Covid19mathblog.com

Big news Pfizer vaccine supposedly 90% effective – https://www.independent.co.uk/news/health/coronavirus-vaccine-covid-pfizer-trial-b1719607.html

“Pfizer and BioNTech have said that their coronavirus vaccine may be more than 90 per cent effective, after the two pharmaceutical firms released interim data from their ongoing large-scale trial.

Preliminary analysis, conducted by an independent data monitoring board, looked at 94 infections recorded so far in the vaccine’s phase 3 study, which has enrolled nearly 44,000 people in the US and five other countries.

Of those participants who were infected with Covid-19, it is currently unclear how many had received the vaccine versus those who had been given a placebo. The current efficacy rate, which is much better than most experts expected, implies that no more than eight volunteers will have been inoculated.”

China has tested a lot more than Pfizer (350K vs 44K)– so somewhat surprised they haven’t made more headlines – noted https://covid19mathblog.com/2020/10/covid-10-30-20/ . Going with the math 90% of death are 55 and older – then those dying have more than 1 comorbidity – so if we take care of those than 90% of 90% will be eliminated ….Therefore need 45 million vaccine dosage assuming ~half of 55+ have multiple comorbidity. Vaccine should be distributed to those who are 55 and older with more than 1 comorbidity first then progress forward. Healthcare and nursing home workers should probably also be included.

On not good news – as noted Europe are seeing real issues with deaths rising not just confirmation. Even Germany who has implemented ventilation programs is seeing concerns – https://www.bloomberg.com/news/articles/2020-11-09/germany-s-severe-covid-19-cases-hit-peak-as-pandemic-intensifies

“Germany has more severe Covid-19 patients than at any point since the pandemic began, underscoring the urgency facing authorities to contain the disease.”

“Merkel’s government imposed a month-long, partial lockdown on Nov. 2 to stem the spread of the virus. The restrictions are designed to limit social contact by closing bars and restaurants, while keeping most businesses operating.

Cases have exceeded levels during the initial wave for weeks, and hospitals are now rapidly filling. At the beginning of October, there were less than 400 Covid-19 cases in German ICUs.

Including other patients, 71% of intensive-care capacity is currently occupied. While Germany has a reserve of about 12,500 beds, including a field hospital at Berlin’s convention center, officials have warned that the country would soon run into a shortage of medical personnel if trends continue.”

Unlike the US they are public healthcare so there is no bias to fill beds or increase occupancy. Also the death data is much harder to fake. This is a real issue.

Nursing home issues in the US continue – why not quarantined? Employees working at multiple homes should be tested akin to sports players? Another nursing home study – https://apnews.com/article/596ef4bfe18313ae72368e2c86e85f27

“An analysis of federal data from 20 states for The Associated Press finds that new weekly cases among residents rose nearly four-fold from the end of May to late October, from 1,083 to 4,274. Resident deaths more than doubled, from 318 a week to 699, according to the study by University of Chicago health researchers Rebecca Gorges and Tamara Konetzka.”

“The administration has allocated $5 billion to nursing homes, shipped nearly 14,000 fast-test machines with a goal of supplying every facility and tried to shore up stocks of protective equipment. But the data call into question the broader White House game plan, one that pushes states to reopen while maintaining that vulnerable people can be cocooned, even if the virus rebounds around them.”

““Trying to protect nursing home residents without controlling community spread is a losing battle,” said Konetzka, a nationally recognized expert on long-term care. “Someone has to care for vulnerable nursing home residents, and those caregivers move in and out of the nursing home daily, providing an easy pathway for the virus to enter.””

“Nursing homes and other long-term care facilities account for about 1% of the U.S. population, but represent 40% of COVID-19 deaths, according to the COVID Tracking Project.”

““Many times, the likely causes of nursing home outbreaks are simply nursing homes failing to comply with basic infection control rules,” the statement said.”

“Walkingstick said he believes the U.S. has gotten better at saving the lives of COVID-19 patients, but not at keeping the virus out of nursing homes.”

I certainly don’t agree with Dr. Konetzka conclusion to push the community spread over just fixing the way nursing homes are managed – this is an easy cop out for the nursing home. IF the NBA can isolate – nursing homes should do it – and we should be willing to pay for it if need be. Govt just doled out $5Billion for nursing home test – how much is staff paid? 100K a year? That’s 50,000 staff paid for a year? Have staff live there on a 2 week in 2 week out? Testing on transition? Adapt all the HVAC units at the nursing home to bring in fresh air.

NYC ventilating schools – https://champ.gothamist.com/champ/gothamist/news/nycs-pandemic-ventilation-plan-winter-public-schools-involves-space-heaters-air-purifiers-and-lots-layers

“Following complaints from NYC public school teachers about uncomfortably chilly temperatures in some classrooms, the city Department of Education has put forth a plan intended to keep classrooms warm even when windows must remain open to slow the spread of COVID-19. The plan will include air purifiers, space heaters, and filters to ensure proper airflow, in addition to keeping windows open in rooms with poor ventilation.

The approach will vary depending on the needs of each school, according to a three-page memo drafted by the DOE and obtained by Gothamist. The plan states that 13,700 more MERV-13 filters will be ordered and installed in school HVAC systems to help keep the virus out of the air in classrooms. These filters — adding to an already existing supply — are ordered in accordance with guidelines set forth by the Centers for Disease Control and Prevention, which recommends high-quality filters to combat COVID-19.”

“The memo also recommended windows continue to stay open for ventilation, in accordance with CDC guidelines. In warmer climates, the practice of keeping windows open to reduce the risk of COVID’s spread year-round would work. But in New York City — the only major city in the country to have offered blended learning — keeping windows open is unsustainable even if the heat is on, according to teachers who have already felt the brunt of this method.”

“Before schools reopened, the DOE dispatched School Ventilation Action Teams to assess whether the city’s 56,000 classrooms could be safely occupied. Roughly 95% of the classrooms were approved for occupancy following a CDC-recommended tissue test to assess airflow. Classrooms with open windows — but no proper HVAC systems — were still approved for occupancy.”

Looks like more energy usage for sure ….where is the push for public and office buildings?

Deaths under 1K ….its Sunday reporting…the amazing stat was confirmation for France and US above 100K!

IL leading in both death and confirmation – serious issue in IL

Cook IL leads all US counties – 2nd place in confirmation EL Paso TX!

Serious issue in data or reality in Cook IL and El Paso TX

El Paso TX has now surpassed Miami-Dade confirmation per capita at 7.6%. Cook IL is a scary chart as they have surpassed all the other counties peak

France is leading Europe in death and confirmation.

Covid19mathblog.com

A nuance I did not highlight in yesterday regional breakdown chart – it is clearly seen that deaths and health should be highly correlated. How about confirmations? Should spreading be a function of health? Well it is IF you believe in viral load theory. As noted several times the body can naturally defend of viruses including Covid – however at some level of virus the body can no longer handle it and it will become infected. A healthier person is the less likely to become infectious – the viral load level would need to be higher for infection. Obviously culture plays a big part – whether society wears a mask – wash hands – socializes less – speaks softer – etc… One could also try to argue testing also leads to more confirmation – but at the same time why test if your not infectious or show symptom unless you have money to throw away? Why should Asian countries test as much given they are not seeing the deaths?

S. America vs. Asia (central/eastern) perhaps removes some of the access to health and monetary component when comparing to western world. You can see here there is a big difference in death and confirmed. These high level view are just an indicator of what to delve into for the details – as noted many times the details (county level) – really tell you what is going on – not these aggregation.

This article highlights the concern of testing and viral load – and the point of testing. Should we test for existence or test for infectious? https://www.dailymail.co.uk/news/article-8900897/amp/Oxford-experts-DR-TOM-JEFFERSON-PROFESSOR-CARL-HENEGHAN-reveal-blueprint-handed-Boris-Johnson.html?

“Huge resources have been poured into the roll-out of mass swab tests provided by the NHS. In theory, they should tell us who is infectious, how far the virus is spreading and how fast. In practice, the regime is somewhat aimless and indiscriminate. It has wasted precious resources.

In part, this is because the results identify large numbers of ‘positive’ cases among people who are not infectious. In some cases, the swab tests are picking up levels of Covid-19 which are so very low that the patient will not pass the virus on.

This makes a ‘positive’ reading difficult to interpret. In other cases, administrative errors creep in, as is only too likely given the volume of testing. But the bigger problem is this: the tests give us a simple yes/no answer but fail to identify those who pose a genuine risk.

The results make no distinction between an eight-year-old who is less likely to transmit the virus and a 75-year-old who could prove highly infectious and is in personal danger, especially if suffering multiple health problems.

That is why we must stop relying on yes/no test results alone and start looking at people’s age and symptoms, too.

We are calling for a national programme of testing quality control to ensure that results are accurate, precise and consistent.

We have searched in vain for evidence that many of the tests in use have been independently and centrally validated. We should also be given data showing how sensitive the laboratory processes have been, as this will tell us how much virus was actually present in the swabs.

If your levels of virus are low, then the chances of passing it on are also low. Then we must target the tests at those who truly need them. Care workers, for example, rather than primary school pupils. The contact tracers will perform better if they have fewer, more important, cases to chase.

We understand that the Prime Minister has pinned his hopes on rapid turnaround tests that could give an answer within an hour. Where is the scientific evidence to show that they work? What, we wonder, would be the cost?”

“We failed to protect the old and sick at the start of the year and we are now in danger of failing once again – even though this could be the single most effective measure of them all.

It is people who are over 85 and those who are already unwell who account for the vast majority of deaths. We must increase the number of staff in care homes by a minimum of 20 per cent and set up specialist clinical teams to support them. And we should prevent staff moving between care homes and taking the virus with them.

We must recognise, too, that a dangerous percentage of infections occur within hospitals themselves and seek to guard against them. Hospital-acquired infections may account for up to 25 per cent of Covid cases on the wards. In the North West of England, they recently made up 24 per cent of all Covid patients.

Finally, we must change the tone and scope of the debate.

There has to be a measured discussion that includes the consequences of lockdown as well as the supposed benefits.”

“There have been 23,619 excess deaths in England in people’s homes since the start of April.

Yet only ten per cent of these are directly related to Covid. The rest, we might assume, are the result of restricting national life and access to usual healthcare. These deaths have largely been ignored.

If we retain hope and support each other through this winter, there is every reason to be optimistic.

There are already corners of the country which are showing resilience. It is no coincidence that districts which suffered the worst of the original outbreak are now doing better. But it is time to listen to the public and establish a dialogue.

It is time to cut through the confusion with a clear vision and a national plan that goes beyond the blunt tool of lockdown to take us through the coming months.”

“The identification of cases is needed to care for those with serious symptoms and/or the contagious (often overlapping, especially in older age groups). Aimless and indiscriminate mass testing is a waste of resources and heightens anxiety. No breakdown by severity or contagiousness has ever been reported in the case data, hampering progress. Contact tracers will perform better if they have fewer cases to chase. If they can concentrate on the important cases there will be a clear focus.

There is evidence of limited transmission in schools. Also, not all cases of Covid are the same. Some cases that pass a low threshold for a ‘positive’ test are unlikely to be contagious. The odds of children being infectious are lower than adults, while sports activities do not increase the risk of transmission and help to maintain cardiovascular fitness. School disruption will have long term consequences.

There is weak evidence of transmission between healthy individuals and of asymptomatic transmission. Similarly, tiny levels of virus can be detected if testers carry out multiple test cycles. But cases above a certain threshold of test cycles are less likely to be contagious because the virus, or fragments of the virus, are present only in very low quantities.

We do know that the window of transmission for asymptomatic adults is shorter than that of symptomatics; for them, the duration of infectiousness is up to 7 days. Also, being aged over 75 is known to be an increased risk factor for Covid-19 mortality, especially if there are pre-existing conditions such as cardiovascular problems.

Tests on their own (with a binary infectious Yes/No) do not provide sufficient information to identify contagiousness or seriousness. Full test results including cycle threshold should be made available and presented by the risk of contagiousness.

The College of American Pathologists (CAP) Microbiology Committee advised caution must be used in interpreting the Cycle Threshold (Ct) Value.”

“three-quarters of the Covid deaths were in over 75s. In care homes, 82 per cent of outbreaks occurred within an eight-week period in Spring and led to around 40 per cent of deaths with Covid 19 – 23,005 excess deaths. In addition, there have also been 23, 619 excess deaths of people in their own homes since the week beginning 30 March this year. However, deaths in their own homes are predominantly due to other causes: only 2,421 (roughly 10 per cent) are Covid-19 deaths. The 90 per cent of deaths at home that are not due to Covid-19 deaths have largely been ignored.

While the majority of Covid deaths have occurred in hospitals – 32,275 cases – the excess deaths are 8,486 or 7 per cent higher than what would be expected in an average year.

Over-85s and those with pre-existing pathologies account for the vast majority of death with Covid 19. In an investigation of six London nursing homes, nearly 40 per cent of residents and 21 per cent of staff were infected.

Health Care Acquired Infections may account for up to 25% of cases and perhaps deaths in people admitted to hospital without Covid 19 on admission. They comprised 18 per cent of all new hospital cases on 6 October. In the North West of England, HCAIs made up 24 per cent of all patients on this date.

Deaths in own homes have seen 23,619 excess deaths since week 14, and are predominantly due to other causes: 90% are non-Covid deaths.”

“lockdown saw a 50 per cent reduction in common mental health problems diagnosed.

The mental health effects have affected young adults and women much more; groups that already had lower levels of mental health before Covid-19. Hence inequalities in mental health have been increased by the pandemic.”

“Cancer diagnosis: Cancer services have been severely affected, with over two million people in the UK waiting for screening, tests and treatments within 10 weeks of lockdown. There’s been a significant drop in two-week referrals with 290,000 fewer people being referred for further tests than normal. Roughly 130,000 people who would ordinarily be referred to a consultant have not been.

Cancer treatment: Around 12,750 people are waiting for cancer surgery across the UK, the number of operations fell to around 60 per cent of expected levels. There has also been a sharp drop in those receiving chemotherapy.”

US still above 1K with 127K confirmations!

Illinois is just going parabolic in terms of confirmations – 12.4K! Texas leads in death at 100

Interesting to continue to see quite dispersion in both death and confirmation

Cook IL needs some in-depth analysis -leading confirmation by a long shot and also deaths. Cascade Montana showing up 2nd in deaths in all of US counties is also quite strange.

Cook IL is now over 4% of population confirmed and rising – this can easily double at this pace.

No rapid growth in European countries. Belgium and Ireland continue to contract in confirmations and death.

Covid19mathblog.com

It is still 2020 – looks like a potential mutation that infected 12 jumped from minks to people! – https://bgr.com/2020/11/06/coronavirus-mutation-denmark-mink-pandemic-potential/?bgr-partner=flipboard

“The government of Denmark shocked the world a few days ago when it announced it would slaughter as many as 17 million minks in the country, effectively destroying the entire mink fur industry in the country. The officials opted for this radical option because of the novel coronavirus, as the pathogen developed a potentially dangerous mutation inside the captive mink population. Reports from the country said that the mutated coronavirus has already infected at least 12 people. Researchers are worried that the new strain might be so dangerous that it could effectively render the current COVID-19 vaccine candidates useless.”

“Researchers have not fully detailed the mutation, and more data is needed. However, a Dutch virologist has offered a few details about the mink coronavirus. “It seems the mink-variant mutation is found in the spike protein of the Sars-Cov-2 virus, but we don’t really know,” Wim van der Poel told the paper. “And we don’t know what kind of vaccine we are going to have. So a lot more research is needed.”

“The Dutch government was among the first to order mink cullings earlier this year when it became clear that the animals can be infected with the pathogen and transmit it to humans.

Researchers have no idea whether the mutated coronavirus is able to spread well to humans, but the 12 infected people in Denmark prove there’s reason to worry. University of Reading virologist Ian Jones explained to The Guardian that the virus would have to adapt inside animals to enter cells. As a result, it will “modify the spike protein to enable this to happen efficiently.”

He continued, “The danger is that the mutated virus could then spread back into man and evade any vaccine response which would have been designed to the original, non-mutated version of the spike protein, and not the mink-adapted version.”

Finland experts think Denmark’s decision to kill all the mink population in farms is too extreme. Instead, they advise control measures that are already working in the country. The 150 mink farms in Finnland are all believed to be COVID-19 free.””

The nasal spray discussed yesterday seems to be the best option since it was focused on the blocking the connection – therefore will work for these mutations. Operation warp speed on the nasal spray!

Okay so the next big purchase IF you and your family are socialites or just anyone person in the household cant be a hermit – then you need to get Energy Recovery Ventilator (EVR) places on your HVAC. They even sell these on amazon. This will enable your existing HVAC to bring in fresh air – probably looking around 2K installed and all. Government should probably offer rebates or such if they are serious about slowing the spread in the hot spot areas. https://www.cleveland.com/metro/2020/11/during-1918-pandemic-people-opened-windows-now-hvac-experts-suggest-adding-filters-purifiers-instead.html

The solution to pollution is dilution!

If you have been following our county watch – El Paso was out there – something was wrong for sure – and it was – reporting issues! – https://kfoxtv.com/news/coronavirus/el-paso-city-officials-to-provide-update-on-efforts-to-address-spread-of-covid-19

“El Paso Health Director Angela Mora addressed the all-time high coronavirus case count of 3,100, due to data being entered automatically.

Up until Sunday, data provided from the state had been entered manually.

"To increase our efficiencies we are turning to automatic upload for the reports that come from the state which usually are a very large number of cases," said Mora.”

“The health director went on to clarify that the number of cases for Tuesday were inaccurate. Portions of Tuesday’s total should have been applied to Sunday and Monday.”

However the 7 day Moving Average is still off the chart….Even more alarming is the blame source – wonder if there is proof to back the blame?

“The virus is spreading at gatherings of friends and families and at large retail stores, Margo said.

“It’s coming from shopping, primarily the large big box retailers," Margo said.

Margo said his office reached out to large retailers like Walmart and Target and asking them to be proactive.”

“Recently, Walmart has announced some of its stores in El Paso were temporarily closed to deep clean.”

Another article notes based on contact tracing https://www.ktsm.com/news/big-box-stores-top-source-of-covid-19-spread-in-el-paso-officials-say/

““Shopping in El Paso, given our culture and our nature, is a family event. We have stressed and said please. Don’t take your family to go shopping if you can do it with one person,” Mayor Dee Margo said during a news conference on Thursday.

Margo said contact tracing data has been continuing to show big box stores as the leading source of where the virus has been infecting community members. “The main retailers — the Walmart, Target, Home Depot, Lowes — and all those fall under federal guidelines. As determined by Homeland Security, we have no legal oversight control over any limitations to those stores.””

They should measure the fresh air circulations at these stores – they are controllable. Also of note they did not open schools – but as noted they cant stop these family gatherings – school is not likely the super spreader compared to family gatherings – also I am still suspect on the blame on big box store without evaluating the HVAC system.

Search for what is going on in Cook IL did not lead to much other than this article which shows they have closed down things that don’t matter as much – because if it did they would not be leading the country in confirmation – https://www.wbez.org/stories/illinois-releases-data-on-contact-tracing-and-where-people-may-have-been-exposed-to-covid-19/c6585458-050e-4e3b-a658-8203b563974e

“This comes as Pritzker had been hammered for months for his decision to shut down bars and restaurants, saying they’ve been a key source of the spread of the virus, but state officials had not provided substantial data to back up those claims.

Statewide, the data show an “other” category — which it says includes locations such as warehouses, funerals and hair salons — leads in possible exposure, with more than 4,179 cases. Next comes restaurants and bars, with nearly 3,900 cases, or nearly 11% of all cases reported in the document.”

“The reporting shows that 52 outbreaks were tied to factories or manufacturing since July 1, the biggest number of any industry or location. Next came community events, followed by church, temple and religious services.

But in the past 30 days, outbreaks were led by church, temple and religious services, followed by community events, group homes and schools.”

What is so sad both El Paso and Cook articles never talked about ventilation….I am sure there is a big difference in ventilation which is MORE important than the type of building. I am certain a school or a store can be a better place to be in IF they upgraded their HVAC for more fresh air than any type of building.

US above 1K at 1146

TX leading death – IL leading confirmation

Cook IL lead all counties in the US in both categories

Cook county is out there now …..Something is wrong

Alarming thing for Cook deaths are now surging so its not just accounting issue in Cook – their current confirmation per day has peaked above LA peak of 3200 – its not looking good at all for Cook IL

Something is not right – how can Russia, Asian, African Countries be so much better off than US, Europe, and Central/South American Countries – there has to be something going on….the only real directional metric is BMI – its time to get healthy that’s got to be it! We can quarantine we can hide in a hole – covid seems to be speeding up the death of the unhealthy as we examine these large aggregations – of course there will be exceptions – but the central message for these large variances comes back to health and our food system and personal choices….Null is holding every other category.

Covid19mathblog.com

Lets start with some good news – a non-toxic low cost nasal spray could be the perfect weapon against covid – https://www.biorxiv.org/content/10.1101/2020.11.04.361154v1.full.pdf

“We have designed a dimeric lipopeptide fusion inhibitor that blocks this critical first step of

infection for emerging coronaviruses and document that it completely prevents SARS-CoV-2 infection

in ferrets. Daily intranasal administration to ferrets completely prevented SARS-CoV-2 direct-contact

transmission during 24-hour co-housing with infected animals, under stringent conditions that resulted

in infection of 100% of untreated animals. These lipopeptides are highly stable and non-toxic and thus

readily translate into a safe and effective intranasal prophylactic approach to reduce transmission of

SARS-CoV-2”

Lets go warp speed on this! Great idea focus on the connector and block it in a discrete amount of time.

Kind of obvious but quantified odds going to work double odds of getting covid vs telecommuting. Unfortunately didn’t dig deeper to understand locations that are less likely and the corresponding setting in the HVAC and filtration. https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a4.htm?s_cid=mm6944a4_w

“Adults who received positive test results for SARS-CoV-2 infection were more likely to report exclusively going to an office or school setting in the 2 weeks before illness onset, compared with those who tested negative, even among those working in a profession outside of the critical infrastructure.

\What are the implications for public health practice?

Businesses and employers should promote alternative work site options, such as teleworking, where possible, to reduce exposures to SARS-CoV-2. Where telework options are not feasible, worker safety measures should continue to be scaled up to reduce possible worksite exposures.”

Expanding on our chart of deaths per 100K – we now show Covid-19 death relative to other death per 100K by country. There is obviously a connection with depth of quarantine effectiveness and death from covid. There is a big gray area when policy becomes unenforceable which in many cases in Western country this becomes an issue. However we can see strict countries like New Zealand and Australia has been able to limit covid deaths – but at a significant cost. There is a sweet spot in terms of reaction and outcome. I don’t think 0 death is realistic target else other deaths that could be avoided would be more mitigated so even though it sounds weird to say we do have a level of death that is acceptable in society. Certainly covid response should be more proactive at some level given the contagiousness is not there for many of these other ways to die – but the value of life should be equal. Western countries for sure can see that covid is a big issue – but for the rest of the world that doesn’t seem to be the case even if one extrapolates 5X more covid deaths in many countries.

For the US – clearly covid death is on the high end. However it would seem a lot of this is skewed to death at nursing home and particular focused location NY, NJ, MA. Heart disease and cancer still dominate the deaths in the US.

State view of covid deaths

If we look at UK we can see the seriousness of covid like the US

Same for Spain

Same in France

However in Germany things are different – there are other deaths that are causing much bigger issues than Covid. Perhaps how they prevented covid is certainly a worthy discussion.

Sweden is high as noted by several media – but once again a big nursing home issue – and general quarantine wont necessarily solve the root issue of poor nursing home management.

Poland flu is still higher than covid

Russia has other issues that are higher but flu is lower.

China measurement of Covid death probably very relax compared to all others – it is at level that more people die from skin disease and fires.

S. Korea flu is 20X more of an issue than covid – obviously if they responded with the regular flu as they did covid they would likely reduce regular flu deaths much lower.

Vietnam you cannot even see covid on the chart.

Similar with Thailand – perhaps culture of fans and open windows and natural immunity via BCG?

Singapore you are 70x more likely to die from regular flu

Saudi Arabia regular flu death likely 2X

Nigeria you are 240X more likely to die from regular flu – Nigeria has the flu as the highest cause of death!

S. Africa currently Flu is 3X to covid

Australia regular flu is 2X vs. covid deaths – more likely to die from a fall than covid in Australia.

New Zealand with all the strict measures you are more likely to die from alcohol than covid. 8X more likely to die from regular flu.

India suicide deaths are much greater than covid right now. Standard flu 6X more likely to die from vs. covid.

Mexico is unique because the leading death is Diabetes – Covid is a top 3 – but it is likely connected here.

In Peru covid is the leading cause of death! Perhaps the opposite of China – potential over reporting? The ONLY country in the world that covid is the leading cause of death.

Brazil it is 3rd place – brazil looks very similar to the western countries with cancer and heart disease ahead – then Covid

US deaths top 1210 with 122K confirmations

Illinois leads in confirmation as TX leads in death

On a county basis Cook IL leads them all – TX is just a dispersion of deaths.

Cook IL there is something going on along with El Paso TX and LA CA

Belgium and Ireland finally seeing some reduction in confirmations.

Covid19mathblog.com

It is still 2020 – so here is some bad news on the covid front – https://www.sciencealert.com/case-study-reveals-rare-patient-who-showed-no-symptoms-but-shed-infectious-sars-cov-2-for-70-days

“A team of researchers and doctors has now reported the case of one woman with leukemia who had no symptoms of COVID-19 but 70 days after her first positive test, she was still shedding infectious SARS-CoV-2 particles.”

“She first tested positive for SARS-CoV-2 on 2 March 2020 after she was admitted to hospital for severe anaemia related to her cancer. She then tested positive for COVID-19 another 13 times and yet showed no symptoms of the disease. Twice she received plasma from people who had recovered from COVID-19, and eventually cleared the virus from her system sometime in mid-June.

Doctors don’t know exactly when she acquired the coronavirus, but most likely it was at a rehabilitation facility which had a large COVID-19 outbreak in February, where the woman had stayed days earlier.

From the throat swabs collected over the course of her 15-week infection, the researchers showed that the woman was shedding infectious SARS-CoV-2 particles for 70 days. Some of its genetic material was also detected up to 105 days after she first tested positive.

We have to be careful here to distinguish between infectious viral particles and the results of a diagnostic test, which just detects shreds of viral RNA. Importantly, in this study the researchers actually isolated SARS-CoV-2 from a few swab samples – day 70 included – to test whether the virus collected was able to replicate in lab-grown cells, which it was.

"This indicates that, most likely, the infectious virus shed by the patient would still be able to establish a productive infection in contacts upon transmission," the researchers wrote.”

Trying to contain something like this would require a very long quarantine – and perhaps permanent quarantine from the rest of the world AFTER testing all in the bubble – and then kicking out those positive from the bubble – also a good way to get rid of people you don’t like.

Death per 100K Population by Country – Filtered for 50+ – interesting to note no Asian country in this list.

School review – same conclusion schools not likely super spreader places – there are some better schools in terms of implementation to reduce viral load and we need to learn from them:

TX – School most open and open longest Ft. Bend not seeing any increase in confirmation. El Paso TX the most closed schooling county seeing a surge in confirmation. Travis TX opened up a month ago and still no major increase. Fort Bend should be evaluated to what they did.

FL – Broward county opened up and saw an increase in confirmation. However Pinellas been opened and did not see an increase. Palm Beach has started to climb but this was a month plus of already being opened. Pinellas should be examined on how and what they did.

CA – poor sample – but most opened was San Diego – yet not much different vs. Santa Clara who was closed.

OH All counties below growing but Lorain never opened school – so it would not seem schools is causing the expansion of confirmation

CO – Confirmation rising for all. El Paso rapid rise and probably needs to review what exactly is going on. Adams has bee rising but was rising even before school opening.

PA – Dauphin PA just opened up but confirmation was already climbing. Centre has been opened but confirmation are actually holding steady.

Big confirmation for France and US – Spain, France, and US deaths over 1K

TX lead in both confirmation and death

The leading county in death and confirmation in TX was El Paso – again. Maricopa AZ actually lead all counties in death.

Clearly the issue is quite focus with the top 5 counties representing 10% of the confirmation for the entire country. We need to figure out was is going on in El Paso TX Cook IL Rhode Island and Los Angeles.

Rolling up the regions you can see the pain Europe is seeing. Comparing US totals with European individual countries mask Europe issues and makes US seems overwhelming. However Europe as a whole has much bigger problems than the US.

Covid19mathblog.com

This story is more important than the headline. This is a report about the issue of testing which we have been routinely discussing here – even the holy grail PCR test has some faults. https://www.nytimes.com/2020/11/02/health/coronavirus-testing-quidel-sofia.html

“In a head-to-head comparison, researchers at the University of Arizona found that, in symptomatic people, a rapid test made by Quidel could detect more than 80 percent of coronavirus infections found by a slower, lab-based P.C.R. test. But when the rapid test was used instead to randomly screen students and staff members who did not feel sick, it detected only 32 percent of the positive cases identified by the P.C.R. test. Quidel’s tests are authorized for use only in people with symptoms, but their use in those who are asymptomatic has been strongly encouraged by the federal government.”

“Much of coronavirus testing has so far relied heavily on a laboratory technique called polymerase chain reaction, or P.C.R., which can amplify very small amounts of genetic material from the virus, and which is sensitive enough to detect the pathogen even when it is scarce. But these tests are slow and expensive, sometimes taking days to return results. At the University of Arizona, which hosts nearly 50,000 students and staff in a typical year, there are enough laboratory resources to run only about 1,500 P.C.R. tests each week, said David Harris, a stem cell researcher and an author on the study.

Quidel’s test, called the Sofia, looks for bits of coronavirus proteins, or antigens, instead of genetic material. It is less accurate than P.C.R.-based tests. But it takes only 15 to 30 minutes to run, using a toaster-size instrument, and costs about $23, compared with $50 or more for a typical P.C.R. test.”

“Among 885 people who had experienced Covid-19-like symptoms or had recently been exposed to the coronavirus, 305 tested positive by P.C.R. — 54 of whom were missed by the antigen test, or 18 percent.

That number might have been lower if the test group had included only people with symptoms, Doug Bryant, Quidel’s president and chief executive, said in an interview. The Sofia’s instruction manual claims that the product can detect 96.7 of the infections that P.C.R. tests can when used on people in the first five days of their illness.”

“The researchers also screened for the virus in another 1,551 randomly selected people who had no symptoms. Nineteen of them tested positive by P.C.R.; of those who did, only six were caught by the Sofia.”

“Among people without symptoms, the Sofia also produced more false positives than P.C.R.-confirmed positives, mistakenly identifying seven participants as infected when they were not actually carrying the coronavirus.”

“Of the 13 asymptomatic people who were not identified by the Sofia test, 12 had C.T. values in the 30s.

“At these high values, we don’t even know if a P.C.R. test is ‘correct,’” said Werner Kroll, senior vice president of research and development at Quidel. As with any diagnostic tool, false positives can appear in P.C.R.-based tests. These tests can also pick up on harmless genetic fragments of the coronavirus that linger in the body for weeks after people have recovered.

The researchers were also unable to grow the coronavirus out of samples from volunteers whose P.C.R. tests had C.T. values above 27. “If I don’t have live virus, I am not infectious at all,” Dr. Harris said.

When Dr. Harris and his colleagues discarded all P.C.R. positives with C.T. values above 30 from their data set, the rapid test detected more than 85 percent of the coronavirus infections detected by the lab test, regardless of whether people were symptomatic.

“Although C.T. values do tend to increase as virus levels diminish, exceptions to this trend exist — and there is no universal “magic-number cutoff” for infectiousness, Dr. Dien Bard said.

Failing to grow the coronavirus out of a person’s sample also does not guarantee that individual is not contagious to others, said Omai Garner, the associate director of clinical microbiology in the UCLA Health System, who was not involved in the study.”

Nonetheless all testing results should come with CT values. The goal for testing SHOULD be for infectiousness not for mere existence.

First day above 1K deaths in awhile – US reporting 1130

Texas leading the way in both confirmation and deaths

On a county basis you don’t see TX being a big leader in death. Maricopa, Clark, and LA leading in that category. The leading TX county in confirmation is El Paso – border county. However the big confirmation leader is Cook IL

Lots of dispersion in death and confirmation – this is very sudden – all summer it has been quite focused

Cook IL data looks ridiculous – super high confirmation and deaths not even budging – what are they confirming? It is like testing to know people have colds?

Sweden just got uptick in confirmation and deaths

Covid19mathblog.com

This is an interesting report highlighting how nursing home represented 40+% of US death. Root cause analysis of death allow solutions. WOULD quarantine entire society help nursing home deaths? Is there a more precise measure for nursing home covid-19 death prevention? Another Big Data analysis as they used phone tracking to understand what is going on. https://www.anderson.ucla.edu/faculty_pages/keith.chen/papers/WP_Nursing_Home_Networks_and_COVID19.pdf

“We perform the

first large-scale analysis of nursing home connections via shared staff and contractors using device-level

geolocation data from 50 million smartphones, and find that 5.1 percent of smartphone users who visit

a nursing home for at least one hour also visit another facility during our 11-week study period—even

after visitor restrictions were imposed”

“Multivariate regressions comparing demographically

and geographically similar nursing homes suggest that 49 percent of COVID cases among nursing home

residents are attributable to staff movement between facilities.”

“Linked to more than forty percent of all U.S. fatalities as of August 31, 2020, nursing homes and

other long-term care facilities have been disproportionately afflicted by the ongoing coronavirus

pandemic (Conlen et al., 2020; Kaiser Family Foundation, 2020; Girvan, Gregg and Roy, Avik,

2020).1”

“The U.S. Centers for Medicare and Medicaid Services (CMS), the primary

federal regulator of nursing homes, estimates that more than 30 percent of all nursing home residents

in New Jersey, Connecticut, and Massachusetts had contracted SARS-CoV-2 as of June 28, 2020

and that more than 9 percent of the entire nursing home population died in these states (Centers

for Medicare and Medicaid Services, 2020a).”

“No study finds CMS

ratings to be significant explanators of cases, although demographics and urban location are predictive of cases. Two studies of individual states (He et al., 2020; Li et al., 2020) find that higher

CMS-rated nursing homes report fewer cases. One analysis finds no evidence that for-profit status

significantly predicts nursing home cases (Konetzka, 2020), yet a study of Connecticut facilities

does find for-profit status to be a predictor of cases (Rowan et al., 2020). While all of these papers

provide careful statistical analysis of COVID in nursing home settings, no study directly measures

connections amongst homes”

“A study by the State of New York (New York State Department of Health, 2020)

concluded, largely based on the timing of infections, that through no fault of their own, nursing

home workers were likely the main source of SARS-CoV-2 transmission in nursing homes. They

find that roughly one-quarter of nursing home workers in New York State tested positive for the

virus.”

“Using a large-scale analysis of smartphone location data, we document substantial connections

among nursing homes after nationwide visitor restrictions were enacted in March 2020. Consistent

with the CDC’s conclusion that shared workers were a source of infection for the nursing home

outbreak in Kirkland, Washington (McMichael, 2020), our network measures suggest that staff

linkages between nursing homes are a significant predictor of SARS-CoV-2 infections.”

“While some nursing homes and

other long-term care facilities have undertaken actions to create a “staff bubble”, this is still not a

component of extant regulation (Sudo, 2020; Rodricks, 2020). Absent such regulation, allocation

of PPE, testing, and other preventive measures should be targeted thoughtfully, recognizing the

current potential for transmission across homes New CMS testing guidelines as of August 2020

state that a nursing home not experiencing a current outbreak and located in a county with case

positivity rates of less than five percent need only test staff members once per month (Centers

for Medicare and Medicaid Services, 2020d). If two homes are known to share workers, however,

testing could be increased at one home if an outbreak occurs at the other facility. Further, given the

greater chance that a highly connected home experiences a new outbreak—and the risk this creates

for its connections—more frequent testing of highly connected homes could be warranted, even

when county positivity rates are low. While the nursing home population is particularly fragile,

this research has implications for cross-linkages in other congregate settings such as assisted living

homes, prisons, food-processing plants, and large workplace facilities.”

The conclusions are kind of shocking – so football and NBA players who are less likely to die will have more testing than nursing home workers? This is insane.

No country above 600 deaths

Nevada leads death for the first time at 69 deaths. Michigan leads in confirmation along with IL – it was cold up there….

Lander NV lead all counties in deaths. Cook IL confirmation leader – EL Paso TX still up there

Strange death county chart as counties such as Lucas,OH and Johnson, KS show up

Cook IL went parabolic on confirmation – so far deaths are in check – their old peak was 84 deaths a day on 7 day moving average – currently 11

France has a drop in confirmation.

Covid19mathblog.com

Testing mantra is everywhere. It would make sense IF cost was not a function, time much lower, and also the capability of abuse was negated. It would be nice to go do our usual society things from going to family reunion and wedding – even simple flight to vacation – and be able to get a test right at entrance and less than in minute get a result and then allowed in. But lets assume this is the case – can you imagine if someone could hack that and then cause certain individuals from being able to move. This is a lot of power. Another testing news to reduce time…. – https://www.timesofisrael.com/health-ministry-announces-israeli-developed-faster-pcr-tests-for-virus-diagnosis/

“The Health Ministry announced on Monday that an Israeli-developed system would considerably cut the time it takes to process a PCR coronavirus test.”

“The statement from the ministry did not state where the technology had been developed or if it was an amalgamation of work from a number of facilities.

“Israeli technology is breaking records time and time again. The world will be able to see the shortcuts as risk-reducing, more efficient, and, no less important than all that, based on Israeli products,” Edelstein said.”

Excess death discussion has continued to be in the news too. Below are the current excess deaths in US – last date end of Sept. with most states reporting. Reporting seems to be slow.

The excess death and quarantine noted in the following case in Australia where Melbourne has had a very strict quarantine – also please consider the majority of the deaths for covid are 45+ (92%) – so it would be tragic to cause those under 45 to die because of covid restrictions – https://fee.org/articles/four-newborns-die-after-being-denied-heart-surgery-because-of-covid-travel-restrictions/

“Four babies died in Adelaide, Australia over the last four weeks after being denied transport to Melbourne because of government COVID-19 restrictions, health officials say.

Adelaide, the capital city of the state of South Australia, doesn’t offer paediatric cardiac surgery. According to local news reports, this means about 100 babies are sent interstate for treatment annually, typically to Melbourne’s Royal Children’s Hospital.

Because of COVID-19 lockdown restrictions, however, Melbourne no longer remains an option. Patients must be sent to Sydney instead.

The distance from Adelaide to Melbourne is about 725 kilometers, a flight of roughly 75 minutes, while the distance to Sydney is about 1,375 kilometers, a flight of nearly two hours. An extra 45 minutes might not sound like a lot of time, but when you’re talking about surgery on a vital organ in a sick infant, minutes matter.

The infants never left Adelaide, news reports indicate, presumably because doctors either determined they would not survive the lengthy trip or because Sydney’s Children’s Hospital at Westmead—the lone hospital available due to travel restrictions—lacked the capacity to treat them.

Whatever the case, because of the travel restrictions and the lack of a cardiac center in Adelaide, the infants failed to receive treatment that could have saved their lives.

Dr. John Svigos, an obstetrician and gynecologist, told Australian TV network 9 News that the four babies who died in Adelaide “almost certainly" would have benefited from on-site surgery. He noted that recent state restrictions on travel inhibited the hospital’s ability to get the infants treated at other facilities.

“Particularly in our current COVID situation where the usual process of referral to the Melbourne cardiac unit is no longer tenable and referral to Sydney is on a case-by-case basis,” said Svigos, who has operated a private practice at Women’s and Children’s Hospital in Adelaide since 1978. “I shall leave it to you to imagine the profound effect of these deaths on the parents, their families and the dedicated medical and nursing staff dealing with these tragedies.””

“we must look beyond the immediate effects of an action and consider the far-reaching unintended consequences.

Tragically, the COVID-19 pandemic has been a virtual laboratory for lessons in “unseen” evils that have resulted from pursuing “a present good.” By imposing mass lockdowns and sweeping bans on travel and other basic freedoms, governments may have increased social distancing, but they did so at costs we may never fully understand (but are now just beginning to).

We see the immediate, desired effects—less travel, businesses closed or limited in capacity, more children working on laptops and not in school—but we tend to overlook the many unseen, second-order evils. These include the cancer screenings people are not getting, the 100,000 US businesses that will never reopen, the Alcoholics Anonymous meetings people cannot attend, the rise in depression as people lose jobs, the millions of people slipping into poverty and extreme poverty, the rise in suicide, and yes—infants and other people denied surgeries that could have saved them.

Each of these effects will in turn trigger countless other effects, many of which will never be seen or written about.

The effort to protect individuals from the coronavirus through government fiat instead of individual action was akin to performing heart surgery with a broadsword—clumsy, foolish, and deadly.

“How many more deaths of babies and young children will the community and staff be forced to endure?” asked Svigos.

It’s a question every person suffering under inhumane lockdowns and other draconian government restrictions should be asking.”

No country over 500 deaths – Iran 3rd place at 434. US continues with huge confirmations 81.5K

IL leads states in death. TX continues in leading in confirmation

County wise its all Cook IL – leading both confirmation and deaths

Leading TX county in confirmation is El Paso TX – border county

Switzerland is showing an alarming trend in deaths

Covid19mathblog.com

Another study of the obvious – proving the statements made numerous times here and the warning made that the home is less likely to be able to ventilate vs. commercial buildings and likely the source of most spreads per gatherings. https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e1.htm

“To assess household transmission, a case-ascertained study was conducted in Nashville, Tennessee, and Marshfield, Wisconsin, commencing in April 2020. In this study, index patients were defined as the first household members with COVID-19–compatible symptoms who received a positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) test result, and who lived with at least one other household member. After enrollment, index patients and household members were trained remotely by study staff members to complete symptom diaries and obtain self-collected specimens, nasal swabs only or nasal swabs and saliva samples, daily for 14 days. For this analysis, specimens from the first 7 days were tested for SARS-CoV-2 using CDC RT-PCR protocols.† A total of 191 enrolled household contacts of 101 index patients reported having no symptoms on the day of the associated index patient’s illness onset, and among these 191 contacts, 102 had SARS-CoV-2 detected in either nasal or saliva specimens during follow-up, for a secondary infection rate of 53% (95% confidence interval [CI] = 46%–60%).”

“Among fourteen households in which the index patient was aged <18 years, the secondary infection rate from index patients aged <12 years was 53% (95% CI = 31%–74%) and from index patients aged 12–17 years was 38% (95% CI = 23%–56%).”

My hypothesis for why 12-17 less than <12 – teenagers coup up in their room ? and they don’t communicate as much to others in household – I know first hand.

“The median index patient age was 32 years (range = 4–76 years; interquartile range [IQR] = 24–48 years); 14 (14%) index patients were aged <18 years, including five aged <12 years and nine aged 12–17 years. Among index patients, 75 (74%) were non-Hispanic White, eight (8%) were non-Hispanic persons of other races, and 18 (18%) were Hispanic or Latino (Table 1). Index patients received testing for SARS-CoV-2 a median of 1 day (IQR = 1–2) after illness onset and were enrolled in the study a median of 4 days (IQR = 2–4) after illness onset.

The median number of household members per bedroom was one (IQR = 0.8–1.3). Seventy (69%) index patients reported spending >4 hours in the same room with one or more household members the day before and 40 (40%) the day after illness onset. Similarly, 40 (40%) of index patients reported sleeping in the same room with one or more household members before illness onset and 30 (30%) after illness onset.

Among all household members, 102 had nasal swabs or saliva specimens in which SARS-CoV-2 was detected by RT-PCR during the first 7 days of follow-up, for a secondary infection rate of 53% (95% CI = 46%–60%) (Table 2). Secondary infection rates based only on nasal swab specimens yielded similar results (47%, 95% CI = 40%–54%). Excluding 54 household members who had SARS-CoV-2 detected in specimens taken at enrollment, the secondary infection rate was 35% (95% CI = 28%–43%).

Forty percent (41 of 102) of infected household members reported symptoms at the time SARS-CoV-2 was first detected by RT-PCR. During 7 days of follow-up, 67% (68 of 102) of infected household members reported symptoms, which began a median of 4 days (IQR = 3–5) after the index patient’s illness onset. The rates of symptomatic and asymptomatic laboratory-confirmed SARS-CoV-2 infection among household members was 36% (95% CI = 29%–43%) and 18% (95% CI = 13%–24%), respectively.”

“An important finding of this study is that fewer than one half of household members with confirmed SARS-CoV-2 infections reported symptoms at the time infection was first detected, and many reported no symptoms throughout 7 days of follow-up, underscoring the potential for transmission from asymptomatic secondary contacts and the importance of quarantine. Persons aware of recent close contact with an infected person, such as a household member, should quarantine in their homes and get tested for SARS-CoV-2”

The optimistic side 47% don’t become infected even though in same household – not bad odds – not good either. No mentioned of ventilation – no mentioned of health of people infected….Once again an important hypothesis made here is that if you are healthy you can handle higher viral loads before getting infected.

If we hold this to be true – then how exactly will lockdowns work IF you have samples of essential employees in the community and you have gatherings – celebrations etc… It did not work for LA it will not likely work for society bounded by social gatherings. Households need to ventilate more IF you cannot completely isolate. They need access to technology to reduce viral load. Those with kids particularly teenagers it would be VERY hard to guarantee they are not going out and hanging out with friends. You extend this to a family gathering and expect EVERYONE to be isolated – this is very small odds in the US type society.

The discussion of no in school person – lead to numerous social media post of gatherings to do school at each other homes – as noted individual home units do not have an economizer – they don’t bring in any fresh air into the HVAC. At least commercial buildings do and would be much more cost effective to modify than individual homes.

England and France are now in lockdown for a month….got to be awful being a nonessential store. https://www.theguardian.com/world/2020/oct/31/boris-johnson-announces-national-lockdown-england-coronavirus

“Unlike the first national lockdown introduced in March, schools, colleges and universities will remain open, as will childcare and early years care.”

“Johnson also announced a ban on overnight stays and outbound international travel, unless the trips are for work, while places of worship will be open for private prayer but not for services. He also confirmed that the Premier League would continue.”

How one enforces will be interesting – https://www.theguardian.com/world/2020/oct/31/what-could-a-national-covid-lockdown-in-england-mean-coronavirus

What can I leave home for?

People can only leave home for the following reasons:

Education.

To go to work unless it can be done from home.

Outdoor exercise either with household members or with one person from another household.

For all medical reasons and appointments.

To escape injury or harm.

To care for the vulnerable or volunteer.

To shop for food and essentials.

To see people in your support bubble.

Children will still be able to move between homes if their parents are separated.

However, people could face fixed penalty notices from police for leaving their home without one of the above excuses.

NO cheating and it should work – but in all honesty to stop people from celebrating anniversaries bday etc….will be super tough – then not visiting the elderly who perhaps are already looking at near death regardless of covid – all round 2020 suck.

Under 1K death – another super confirmation day for the US at 81K

Missouri leads the US in deaths and TX in confirmations

Dispersion is rather bigger than normal

Maricopa AZ leading the death column whereas El Paso TX leading the confirmations

Positive news on the county chart Cook, El Paso, LA ae trending down on confirmation now

You can certainly see why France has decided to lockdown – whether it works is another question

Covid19mathblog.com

How many lives – how many infections – could have been saved IF this message was earlier – it has been mentioned numerous times here since Apr/May – if we spent a fraction of what we spent on drug research for vaccine/treatment and just focused on what we can do at hand via mechanical solutions I believe many lives and infections could have been prevented- https://www.youtube.com/watch?v=XJC1f7F4qtc&feature=youtu.be

VENTILATION IS A VERY IMPORTANT ASPECT IN PREVENTING THE SPREAD OF COVID-19

A total of 1.2 Million deaths and 45 Million confirmations worldwide. Because we care about human life so much how about looking at something that kills potentially 7X that level https://www.theladders.com/career-advice/you-can-wipe-out-your-risk-for-heart-disease-by-cutting-out-this-food-type

The study noted in the report above – https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcaa076/5918025?searchresult=1

“Ischaemic heart disease (IHD) is a major contributor to the global disease burden, with devastating consequences in terms of human life and health.1 More than 7.0 million deaths were caused by IHD in 2010, making it still the leading cause of death worldwide”

We have known this issue since at least 2010 – no lockdown – no forced govt regulation?

Proposal of solution from lead author from that report –

““More than 6 million deaths could be avoided by reducing intake of processed foods, sugary beverages, trans and saturated fats, and added salt and sugar, while increasing intake of fish, fruits, vegetables, nuts, and whole grains.

Ideally, we should eat 200 to 300 mg of omega-3 fatty acids from seafood each day,” Dr. Xinyao Liu, a researcher at Central South University in Changsha, China, and a study lead author, said in a statement.””

Should we not examine this under the context of so many deaths that COULD be prevented?

““The health effects of hydrogenated oils are detrimental especially to our heart health. They contain trans fat, which can raise our bad cholesterol and lower our good cholesterol, contributing directly to heart disease,” explains Acharya.

“They also can lead to an increased build-up of visceral fat, which is known to be linked to heart disease. Along with hydrogenated oils, processed food contains tons of added sugars in it, which has been linked to numerous health issues such as obesity, diabetes, and more.”

What’s more, consuming processed food actually makes it harder to weave healthy food into the equation—but that shouldn’t deter you from making the shift to a more whole food diet.

According to Nikola Djordjevic MD, we’re less likely to eat healthy food if we eat junk food before. In fact, if we binge eat highly processed food, we will be less likely to eat foods that are good for our health since there will be less room in our body, and we won’t have the desire to eat more.”

“Processed food not only increases our chance of developing heart disease but also diabetes, obesity, and even an increased risk of depression—which has us wondering if that chicken nugget meal is really worth the indulgence or if it should, in fact, be saved for special occasions.”

Personal choice is open on the food front regardless of consequences and burden on hospitals. Personal choice is not being open for behaviors potentially contributing to covid-19. BOTH should be nudge as noted in the Common Sense by Thomas Paine (Must Read Document) https://www.law.gmu.edu/assets/files/academics/founders/Paine_CommonSense.pdf

“Society is produced by our wants, and government by our wickedness; the former promotes our happiness positively by uniting our affections, the latter negatively by restraining our vices…”

We need to restrain some of our vices in order to save lives and we need to balance that of our wants and happiness – nothing can go to the point of absolutes without overpaying for it.

A word of caution for the overuse of hand sanitizers – https://www.healthdigest.com/268566/when-you-use-hand-sanitizer-every-day-this-is-what-really-happens/

“Washing your hands with soap and water helps physically remove many kinds of germs that can linger on your skin, but rubbing hand sanitizer on your hands doesn’t exactly remove all germs, the Centers for Disease Control and Prevention (CDC) revealed. Rather, hand sanitizer kills certain germs upon coming into contact with them”

“"The thing that a lot of people don’t seem to get is that it is not necessary to use hand sanitizer if you’re already washing your hands whenever you should be," Dr. Leann Poston, an Ohio-based physician, told Health Digest. "Hand sanitizer is recommended as a substitute for hand washing when hand washing is not possible. It is not meant to be an extra precaution on top of hand washing."

If you’re wondering right about now why hospitals stock up on hand sanitizer and make it available in all examining rooms, it is not because hand sanitizer offers better protection against the spread of germs than soap and water, but rather because hand sanitizer offers the ability to kill germs when hand washing is unavailable. Although you could say it is more efficient than washing with soap and water, it’s not more effective. “

“the best way to prevent the spread of infections and decrease the risk of getting sick is by washing your hands with "plain soap and water." And when they say "plain soap and water," they mean precisely that. "There is currently no evidence that consumer antiseptic wash products (also known as antibacterial soaps) are any more effective at preventing illness than washing with plain soap and water," the FDA explained. "In fact, some data suggests that antibacterial ingredients could do more harm than good in the long-term and more research is needed."”

“soap and water is capable of removing certain organisms that hand sanitizers are either not consistently effective at killing or those which need to be removed as opposed to killed. These include Clostridioides difficile because it’s impenetrable by alcohol, norovirus because it is enclosed within a protective "capsid" structure, and parasites such as Cryptosporidium because they are actual living organisms. Additionally, hand sanitizers do nothing to remove certain chemicals, pesticides, and heavy metals from the skin. “

“One of the problems with hand sanitizer is that it does not distinguish between bad bacteria and good bacteria. So when you use hand sanitizer, you’re not only killing the germs you want to kill, but you’re also killing the bacteria that naturally lives on your skin and helps you to fight off harmful bacteria, Dr. Giuseppe Aragona, a general practitioner with PrescriptionDoctor.com, told Health Digest.”

“overuse of alcohol-based hand sanitizer can contribute to the development of superbugs that are resistant to antimicrobials. And that’s not just a problem for you. It’s a public health issue, according to one 2020 study. Or as the World Health Organization put it: "Antibiotic resistance is one of the biggest threats to global health, food security, and development today."”

“"If you use hand sanitizer multiple times daily, you’ll exacerbate the dryness because you are by forcing your skin to absorb a lot of moisture, which stresses and stretches the skin and can lead to dryness on the skin’ surface." Soap and water are drying too, so if you’re using hand sanitizer on frequent hand washings, you’re setting yourself up for uncomfortably dry skin on your hands.”

“Having dry skin on your hands is not just uncomfortable, Dr. Leann Poston, an Ohio-based physician, reminded Health Digest — it’s also a setup for infection. Your skin forms a barrier between everything that is inside of your body and the outside world, she explained. When the skin is dry, it is more prone to cracking, and cracked skin offers germs an easy entry point into your body.”

“Overuse of hand sanitizer is associated with dermatitis (inflammation of the skin), according to the Florida Skin Center. "Alcohol-based hand sanitizer can disturb the natural pH and barrier of the skin, leaving skin vulnerable to allergens which can penetrate beneath the surface and trigger an autoimmune reaction," the center revealed.”

Personally I barely use hand sanitizer – I will go wash my hands with soap and water!

DB issues this morning – hopefully resolved by tomorrow report to show standard presentation.