-6% range. This is not obscure data. It is safe to assume the whisper number in the halls of power is half a million dead Americans by election day.

That is a headline risk politicians cannot abide. They have to respond. Since they are poorly informed and poorly positioned to actually do anything of actual value - the country has been resting on its laurels, patting itself on the back that “we're number one,” putting political considerations at the forefront of every decision and experiencing "cost disease" and functional sclerosis among our public institutions for arguably some 20 to 40 years, that it is as shameful as it is predictable that we would not be able to respond in any effective form or fashion - they fall back to their cognitive biases and notions of justice.

For Democrats in progressive states, it means shared sacrifice, more social safety-net, more Big Government nanny-statism. The politicians that are comfortable micro-managing shopping bags, soft-drinks, and carbon emissions are the politicians that are going to be comfortable ordering everyone off the beach, out of the parks, and sitting at home until further notice, regardless of the cost or efficacy to the threat at hand. Also not to worry, if you are too poor to feed yourself, the government will send paid public servants to bring food to your door.

For Republicans, it's the opposite side of the same coin. Distrust the self-anointed experts. Mock shared sacrifice because for as long as anyone can remember the sacrifices and the shares have gone in exactly one direction. Trust private enterprise to solve every problem that comes your way, while remaining conveniently oblivious to the crony-capitalism that modern private enterprise has devolved into.

However, go down a level and what we are seeing is two sides vying for supremacy in a new social-economic order that is set to unfold. A Societal Reset appears at hand. The events this year, an obvious propaganda campaign taking place on the public psyche evidenced by the "two movies, one screen" in social media, speaks to the battle taking place.

The two sides are Chinese-aligned Globalism versus Independent-Nationalist Free Enterprise.

One one side we see Progressive Democrats and Big Business Republicans using "flatten the curve" as justification for a drawn-out economic depression which necessarily and inevitably increases the power and scope of government. Ironically enough, this is approach is akin to a cytokine storm where the infection does not kill the patient, rather their immune system reaction to the infection kills themselves. If we get an economic depression, it will not be from the virus killing a large segment of our working-age population, it will be from the self-induced quarantines and shelter-in-place orders entirely destroying the service sector in our service-oriented economy.

On the other side we see President Trump seemingly (hopefully?) taking the 1921 approach of a swift and severe recession to clear bad debts (in nominal terms) and give time for the manufacturing sector to repatriate and supply chains to reorganize into more fairly balanced, pro-American terms.

The stakes are incredible and I reckon 98% of the population is oblivious to the real contest taking place.

P.S. I'm going to go out on a limb and suggest Governor Cuomo will replace an incapacitated Joe Biden before or very soon after the conclusion of the Democratic National Convention.

1 comment:

jHurt said...

This was a fantastic read, thank you.