Includes images up to full camera resolution.
SARS-CoV-2 aka COVID-19: Studies of Transmission via Coughing and Sneezing offer Compelling Evidence to Require Facial Coverings
SARS-CoV-2 is the virus; COVID-19 is the disease.
COVID-19: Public Policy MUST be Changed: Facial Coverings should ALWAYS be Worn To Protect Others
COVID-19 (SARS-CoV-2): the Tide is Turning for Facial Covering / Mask Official Recommendations
JAMA: Turbulent Gas Clouds and Respiratory Pathogen Emissions Potential Implications for Reducing Transmission of COVID-19
Recent work has demonstrated that exhalations, sneezes, and coughs not only consist of mucosalivary droplets following short-range semiballistic emission trajectories but, importantly, are primarily made of a multiphase turbulent gas (a puff) cloud that entrains ambient air and traps and carries within it clusters of droplets with a continuum of droplet sizes (Figure; Video).
The locally moist and warm atmosphere within the turbulent gas cloud allows the contained droplets to evade evaporation for much longer than occurs with isolated droplets. Under these conditions, the lifetime of a droplet could be considerably extended by a factor of up to 1000, from a fraction of a second to minutes.
... Owing to the forward momentum of the cloud, pathogen-bearing droplets are propelled much farther than if they were emitted in isolation without a turbulent puff cloud trapping and carrying them forward. Given various combinations of an individual patient’s physiology and environmental conditions, such as humidity and temperature, the gas cloud and its payload of pathogen-bearing droplets of all sizes can travel 23 to 27 feet (7-8 m).
DIGLLOYD: those distance figures make MUCH more sense to me. I could not have said how far but it’s obvious that 6 feet 2m was never realistic.
: A novel study by MIT researchers shows that coughs and sneezes have associated gas clouds that keep their potentially infectious droplets aloft over much greater distances than previously realized.
“When you cough or sneeze, you see the droplets, or feel them if someone sneezes on you,” says John Bush, a professor of applied mathematics at MIT, and co-author of a new paper on the subject. “But you don’t see the cloud, the invisible gas phase. The influence of this gas cloud is to extend the range of the individual droplets, particularly the small ones.”
Indeed, the study finds, the smaller droplets that emerge in a cough or sneeze may travel five to 200 times further than they would if those droplets simply moved as groups of unconnected particles — which is what previous estimates had assumed. The tendency of these droplets to stay airborne, resuspended by gas clouds, means that ventilation systems may be more prone to transmitting potentially infectious particles than had been suspected.
...Their conclusions upend some prior thinking on the subject. For instance: Researchers had previously assumed that larger mucus droplets fly farther than smaller ones, because they have more momentum, classically defined as mass times velocity.
DIGLLOYD: in science, assumptions are a Very Bad Idea.
I am glad to see real science confirm what I assumed all along, that droplets have a far broader range than believed. That the droplet lifespan is much longer than believed by a factor of up to 1000 compounds the significance geometricaly: longer lifespan multiplied by much broader distribution might mean 10000 times more risk than assumed.
Remember all those people returning home a month ago, packed in like sardines at customs? Think of the awesomely high risk of infection by airborne means under those conditions.
Fndings like these suggest that the main driver of COVID-19 infection is airborne transmission*. There never has been any credible alternative explanation, and that should have been obvious from the start, hence my January29 recommendation for masks.
The failure of public health officials to mandate the use of facial coverings in public places during this pandemic was and is in my view medical malpractice.
Obviously when a mask blocks the yuck, spread is massively reduced. In that post, I had written “I’d guess 100 times higher than if that cough had been blocked by a facial covering”). It should be obvious to anyone with a few neurons still firing that blocking a violent spewing of respiratory yuck with any covering is vastly superior to an unrestricted blast. Hence the “cough into your elbow” advice. I can’t see how it takes much mental effort to make the connection between “cough into your elbow” and wearing a facial coverings. The WHO, CDC, Surgeon General are not as abjectly stupid as they appear to be, but something far more diseased.
Would COVID-19 could have been hugely reduced in spread and many lives saved if only the so-called experts in the WHO and CDC had not been so pedantically dogmatic and presumptuous about their knowledge?
* By “airborne transmission” I mean both spread directly through the air as well as the contamination of surfaces (deposition of virions through the air). Though the key tranmission vectors as yet remain unproven, no other explanation makes sense, and 'airborne' dovetails perfectly with the high infection rates seen for passengers isolated on cruise ships yet infected anyway—ventilation system!
SARS-CoV-2 aka COVID-19: Humidity of 40% to 60% May be Ideal to Slow It, Low Humidity Might Enhance its Spread
Thanks to reader Joseph Holmes for passing this along.
Check this out!!! Awesome new data on airborne transmission. Two big things: laser imaging of actual sneezes and conversation sub-micron droplets and major research revelation regarding how relative humidity has a huge impact on how long aerosols stay airborne (30% being ~ 6X more hospital infection of various types than 40 to 60% rH).
Check out this superbly revealing Japanese experiment:
Best airborne transmission research yet! Fantastically revealing of what I had thought we'd never be able to see so clearly. Lasers were key to actually being able to see droplets down to 0.1 microns in diameter, brilliant idea. The virus ranges from 0.06 to 0.14 microns in diameter, if memory serves. Yes, "60 to 140 nm"
So that means that an average COVID virus would actually just barely show up in this ultra-sensitive way of detecting them. I hadn't imagined this would be possible, but it's exactly what's needed to see a literal picture of how such particles move. Fantastic!
Combine this with relative humidity (rH) as a newly-recognized, huge variable (see below), plus ventilation, plus 100 to 1 variation in how many droplets individual people expel when talking or coughing or yelling (I forget which if not all three) and wow, quite a picture is emerging of airborne transmission, the greatest mystery we're facing.
Also there is evidence that greater initial inoculation with the virus results in shorter incubation time and worse infection. And that living in polluted air greatly increases the severity of infection (I saw a figure of 90% worse).
Check out this stunning news about what a huge factor simple relative humidity is! In many climates a simple humidifier can work wonders. Like mid-US and eastern locations in winter and many other places, where strong, corrective humidification is absent. We have a cheap little hygrometer/thermometer battery powered gadget on the dining room table. It's now 61 F and 55% rH in here (it's been raining for hours). I've tested this cheap instrument and found it to be accurate. Much more accurate than the old, brass, dial-type.
There is an active conversation going on right now amongst ASHRAE and SAE interior climate control experts on COVID-19. The emerging recommendation is around the importance of maintaining humidity in the 40-60% range to help respiratory droplets "drop" to the ground vs. dry out and become aerosolized.
DIGLLOYD: it would be wonderful to nail down the humidity question and then figure out how to hit 50% or so humidity in all buildings, if it is indeed a significant influence on transmission.
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Includes images up to full camera resolution.
The 45mm focal length was as wide as I had, and lacking an L-bracket for the GFX100, I could only shoot in landscape orientation. Otherwise I would have shot vertically for more height. Still, light and wind do not wait long for panoramas anyway!
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The wind was violent, and even hiding behind a house-sized boulder I was unable to make any sharp images at any aperture other than f/1.8 while the peak color lasted—not even f/2.8 and not even trying multiple times—rather frustrating! And I would have liked to make a panorama too, but not feasible. A bit later after the color had faded, I was able to make mostly sharp images at f/7.1.
Sharpness across the frame suffers accordingly and yet the overall contrast characteristics of the Sony FE 20mm f/1.8G make the result a winner—thus an argument for a reasonably fast lens.
The full resolution image is found on this page:
Today and the past several days, the wind has precluded most photography—I just cannot count on getting a sharp image, even hiding behind house-sized rock formations. There is supposed to be rain coming for several days, so that should be super, and I hope it means snow down to 6000' or so, for beauty on the Mt Whitney range.
Fifteen minutes later, the wind settled just enough to make a reasonably sharp image.
As horrific as the SARS-CoV-2 virus is, I wonder: how many people nationwide were NOT killed or injured because of COVID-19*? And how that compares to COVID-19 deaths.
That is, by staying homes and with eerily empty roads, traffic accidents are reduced substantially. Similarly, people die from bad economic conditions, and many people are losing their life savings and investments (e.g., the person who invested everything in a small business). Suicides rise, other adverse health outcomes occur, etc. These things are well known from recessions and this is the mother of all recessions, and though hopefully short-lived, for too many, it will have lifelong effects.
* See for example: Special Report: Impact of COVID19 on California Traffic Accidents eg just in California alone “6,000 fewer injury/fatal accidents per month that can be directly or indirectly attributed to the shelter-in-place order”.
I am NOT making an argument in any way for reducing the efforts to fight COVID-19, nor am I taking any position on when the economy should reopen.
But at some point, only the irrational can argue that more deaths are better—that some kinds of deaths matter more than others (worth debating). The “crossover” day will come, simply as a matter of mathematics.
I’m guessing wildly that the crossover day will come by the end of May. But I also think that if we could get the supply of N95 masks along with training in their fitting such that everyone can wear one properly, along with glove use with frequent changes, we could bring that forward by 3-4 weeks. Maybe you should not go back to work until you are trained to wear an N95 mask properly and/or have proof of infection/recovery?
No matter what the President and Governors and Congress do, blame will be spread thickly for acting too soon or too late. But the mark of a leader is to make hard decisions and take the heat. I don’t have to like it, but I do respect it.
I for one am willing to accept any reasonably logical action which involves risk assessment, because no one can weigh all the factors or predict the future, and everyone weights the various factors differently. And that is why the advisory for the public to not wear masks infuriates me—it has no scientific or logical basis. But at least recommendations for mask use are finally changing*.
I take on the risk of driving for a benefit (getting where I want to go), and I take that on willingly and gladly. Such is life. Ditto for COVID-19.
* Ditto for the irresponsible medical profession and it’s paint-by-numbers statin usage—little or no risk assessment for individuals as a whole being, and near zero adverse event reporting by doctors. GIGO medicine.
Not that any of this makes me favor a quick change for myself and my wife and my parents—we are all higher risk and while my business is being hurt and I’m having to draw on savings, I favor a longer closure rather than a shorter one.
But my three daughters are being hurt every day by not being able to work and save for college, and the government does exactly zero for them (being on my tax return, they get $0 as part of the stimulus package and their colleges are not refunding them anything for their greatly altered college experience). So even within my own family, the decision on when to reopen the economy is conflicted! Millions more are being hurt also, and the government is so incompetent that at-risk people still won’t get checks for weeks to come.
There is confusion on the nature of COVID-19 (SARS-CoV2), due to choice of names.
Naming the coronavirus disease (COVID-19) and the virus that causes it
Official names have been announced for the virus responsible for COVID-19 (previously known as “2019 novel coronavirus”) and the disease it causes. The official names are:
Disease: coronavirus disease (COVID-19)
Virus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Why do the virus and the disease have different names?
Viruses, and the diseases they cause, often have different names. For example, HIV is the virus that causes AIDS. People often know the name of a disease, but not the name of the virus that causes it.
There are different processes, and purposes, for naming viruses and diseases.
Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines and medicines. Virologists and the wider scientific community do this work, so viruses are named by the International Committee on Taxonomy of Viruses (ICTV).
Diseases are named to enable discussion on disease prevention, spread, transmissibility, severity and treatment. Human disease preparedness and response is WHO’s role, so diseases are officially named by WHO in the International Classification of Diseases (ICD). ICTV announced “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” as the name of the new virus on 11 February 2020.
This name was chosen because the virus is genetically related to the coronavirus responsible for the SARS outbreak of 2003. While related, the two viruses are different. WHO announced “COVID-19” as the name of this new disease on 11 February 2020, following guidelines previously developed with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO).
What name does WHO use for the virus?
From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.
For that reason and others, WHO has begun referring to the virus as “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public. Neither of these designations are intended as replacements for the official name of the virus as agreed by the ICTV.
DIGLLOYD: “the virus responsible for” instead of “SARS-CoV2” is a bit too Orwellian for me. Maybe more fear would have resulted in better outcomes?
Lying to people and confusing the facts never leads to better outcomes IMO. Perhaps if people had heard “SARS”, the disease would have been taken more seriously earlier, including mask use. But that’s only my speculation and no one will ever know. As a policy issue with political aspects, it seems to me that the public ought to have a say in the matter.
Three examples, commentary deferred.
Includes images up to full camera resolution.
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Let’s not call COVID-19 for what it is: SARS-CoV2 (SARS = Severe Acute Respiratory Syndrome). It might scare the public, and that is terribly important, more important than life itself for some.
The WHO and CDC are managed by Good Guys who will protect us. Except that they are politicians and intellectual crooks.
Person to person transmission is unlikely. The “experts” told us so.
Masks are a stupidly useless idea for the public; the virus knows this, so they work only if your job is a healthcare worker. You, dear reader, are a moron for thinking masks might be a good idea. The “experts” told us so.
How many particulate respirator masks are we making to protect people, and when will we have enough? The powers that be are clueless in understanding this and many similar things that are critical to know. If you cannot measure it, you cannot manage it.
Let’s admit tens of thousands of people from China, a good number of which might be carrying SARS-CoV2. (see 430,000 People Have Traveled From China to U.S. Since Coronavirus Surfaced).
There were 1,300 direct flights to 17 cities before President Trump’s travel restrictions. Since then, nearly 40,000 Americans and other authorized travelers have made the trip...
Don’t let any of this bother you—after all, if you or a loved one die leaving a vast painful vacuum in psyche, someone has to be a statistic—do your 'duty' to the powers that be, sorry excuses for human beings though they be. Or maybe they are just typical examples? Life will go on without you or the ones you love so cheer up.
Of course, sarcasm should be understood in the foregoing.
Do our politicians fucking understand any of this, or how awful it all is?
If you ever doubted the government was incompetent and should be strictly limited...
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Scaling to 240 Megapixels with Gigapixel AI: the Voigtlander 50mm f/2 APO-Lanthar image “Alabama Hills Plain View to Mt Whitney Range”
Accordingly, I’ve added a 240 megapixel scaled image to this series:
This crop is from the 240 megapixel image, scaled from the 60 megapixel shown below it.
Shootout: Fujifilm GF 50mm f/3.5 R LM vs Fujifilm GF 45-100mm f/4: View Over Granite Formations to Mt Whitney (Fujifilm GFX100)
Update, morning of April 4: I’ve added more crops and substantially more commentary. My initial analysis was incomplete, and now the comparison lays bare all the aspects of what is going on with the zoom, and what you might do about it as a practical matter. After all, a zoom is awfully handy and put to many different purposes.
Includes images up to full camera resolution from f/4 through f/11
MD Franklin K in France writes:
As everybody on earth, we’re confined. For instance, last Sunday I drove 650 kms to go to my work town. I saw 4 cars… on a highway !! and very few trucks, maybe a dozen. It was incredible to drive alone on this highway, accompanied by snow - evident isn’t it ?
We just have 2 COVID-19 patients, but we’re not authorized to test them !! In France we don’t have any test and the Health Minister - a physician - proclaims it is not necessary. No swab, no biochemical material to perform the tests. The government concludes: no testing required. State lie. Make the word vanishing and the concept will die; exactly as in Orwell’s 1984 book. I’m living in a banana republic!!
For the first time in years, I'm angry:
- no face shield. While the Academy of medicine recommends the generalized use of masks... my department we have 58 high protection masks, which have to be changed every 2 hours. No deliveries for a month. Similarly, Macron makes a speech saying that "France has ordered a billion masks from China", whereas it should have been done a month ago.
- there are no more surblouses in France. The government is very proud to announce that 20,000 have been ordered in Turkey. 20000 !! We use 65 of them a day in my nephrology and dialysis unit alone.
- there is no more hydroalcoholic gel in pharmacies.
- we are beginning to run out of curare, which is used to prevent the movement of intubated and ventilated patients.
- Also, we're running out of sedatives.
- We're starting this morning to say that we may be running out of oxygen.
I'm disgusted. I knew the hospital was sick for 25 years, but not that sick.
I'm angry, very angry.
DIGLLOYD: this does not bode well for France.
Health care professionals have been heroes in this pandemic, but I don’t hold any of them by an conceivable moral standard to treat patients without protective gear. Were I a patient myself, I’d say “go home”—my problem should not require you to endanger your life on my behalf in such a dangerous way. I’ll take my chances rather than ask someone to take on my risk in an unreasonable way.
These examples taken in the Alabama Hills area.
Includes images up to full 60MP camera resolution, more for some panoramas.
The weather has now turned poor for photography: clear skies all day with haze. Not at all interesting compared to last week as with the image below.
Or singing or heavy breathing most of all, I’d bet.
Experts have figured out that SARS-CoV2 aka COVID-19* may be transmittable through the air after all.
Who could have guessed it? I mean, besides those without qualifications like you and I? It just had to be people having sex, or fecal-oral, or hand-to-mouth via surface contamination or something. Anything but the obvious—the computer models say so!
There is/was no credible explanation for the awesomely infectious efficiency of SARS-CoV2, something the experts have never bothered to acknowledge. Wait—I think I see those beautiful clothes the emperor is wearing...
Sure, that makes no sense at all but good models take a lot of work to build, and it is such a bother to form a hypothesis and prove or disprove it, especially if one has to leave the lab and see how the real world is behaving. And even more bothersome to question incestuous belief systems. And who wants to get fired for asking questions?
* The WHO and CDC Orwellian doublespeak term for SARS-CoV2 is COVID-19 / Coronavirus, an evasive term that hides its nature, those terms being medically and scientifically inept, but politically correct.
[Note the equivocal use of “may”...]
The coronavirus that causes COVID-19 may spread through the air in tiny particles that infected people exhale during normal breathing and speech.
Until now, experts have said that the virus, called SARS-CoV-2, doesn’t spread through the air in that way, but rather through relatively large droplets released when people cough or sneeze. Those droplets can contaminate surfaces or objects and infect people who touch the surface and then touch their faces.
Large droplets are still a means of infection, but researchers now say that tiny airborne particles may also carry infectious virus. “Currently available research supports the possibility that SARS-CoV-2 could be spread via bioaerosols generated directly by patients’ exhalation,” researchers from the U.S. National Academies of Science, Engineering and Medicine wrote in an April 1 report to the White House Office of Science and Technology Policy.
If the coronavirus is airborne, that could help explain why it is so contagious, and can spread before people have symptoms (SN: 3/13/20).
Note well the obvious contradiction between “public should not use masks” and “rather through relatively large droplets released when people cough or sneeze”. Lies and contradictions from experts.
And why do we need “help explaining” transmission—don’t the “experts” have that all figured out months ago with rigorous replicated studies? Ooops—it was all just guessing—tell that to the families burying their dead.
Experts are often the last to understand reality
You cannot trust official experts because they are so caught up in their own self pride and hyper needing to be right that the real world is just too inconvenient to deal with*. Or they have political considerations: government policy/guidelines, political correctness including misleading terminology, incestuous amplification of ideas, medical licensing boards, insurance companies, etc.
How much pure science exists today, unmolested by money or that litany of potent factors, and when large percentages of scientific studies are shown to be non-replicable along with dishonest failure-to-publish contrary studies? You don’t find what you don’t look for.
You and I just do not have the brains or training to have anything meaningful to say, wild-eyed ignoramuses that we are. So we should shut the f* up and let the experts tell us what to think.
Yes, I’m pissed off, really pissed off because people are dying needlessly.
This public health nightmare has been mishandled at every level by every leader and every organization that should have had their shit together. All incestuously parroting the same twaddle about masks and transmission for which they had no evidence. The whole lot of them should hang their heads in shame at their incompetence (I refer primarily to the CDC and WHO and Surgeon General, not to the heroes that are the frontline healthcare pros putting their lives on the line).
On the mask front, that huge “ship” has tremendous inertia and is still only slowly turning direction even as fools like myself have begun wearing masks, while the experts are slowly figuring out that the virus doesn’t care what your job title is.
* This is the same type of mentality has harmed untold millions of people with debunked dietary advice for decades, along with hundreds of other debunked medical lies that are still bandied about as true. The worst and most current of these lies being the worst of all time: the systemic poison of statins currently damaging untold millions of people.
I’ve added half a dozen examples below at full resolution in:
I just love how the Sigma FE 105mm f/1.4 DG HSM Art delivers outstanding real (actual) depth of field. It makes a terrific lens for panoramas and stitched images.
I really should buy this sample, because it shows perfect symmetry and amazing sharpness, better than the sample I tested on the Nikon D850 some time ago, even though the sensor on the Sony A7R IV raises the ante to 60MP.
As I anticipate 3 more weeks away from my family, staying here in the Alabama Hills I feel fortunate that there are no developed campgrounds in the Alabama Hills proper, hence I can hang out here. But if they close it, I’ll just go drive to some nice canyon on BLM or National Forest somewhere—anywhere with a cell signal. It would be stupid to close it, since no one is closer than a city block most of the time. I try to maintain at least 1/4 mile between myself and others, for noise and smoke reasons (can’t stand smoke and without it the air has been just wonderful).
Compared to usual, the Alabama Hills is practically empty with about 1/10 the usual number of visitors.
The Eastern Sierra area had been free of the virus until recently, but the virus has arrived in Inyo County and in Mono County. A few people are now wearing masks. I wore my N100 particular respirator and went through 4 changes of gloves today. My only risk is restocking, like I did today.
I just restocked in Ridecrest today, and I now have food for two weeks and water for about the same, and a water purifier if I really need one (the creek is not that far). The main thing is that ice only lasts 7 or 8 days in my cooler. So I’ll just eat all perishable food in that time frame. With the virus going nuts, I am going to settle in and just photograph and publish stuff and ride my bike and stay away from all risk.
Walmart is often and annoyingly low on stock, but they seemed unusually low today on many things, so I think there has been some buying urgency. OTOH, the store was lightly visited around 5 PM so I dunno.
Tonight, I am at the end of a long dirt dead-end road. The sounds I hear are owls and wind and that is as good as it gets—I feel lucky to be safe, and my family is stocked up and safe too. I hope most of you are lucky and fortunate too.
While here, I have been taking a straw poll of sorts (standing at least 10 feet back and there was appropriate wind so no risk). Almost all of these visitors were transient (a few days at most), unlike me:
- College students with no college to go to (remote study starting though). Just a weekend outing, all 6 of them with zero social distancing so either all were well or all were going to be all sick.
- A family from Switzerland in a rented RV with a baby and a 5/6 year old. Very nice couple “stranded” and I told them a number of other places to visit and hang out at.
- A couple from New York City, the guy being a photographer who had all his jobs canceled. So three weeks ago they left (good timing!) and are just enjoying themselves.... so much better than being in NYC.
- Another nice couple enjoying recreational marijuana and not worrying about much of anything out in the middle of nowhere.
- Various single people, and a few extended families.
Sony FE 20mm f/1.8 G Aperture Series: View Over Dry Wash to Early Sun on Mt Whitney Range (Sony A7R IV)
This series from f/1.8 through f/8 evaluates the Sony FE 20mm f/1.8 G on a near-far distance scene and looks at total sharpness near to far and edge to edge.
Shot in pixel shift mode, to my surprise and delight the pixel shift images worked well and are used here, thus showing off the true resolving power of the lens with a stunning level of detail.
Includes images up to full camera resolution.
Also added is an 87-megapixel panorama of the same scene, here:
The about $898 Sony FE 20mm f/1.8 G looks to be a tremendous value.
You have been lied to in the most grotesque (deadly) way possible by the CDC, WHO, Surgeon General, etc. But the criminally negligent stupidity should soon end, as logic and sense prevail. Will we see the infection rates drop after mass adoption of facial coverings? Place your bets now.
Please see my post from two days ago, COVID-19: Public Policy MUST be Changed: Facial Coverings should ALWAYS be Worn To Protect Others as well as all my COVID-19 posts.
I have long recommended an N95/N100/P100 particulate repiratator for many reasons and they are excellent for COVID-19. Stock up when they are back in ready supply but read my usage tips in various older posts—many are hard to breath through when exercising.
Take a deep breathing for a few minutes first because they might make you angry once you see what so-called experts have been telling you versus a much more logical / sensible set of courageous professionals think.
'Stealth Transmission' of COVID-19 Demands Widespread Mask Usage, by Barbara Einav, MD and cardiologist and clinical assistant professor at SUNY Upstate Medical University.
Much of Central Europe is now following the example set by China, Taiwan and South Korea. On Monday, Austria mandated its citizens wear masks when outside the home, after the Czech, Slovak and Bosnian governments issued similar orders.
So one tests positive for SARS-CoV-2, not Covid-19, as it’s the virus and not the disease that does the infecting...The WHO writes on its website that it steers clear of SARS-CoV-2 because “using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations”...
Last I recall, masks were a good idea for SARS.
Encourage the Public to Wear Masks. There is emerging evidence that asymptomatic and presymptomatic transmission of COVID-19 is possible, which complicates efforts to pursue case-based interventions.
To reduce this risk during Phase I, everyone, including people without symptoms, should be encouraged to wear nonmedical fabric face masks while in public. Face masks will be most effective at slowing the spread of SARS-CoV-2 if they are widely used, because they may help prevent people who are asymptomatically infected from transmitting the disease unknowingly.
Face masks are used widely by members of the public in some countries that have successfully managed their outbreaks, including South Korea and Hong Kong.20 The World Health Organization (WHO) recommended members of the public use face masks in the event of a severe influenza pandemic.
We have to reopen sometime.
... However, people should not go out and purchase critical N95 and surgical masks, which are desperately needed by health care workers...
Experts believing that novel coronavirus is primarily transmitted through the droplets of an infected individual — something that happens when they cough or sneeze, for instance — and that fabrics can filter them out. “This not only helps to reduce the risk a well person can breathe those droplets in, but also protects others around someone with mild symptoms who may not yet realize they have the illness,” the agency’s release stated. As a result, residents should strive to wear some type of face covering anytime they leave their homes to perform essential tasks, like going to the supermarket or visiting the pharmacy. Even with masks, people will still need to continue the practice of physical distancing and staying home when possible. Frequent hand washing and the use of hand sanitizer are also still being advised. “It’s an extra layer of protection that I think we need to add,” Kaiser said of the face coverings.
DIGLLOYD: even though it is clearly stated, I wonder if at least some portion of the public will remember “N95 not good” and that is not good. The whole statement is pointless anyway, since there are none to buy, and the government can comandeer the supply and/or prohibit sale to consumers at any time, if this has not already been one. I also rather wonder whether equipping every person with an N95 mask might in fact be a net win for slowing spread and lowering deaths—just a thought, not stating it as probable. But it could be so and no one knows.
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COVID-19: Nebraska Medicine: “Study documents widespread contamination of the environment near patients with COVID-19”
Please see my post from two days ago, COVID-19: Public Policy MUST be Changed: Facial Coverings should ALWAYS be Worn To Protect Others. I’m “all in” here—I sure hope I am totally, utterly wrong.
This study is far from the end of the story; it's just a bare start. But it raises the prospect of airborne transmission of COVID-19 as well as surface contamination via the air, e.g., coughing/sneezing/breathing causing virions to land on surfaces. Either way, wearing a facial covering (ideally an N95/N100 mask when supply ramps up), might greatly reduce such spread.
IMPORTANT context about this information: Our findings DO NOT confirm that this virus spreads in an airborne fashion. The identification of genetic material from the virus that causes COVID-19 in air samples found in this study provides limited evidence that some potential for airborne transmission exists. More study is underway to determine if live culturable virus was captured in this study and additional evidence is needed to determine the risk of SARS-CoV-2 transmission via the airborne route. PLEASE EMPHASIZE THIS in all stories generated from this release.
...The study suggests that COVID-19 patients, even those who are only mildly ill, may create aerosols of virus and contaminate surfaces that may pose a risk for transmission.
...Many commonly used items, toilet facilities, and air samples had evidence of the virus, indicating that SARS-CoV-2 is widely disseminated in the environment. These findings indicate that disease might be spread through both direct (droplet and person-to-person) as well as indirect contact (contaminated objects and airborne transmission) and suggests airborne isolation precautions could be appropriate.
Studies like these are needed to understand proper precautions for healthcare workers, first responders and others who care for the ill and are needed to combat this pandemic,”...
DIGLLOYD: so if I’m not a healthcare worker, I don’t need to take similar precautions? The virus knows my job?
Shouldn’t “airborne isolation” start at the source by blocking respiratory particles from coughing/sneezing/breathing? Surely this suggests that everyone should wear a facial covering until we are sure, as a precaution against a deadly threat? If a facial covering reduces transmission by, say, 10% that would be a huge win.
Point is, as a public health precaution, a facial covering would block most respiratory particles, so whether it is direct airborne transmission or surface contamination (via coughing, etc), both would be greatly reduced (blocked) by the covering.
To suggest that the general public need take only basic precautions such as 6 foot distancing and hand washing—well, how is that working for us folks?
NuGard KX Case for iPhones and iPads.
Outstanding protection against drops and impact!
Plus, excellent grip for wet hands, cycling, etc.
COVID-19: Facial Covering (Mask) Policy: Will Public Officials Take Full Responsibility for Bad Advice? (if so-proven)
Please see my post from two days ago, COVID-19: Public Policy MUST be Changed: Facial Coverings should ALWAYS be Worn To Protect Others. I’m “all in” here—I sure as hell hope I am totally, utterly wrong.
Summarizing, my position is that ALL persons entering any space frequented by others should wear a facial covering over nose and mouth, primarily to block viral spread by blocking droplets/particles from coughing/sneezing/breathing.
I say “facial covering” because just about anything blocks particles to a good degree, and that is proven by science. Even 50% blockage is hugely better risk reduction than 0%.
I also assert that doing so is zero-cost in terms of public health, with a huge potential upside in taming the wildfire spread of the disease. Whereas the alternative of the public goeing without facial covering is scientifically without supporting data and carries an enormous risk. What is the harm exactly of blocking respiratory particles if only with a handkerchief when someone coughes or sneezes or breathes?
Pushback, paucity of science, but some emerging evidence
I am still getting pushback from some, whose position is that facial coverings (not necessarily an official mask) should not be worn, or are even harmful. Ironically, this position stems from “no science for it”, yet there is no science to prove otherwise! However, every MD that has emailed so far is in agreement*.
Just today, the USA Surgeon General reiterated the no-need-for-masks advice we have seen for months, even as the infection rate goes exponential. People are dying by the thousands, and these officials have no science to back up their recommendation—they are guessing (or have some unstated policy objective; I cannot read their minds).
Even today, the experts cannot tell us the primary mode of transmission—they don’t know, all they have is unproven hypotheses. Yet they are willing to put our lives at risk via guesswork*. The question remains open and poorly understood, with only initial efforts that are not definitive:
Is it credible that the majority of infections come from direct contact with surfaces, on which we are told the virus cannot live long except on certain ones? Is it credible that this contamination comes only from direct contact (e.g., not from the air)? Do we really think that the fecal-oral route is a major vector when most all restaurants are closed (little food handling)? Sure, it’s possible those are the only primary vectors of infection, but that would suggest that hand washing is either not being done or is being done ineffectively. Because if it’s not through the air, then it must be via hands (to mouth/nose/eyes).
Far more credible is that airborne transmission of some kind is hugely important. If only because coughing and sneezing spread the virus onto nearby surfaces, where hands can then pick it up. Direct airborne transmission seems likely too and facial coverings block both situations.
How did all those cruise ship passengers get infected, if not through the HVAC system? By being locked in their rooms out of contact with others? Seriously?
The tide is turning, and ignorance will have to fade
The tide turning in the press. And soon we will see more studies showing that COVID-19 virions can travel through the air surprising distances. But who on earth wants to wait a year for absolute certainty when simple hygienic precautions (facial covering) have no downside?
What kind of social unrest will ensue when the public sees they have been lied to in the most grotesque way possible? Distrust in health authorities stemming from a mistake of this magnitude cannot be undone; it will last for generations and have downstream repercussions we cannot yet imagine.
* If you are an MD or epidemiologist or similar, and have a reasoned position of your own not based on groupthink, please email me and tell me why you think facial coverings are a bad or useless idea—I will publish it.
** It is a fact that experts in the medical field have made huge numbers of errors in medical beliefs since the days of leeches—it is almost the rule, rather than the exception. It’s a tough field to work in, very complex. All I look to see is clear and free thinking, free of groupthink and based on repeatable non-corporate-funded and non-political hard direct science—errors are par for the course and all anyone can do is their best.
Fujifilm GF 50mm f/3.5 R LM WR Aperture Series: Alabama Hills View Southwest to Receding Sierra Nevada, Last Color in Sky (Fujifilm GFX100)
This series from f/3.5 to f/10 was shot in the Alabama Hills near Mt Whitney, looking southwest towards the receding Sierra Nevada range, and Owens Lake. It looks at sharpness near to far and across the frame.
Just how good is f/3.5, and which aperture is optimal?
Includes images up to full camera resolution.
The Fujifilm GF 50mm f/3.5 R LM WR would be my #1 all-arounder on Fujifilm medium format — fantastic consistent performance.
Update March 30: the $500 deal on the GF 50/3.5 is gone as of today; it's back up to $999.
Also added are a couple of panoramas to the examples page.
Fujifilm GF 50mm f/3.5 R LM WR Aperture Series: Alabama Hills Granite to Whitney Range (Fujifilm GFX100)
Includes images up to full camera resolution.
WOW—if you are a Fujifilm medium format user, you want this dirt-cheap lens. At 1/3 the price of the 63mm f/2.8, this 50/3.5 is a total steal—and I think the 50/3.5 is a better lens!
Update March 30: the $500 deal on the GF 50/3.5 is gone as of today; it's back up to $999.
UPDATE March 30: this link sent to me form Dr S just showed up today. Emphasis added. Be sure to read the whole 2-page article (not just the first page).
UPDATE April 7: see this short video at Petapixel: This Old Photo Technique Shows How Masks Help Prevent the Spread of COVID-19. The short video shows how effective a mask against coughing.
This doctor’s article totally vindicates my position, which I lay out further below, and which I published before this doctor’s article was published.
Layman translation for the public: the CDC, WHO, etc are in effect INFECTING and KILLING PEOPLE with their idiotic anti-scientific guidelines. I predict that we will see a reversal of the mask guidelines, well after thousands of people have met their demise, needlessly—it’s a statistical certainty.
Huge kudos to this doctor for speaking out. The medical establishment, licensing boards, insurance companies, etc can exert enormous pressures on doctors who do not toe the line on official guidelines—it is far removed from a free market of ideas.
'Stealth Transmission' of COVID-19 Demands Widespread Mask Usage, by Barbara Einav, MD and cardiologist and clinical assistant professor at SUNY Upstate Medical University.
I was concerned to see that most healthcare workers (HCWs) and patients are still roaming the hospital floors and the emergency department without wearing masks. Hospitals are citing guidelines from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) restricting mask use mostly to close encounters with symptomatic individuals or confirmed cases with COVID-19.
I decided to research the evidence and justification behind official prevention guidelines. My findings were rather striking.
It is widely agreed that face masks (even surgical masks and non-fit-tested respirators) are an effective barrier against COVID-19, as its primary mode of transmission is through respiratory droplets. Contrary to common belief, however, respiratory droplets are released not only when sneezing or coughing, but also when talking.
... Still, the CDC strongly discourages mask use in the community or by healthcare workers when not directly exposed to a symptomatic individual. The message from authorities is clear: Among asymptomatic individuals, masks are not effective against the spread of COVID-19. In fact, facing a nationwide shortage of masks, the surgeon general tweeted, "STOP BUYING MASKS!"
To be clear, mask use is one of the most effective physical interventions to prevent the spread of respiratory viruses. A comprehensive Cochrane review examined multiple physical preventive measures (eg, screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) and found that masks were the most consistent and comprehensive measure.
... As the weight of evidence shifts toward supporting a major role for asymptomatic transmission, the use of personal facemasks, especially in crowded areas, becomes instrumental in preventing community spread of the virus. We can no longer rely on symptoms or screening to tell us whether mask protection is needed.
... Asymptomatic transmission was also estimated in multiple modeling studies of the outbreak. A study published in the journal Science shows that "nondocumented infections were the infection source for 79% of documented cases." Jeffrey Shaman, the lead author, stated that this "stealth transmission" is flying under the radar and becoming a major driver of the epidemic.
... In the meantime, homemade cloth masks could be used in the community, similar to CDC advice to HCWs "when no facemasks are available." Limited data suggest that cloth masks protect against droplet transmission better than no barrier.
The idea that masks or facial coverings don’t limit the spread of disease is absurd. That the WHO and CDC advised going without is criminal negligence.
My original post, below, March 29 2020
Ask yourself why a surgeon wears a surgical mask, even though s/he is not sick.
Not being an MD, my views are dismissed by many people. So here is one MD, Associate Professor of Neurobiology and Bioengineering at Stanford, Michael Lin.
There are only two realistic and common ways the COVID-19 virus can be transmitted:
- Airborne particles containing virions—infection by inhalation. An N95 or N100 mask addresses that risk for those who have them. This is why health care workers are up in arms about the shortage.
- Contact with contaminated surfaces e.g., hands that pick up virus then go to mouth/nose/etc.
We can safely ignore sex, fecal contamination, etc as extremely unlikely to be more than footnotes in transmission of COVID-19.
My assertion is that coughing and sneezing into open air that other people might inhale is a likely mode of transmission, perhaps even the primary mode (no one knows yet). That includes directly breathing that air as well as the surfaces upon which droplets land.
If that is so, a facial covering should be the #1 means of reducing virus transmission. If that is not true, then why do we need social distancing at all? Surely one cough with thousands of virus-infected tiny droplets spewed out violently en masse is 1000 times more infectious than just breathing air from normal exhalation.
A facial covering will block most all such particles from getting into the air. We all know this and if you need reminding, pick up a napkin and cough into it. Or cough without one onto your kitchen table. Why public health officials don’t 'get' this is baffling. The professionals are getting infected with full protective gear, public health officials are telling the public that masks are useless.
Nationwide Public-Policy Proposal
PURPOSE: stop the dispersal of virions by coughing/sneezing/forceful exhalations, and thus reduce both airborne and surface contamination, and thereby reduce hand-to-face transmission as well.
- All people in all spaces frequented by others should wear a facial covering over mouth and nose in order to protect others in the event of coughing or sneezing.
- All people entering any space frequented by others should wear fresh disposable gloves, removing them upon exiting that space and changing them frequently. Hand washing is highly encouraged also, but not a substitute for keeping contamination off hands in the first place.
If such a policy reduces transmission by 50% or even 20%, that’s a HUGE win. Even 5% is a huge win. It’s a certainty that it will have some effect, so why is it not public policy?
Perfect? Of course not. We are talking about reducing the risk, not eliminating it!
Do we need an MD to tell us this makes basic hygienic sense? Don’t be ridiculous—officials are telling us to take the risk without any data at all. Fact is, coughing/sneezing could be the primary mode of transmission and this has not been proven or disproven. Meanwhile, doctors and nurses are up in arms from lack of protective gear, particularly masks.
LIES to the public
From today’s WSJ:
“I got infected even wearing all of my protective equipment,” said Shelley Urquhart, a pulmonary and critical-care nurse practitioner at Norton Audubon Hospital in Louisville, Ky., who tested positive for the virus last week.
The WHO, CDC, surgeon general, etc have ALL promulgated and continue to promulgate the grotesque lie that the public does not need to wear masks. Statistically speaking, the failure to wear masks has surely cost lives and will continue to do so. The intent presumably was to preserve mask supply for health care workers, but the perverse consequences of escalating infections and death are surely the result.
Count me out on ever trusting these organizations again for any advice on personal protection.
Whoever is stupid enough to not understand the concept of “friction” (reducing any problem with retarding mechanisms)—MD or not—is a total moron. Why the FUCK are public health officials LYING to us about masks? You DO NOT fuck around with stuff like this. You DO NOT lie to the public and endanger them based on ZERO data. This thing is deadly and spreading, and these assholes are putting everyone at risk. And that is too-gentle language when people are dying in droves. Assholes who are traitors to humanity.
- The fact is that when someone coughs or sneezes, this is a virion-dispersal mechanism. Imagine yourself within 10 feet of an infected person who coughs in your direction or where the air moves towards you after the cough: what do you think your odds are of being infected? Twice as high? Ten times as high? I’d guess 100 times higher than if that cough had been blocked by a facial covering, thus blocking thousands of tiny wet droplets containing virus.
- No one knows the primary mode of transmission of COVID-19... direct person-to-person, droplets in the air from coughing or just breathing, touching surfaces contaminated (how contaminated?), etc. Yet the “experts” claim that masks are useless for the public. It is highly plausible that a single cough can contaminate at least 1000 cubic feet of air and nearby surfaces. So blocking droplets from a cough should be given very serious thought.
- The public is getting infected by the public and none of the experts can say it’s not through the air via coughing and sneezing (or just breathing). Yet the experts recommend that the public should not wear masks. Where is that hard data showing that masks are useless and unnecessary? Why do doctors and nurses need them?!
- The 6-foot rule is absurd; I have seen my own snot fly 20 feet, and there are often air currents, even indoors, that can quickly move small droplets 20 or 30 feet. Put 10 people in even a moderately large room with any kind of HVAC and pretty soon one cough or sneeze is in the entire room. Within minutes, everyone is breathing in that air. But what if that person had worn a face covering? Most or all of the infectious droplets are still in the fabric of that covering after a cough! Any covering.
- The fact is that when someone touches their face, infectious agents transfer from fingers/hands to nose/mouth/eyes and the fact is that if ANY facial covering is worn, from a surgical mask to a handkerchief to a full N100 mask, the ability to easily touch one’s nose or mouth is STOPPED. This alone makes ANY kind of facial covering worthwhile to avoid self transmission (hands to mouth/nose). Eyes are still a possibility but nothing is perfect.
Eeraj Q writes:
Saw your notes on COVID-19 / masks. Passing along this link in case you want to share on your site: https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/
DIGLLOYD: looks plausible. I am sticking with my position that at the least, blocking coughs and sneezes and reducing facial contact by hands is WAY better than no mask at all.
"Thanks to you, and to your early alerts, my family was able to acquire the small amount of N95 and N100 masks we needed, just in time."
Yes, same message and thank you from me - you were right, and I am glad I trusted your early warning.
DIGLLOYD: in spite of the warning, I was not smart enough to get a supply for my family; we have one or two per person and fortunately can all self isolate and so the masks remain adequate due to little need.
Michael E writes:
If we all wore masks, there would be less for the doctors and the nurses to do. This in response to people SHOUTING AT ME online for suggesting to my blog folks (7600 or so) that we should all have masks, if only for the sake of not contaminating others. As for me, a surgical mask prevents that (a bit), but I would rather wear a N95 or P100 mask, although they are hard (for me) to breath through.
DIGLLOYD: agreed, but I will say “any facial covering”—if only to block thousands of tiny infectious droplets from entering the nearby air when coughing/sneezing/etc. These droplets that can land directly on faces or hands, or be inhaled, or land on surfaces. You can feel them if someone coughs towards you!
Per K writes:
Regarding face masks, For the public not using a mask is better:
- An efficient face mask requires proper handling (tight, take on/off handling the wrong way can be a disaster) by pro's
- A mask can give you a false security - very dangerous. Looking at people that wear mask many are useless to begin with and people take them on/off al the time.
- There is a huge global demand for masks at the moment
- let's prioritize those who work with the patients and those who take care of our elderly.
- Social distancing IS effective
DIGLLOYD: these views are IMO quite dangerous.
For starters, the first item is not even on topic—my key point in this post is blocking transmission of infectious particles due to coughing. This post was NOT about filtering out 100% of the virus in air breathed in. The point is to drastically reduce infectious particles in the air to begin with!
If I am right about this even to the extent of only a 10% risk reduction, then the public policy of no-mask-use will kill thousands of people. I very much wish to be wrong on this. But the fact is that aerosolizing the virus into droplets when coughing must be assumed to be very dangerous to those nearby (far more than 6 feet / 2 meters), and no expert can refute that with any data whatsoever.
There is no proof or study of any kind supporting the idea that NOT using a mask is as good as using one. And it directly contradicts itself by saying that we should save them for professionals. What would be the point of that if they don’t do anything useful? Mask supply will increase rapidly, and mask sterilization is close at hand as well. So if we see a reversal of public policy once supply is adequate, then the lie should be fully exposed, and we will know that our experts have caused thousands of deaths, needlessly.
Why would social distancing be needed at all if airborne transmission were not a causal factor? It could just be “no touching” instead. Surely coughing and spewing thousands of droplets is 1000X worse than just breathing normally.
Have you ever had anyone cough towards you and felt the droplets on your face? I have, many times—it’s gross. I can feel the droplets landing on my face. But even if you cannot feel them, they are there, and it takes only one near a nostril or mouth and the infection is transmitted. So block those droplets with a facial covering.
I have clearly stated that “any facial covering” is worthwhile in order to protect others by blocking thousands of tiny infectious droplets when coughing/sneezing/etc, droplets that can land directly on faces or hands, or be inhaled, or land on surfaces.
I have used the term “facial covering” in my post above, any facial covering. Because any facial covering blocks thousands of infectious droplets from entering the air space when coughing. It doesn’t matter if a few percent get through. It’s all about risk reduction. Which is what ALL medicine is about—nothing is 100% safe and effective.
If infected persons all wore masks, the risk of transmission to those very same professionals would be lessened. Ditto for transmission to the rest of the public. Therefore, everyone should wear a facial covering whenever in a space used by others, since we don’t know who is infected and it is exponentially increasing.
In no way have I suggested that social distancing should be lessened. Indeed, maintaining and increasing social distancing is implicit in my example of 10 people in a room—it’s dangerous to be near other people who may be infected, and we can count on airborne transmission as a likely culprit. Until science rules that out (highly improbable!) it must be assumed as a key vector.
The one thing I agree on above is that *if* wearing a mask decreases social distancing or similar, then the benefit of a mask will be offset by some unknown amount. But the mask will still block a cough and will still capture some amount of infectious particles. Thus I deem that statement highly speculative and without supporting evidence of any kind. Moreover, there are situations where close proximity cannot be avoided.
Michael R writes:
Definitely in agreement with you Lloyd. During the H1N1 outbreak I purchased a box of 24 n100 masks, it just seemed prudent. They came in handy during the Norcal fires and while doing drywall repairs during a renovation. They are well beyond their expiration date, but appear perfectly good inside their sealed individual packaging.
I felt the guidance against mask usage was patently ridiculous, and hid the real motivation… saving masks for healthcare works given a lack of preparation and supplies.Equipping healthcare workers is obviously a critical priority but arguing there is no utility for the public is completely disingenuous. Every virus micro-droplet blocked at source or at a recipient has a positive outcome value.
I gave three last week to front-line workers at my grocery store… I hope they are wearing them now. As soon as supplies are plentiful again, I’ll be purchasing another supply of the best possible masks for the next wave of COVID-19 or whatever comes next.
We have earthquake kits in CA, masks and their use should be part of everyone’s personal healthcare protection. Thanks for helping puncture this disinformation. Undoubtedly it will be clear the mask prohibition was wrong.
DIGLLOYD: well done!
Reader Staale A writes with a link to OurWorldInData.org, which among other things does a great job of explaining the CFR (Case Fatality Rate) and IFR (Infection Fatality Rate), the latter being a total unknown. It is by far the best discussion I have seen of COVID-19 infection and mortality—excellent analysis and logic.
That page should be required reading for every member of the media, which is wrongly characterizing so many things, including COVID-19. And for those so inclined to read and understand the article, you will acquire a critical skill in understanding just how bad the media is at explaining what is going on.
Case Fatality Rate (CFR) = (Number of deaths from disease) / (Number of diagnosed cases of disease)
Crude Mortality Rate (CMR) = (Number of deaths from disease) / (total population)
Infection Fatality Rate (IFR) = (Number of deaths from disease) / (number infected)
The various graphs are the best I’ve seen in coverage:
For those who are still saying “it’s just the flu”: infection rates are escalating (this thing is just getting started) and the Case Fatality Rate (CFR) is so far 12 times higher for all ages. The graph below should make anyone in a higher-risk group concerned enough to take every possible precaution.
The key point is that the “case fatality rate”, the most commonly discussed measure of the risk of dying, is not the answer to the question, for two reasons. One, it relies on the number of confirmed cases, and many cases are not confirmed; and two, it relies on the total number of deaths, and with COVID-19, some people who are sick and will die soon have not yet died. These two facts mean that it is extremely difficult to make accurate estimates of the true risk of death.
What we want to know isn’t the case fatality rate: it’s the infection fatality rate
Remember the question we asked at the beginning: if someone is infected with COVID-19, how likely is it that they will die? The answer to that question is captured by the infection fatality rate, or IFR.
However, the total number of cases of COVID-19 is not known. That’s partly because not everyone with COVID-19 is tested..... and despite what some media reports imply, the CFR is not the same as – or, probably, even similar to – the IFR. Next, we’ll discuss why.
The case fatality rate isn’t constant: it changes with the context
Sometimes journalists talk about the CFR as if it’s a single, steady number, an unchanging fact about the disease. This is a particularly bad example from the New York Times in the early days of the COVID-19 outbreak. But it’s not a biological constant; instead, it reflects the severity of the disease in a particular context, at a particular time, in a particular population...
Importantly, this means that the number of tests carried out affects the CFR – you can only confirm a case by testing a patient. So when we compare the CFR between different countries, the differences do not only reflect rates of mortality, but also differences in the scale of testing efforts.
What we do know if that the mortality risk is higher for older populations and those with underlying health conditions such as cardiovascular disease, diabetes and respiratory disease – we look at some preliminary evidence for this in our full coverage of the COVID-19 pandemic here.
OK, I’m toast from getting up at 5 AM and I will have to sleep late tomorrow. At my middle age, I can only burn the candle at one end, not both ends as when I was in my 40's.
I’ve added the 232-megapixel panorama below to this example page:
Includes images up to full camera resolution.
Below, I was wrapping up my shooting when this oddball veiled lighting showed up. I am pretty sure I could “pop” this image nicely given more time and effort, but I’m enjoying it as it stands. It shows the Alabama Hills and nearby Sierra Nevada with Lone Pine Peak and Mt Whitney combined in a way not often seen.
Thank you to knowledgeable readers, particularly medical doctors, who have given me sound perspective over the past few days—much appreciated!
Looks like I will be living in my van for at least 2 more weeks and maybe another month! I have zero risk of infection except when getting supplies every 10 days or so.
Asking around, and ready to be proven wrong by facts, I nonetheless retain my optimism that in ~2 weeks (by mid April) medical professionals will have at least some hints at where we might go from here in terms of drugs to treat COVID-19, as well as faster and hopefully more accurate diagnosis, along with improved triage and initial treatments.
The triple-drug treatment involving hydroxychloroquine might be a dud, might be premature optimism. Apparently there are more than a dozen protocols being tested with many different treatments. Of those, if only one of those treatments works well (and is widely available), we are in much better shape. Two weeks should tell us something, given the rapid progression of the disease.
One big problem I see in managing the whole thing is that apparently we do not have a test for infected/recovered/virus eliminated from the system people, which would require some kind of antibody test. So we do not know who is “safe” and we do not even know for sure if re-infection is possible. Not good.
While people are dying from COVID-19, having everyone isolate for months will be a disaster with repercussions for years to come and cause deaths by various other mechanisms. I hope the experts can figure out the tipping point between more versus less harm as infections rise. If there is immunity, I wonder if the requirement to wear a visible “I recovered” badge might be socially useful for getting things functioning again.
A light at the end of the tunnel is badly needed. And it doesn’t matter much whether the optimism is unfounded for 'A', should 'B' comes along instead and prove-out as a solution.
- I have myself and my wife and my parents all in the 'kill zone' and so a lot on the line. I know people that if lost would shake me badly. So do you all. I’m doing my best to talk about this whole thing in my own way, so I hope that “mind reading” my thoughts and intentions will be suspended among my readers, and my good intentions taken as default. I will be wrong about some (maybe many) things, but my heart is in the right place.
- Would it make sense on a strictly volunteer basis for young low-risk people to volunteer to travel to special tent-city “infection camps” of 10K people or so in isolated areas to gain immunity for ~1 month and thus get them recovered and non-infectious and then back to work (wear a special badge of honor?) quickly so as to protect the rest of the country from transmission vectors and to have able-bodied workers? Terrible idea? Probably, but I don’t know but I wonder if such ideas are at least considered by experts.
- Public policy is incoherent with respect to those most at risk. It might be time for those at high risk to be handled specially: strict limitations on movement and exposure along with special services like home delivery of all necessities so that those at risk need not expose themselves. Good idea or bad? Not for me to say, but I do know that we cannot afford to have too many at risk people get seriously ill, or the entire care system will collapse. If you are at low risk, see what you can do to help your neighbors who might need help, such as getting groceries or medications or whatever, all with appropriate protective gear of course. I don’t understand why the government is not directly forming such groups, or some private company, like Apple or Google or whatever.
- As an entirely apolitical question: it good or bad for a President (any President, set aside politics!) to offer unfounded optimism, e.g., “encouraging results” that remain entirely unproven? Is it better to remain non-committal or even to express alarm/negativity? Or just shut up and let doctors communicate, most likely in terms most people cannot understand? I tend to be in the camp that optimism is better, even if it doesn’t pan out with 'A', and 'B' arrives to the rescue instead. I don’t know what is best, but I doubt that anyone else knows either. I do know that mass panic and social breakdown are huge risks if people come to believe that all that is left is save-yourself mentality. It is critical that the national psychology be strengthened, as in “we are all in this as a team and there is hope”—that’s what I expect from our leaders at every level. The opportunity for shared purpose is massive, all-important, and could end up being tremendously constructive.
I’m considering stopping these posts on COVID-19—I have to ask myself if they are helping anyone or just one more voice in the wind. While nearly all readers have been supportive, there are some not so nice emails each day (usually only one), but that’s one more than I want in my day.
Jan-Dieter S writes:
Please do not give in to them bloody ninnies.
Thanks to you, and to your early alerts, my family was able to acquire the small amount of N95 and N100 masks we needed, just in time. Not only that, you alerted us to the difficulties of dealing with the bloody China virus. You do have your heart in the right place, absolutely no doubt about it.
These are indeed very trying times; the political apparatus (the DC swamp) is not going to give up without a (very dirty) fight.
This is the ONE battle we MUST win. Hang in there. As an aside - the one number (or metric) we should be looking for, can be derived from published data (like what Johns Hopkins publishes): There will be a point in time when the total number of virus related deaths (normalized per 100k population, or whatever) will indeed level off (i.e., have a negative first derivative) - on a state-by-state basis, and also nationally, at some point in time.
Unfortunately, nobody seems to be publishing time series right now (not sure why), even though those would reveal when we do reach that tipping point. If and when we get there, we know that we have either reached herd immunity, or the medications that we have come up with in the meantime are getting serious traction. This IS the one important turning point that we are looking for. And if and when we reach it, hold on to your breaches: At that time, the U.S. stock market will come roaring back, faster and stronger than what we have seen before, ever.
DIGLOYD: the lies about masks not being useful for the public continue to this day (the WHO is to be condemned for this). But I urge people not to hoard masks as they are indeed in very short supply (not that it is possible to even find N95 or N100 masks these days).
The virus has to be transferred somehow. It’s not magic. Surely that is by contact e.g. hands touching things, then hands to face, along with airborne transmission. I’d bet that 99% of transmission is by such means.
If everyone wore a mask and gloves in all places where people interact, I’d bet that the rate of infection would drop precipitously. So why are we not requiring gloves and masks for EVERYONE in ALL places that people share/visit?
It does NOT take a doctor to understand that a cough or sneeze blocked by even a handkerchief keeps huge numbers of particles from entering the surrouding air. It does NOT take a doctor to understand that an infected person touching a surface contaminates it. It does NOT take a doctor to understand that wearing a mask means that face touching is greatly reduced (mask blocks it). Or that hands, gloved or ungloved, are far likely to carry the virus and that gloves can be changed a dozen times day. When I went shopping for supplies, I used new gloves at the grocery store, new ones at the gas station, etc. The risk for me acquiring or contaminating a surface are thus greatly reduced.
I’d bet that even a poor quality mask (e.g., a surgical mask) would block nearly all airborne transmission, because coughing and sneezing would block droplets from getting anywhere.
Tipping point: I fear that because of the lack of basic precautions (masks, gloves) that at least in the USA we haver a long way to go before this is reached.
Kicking off my review of the Fujifilm GF 50mm f/3.5 R LM WR are some examples I shot today. Much more to come.
Includes images up to full camera resolution.
See also a first example in Fujifilm GF 250mm f/4 Examples: Alabama Hills.
It was tough shooting this morning at 25°F with a stiff wind, but I managed to get some decent shots. It’s a bit of a strain to be writing this at nearly 1:00 AM, but I need to be up at 5:30 AM for a shot I want tomorrow morning, and the sunrise won’t wait!
As usual, it takes me 10X longer to assess and process and publish, so I have a ton of Good Stuff and I can hardly do more than just skim and pick out a few images to get done each day, what with all the other efforts.