Month: March 2020

We are now living in the midst of a pandemic like we, who were not alive in 1918, have  never seen before. This present pandemic has the potential to be similar to the 1918 Spanish flu pandemic. Back then there was no influenza vaccine, and so basically everyone was at risk. This present flu pandemic similar in that there is no vaccine and it is unlikely that there will be an effective vaccine in the months to come. It is pretty clear that this Covid-19 virus originated in Wuhan, China and spread from there. Interestingly from Wikipedia: “experts have proposed that the Spanish flu originated somewhere in northern China in 1917 and swiftly moved to western  Europe with the 140,000 Chinese laborers, the French and British governments recruited to perform manual labor to free up troops for wartime duty.” Truth or fiction ? At this point who cares! Back in 1918, the effect on America was devastating, and a similar potential exists today. What are we in America doing about this Wuhan flu?
What are our present choices? What are our basic options? 

1. Pray. A lot of us are doing this, and perhaps it has helped a lot, but at this point how are we to know ?
2. Shelter in place. This is basically what we have been doing now for close to a month, and I am having difficulty seeing progress with this approach. At the present time there is no defined end to this self-imposed isolation. The economic effects are going to be catastrophic for many, and especially for those that past surveys have shown do not have enough cash in reserve to withstand a $400 sudden insult. (Supposedly this is upwards to 30% of all Americans.) Many of those millions that are losing their jobs because of this lockdown, will crash and burn, and “you ain’t seen nothing yet!” When the present shelter in place has ended, what’s going to happen then? Will those who have had this flu and recovered, be able to restart the economy? Hopefully! But who are they? Impossible to tell as many as 80% of those infected with this Wuhan virus are having minimal or even no symptoms. In another month will those seniors who have already been semi-quarantined for months, be able to resume a normal life? Are we putting all of our eggs in the “warm weather will save us” basket? . . . or in the “ a miraculous new flu vaccine will save us” basket?
3. There is another route that I have not heard anybody suggesting. Are you ready for this contrarian-like suggestion? “Encourage having purposeful Covid19 ‘let’s get infected’ get togethers.” (These would be similar to the Mardi Gras party they had in that Washington State nursing home, but with young volunteers.) Crazy? I think not, as the only real way to induce some sort of herd immunity, is to get more of the healthy young herd infected. Young people have only a very minimal risk of dying from this Wuhan virus. If a young person, or even an older person for that matter, wants to get back to work . . . perhaps the route would be as follows: get infected with the virus (which is apparently very infectious and easily spreadable), isolate him/herself for two weeks and thus develop immunity, then go back to work, even be able to go to the beach or even walk in your own park.  Even in the seventy year old age group, the mortality from this virus is about 7-8%, which means that if a 74 year old with no other underlying medical condition gets the virus, he/she has about a 92+% chance of recovering . . . from my perspective, those are pretty good odds.

And perhaps in the very near future, those, who purposely and knowingly infect themselves, and do poorly, can be treated with a chloroquine etc regimen. Will some people die as a result of this wild hair-brained idea? Possibly, yes, but if this helps to save our economy, is it worth it? Choices!!! What would you decide?

Purposely, I am not going to mention the name of the Scofflaw, as I do not want this essay to potentially be used in court against  him . . . or possibly against her.( So I do not have to write “him or her” every time I mention him/her, from now on I am just going to refer to him/her as “him.”  Whew, I’m glad we’ve got that settled!)

So anyway, “he” has been trying to walk every day for exercise especially during this semi-quarantine situation. Someone may have already previously mentioned spotting him stepping over the “do not cross, crime scene” yellow police tape in order to walk around his neighborhood empty park. Let me emphasize that this is only a rumor! Anyway, the place he usually walks was “protected” by yellow “do not cross, crime scene” tape. (“Protected from whom?”, he wondered.)  Because the rumor was that he may have been “captured” on film on the last yellow tape “jumping” escapade, he decided to go to another place to walk . . . kinda like walking incommunicado, so to speak. He then drove over to the local lake (reservoir) that he had walked around before. As he drove up, he noted a large number of cars parked on the street adjacent to the “do not cross, crime scene” yellow police tape across the entrance. Fortunately for the Scofflaw, someone had apparently already cut one of these tapes, so the Scofflaw did not actually have to break the law. (What law? Walking alone on public property!) As the Scofflaw was walking slowly around the lake, he saw about fifty other scofflaws – black, white, brown, yellow, babies, children, and adults, both young and old – actually one women appeared to be older than the Scofflaw! No one came within the six feet unacceptable distance, except for one biker who went whizzing past, and the policewoman who rolled down her window to tell the Scofflaw that the lake was closed. Interestingly off all those at the lake, only the policewoman came realistically closer than six feet – actually she came within two to three feet of the Scofflaw’s face . . . she without a mask. The Scofflaw did finish his entire 58 minute walk without any other contact . . . in fact without any other near contact.
The Scofflaw has lived to “jump” the yellow “keep out, this is a crime scene” tape again – perhaps to walk another day!

As Is the case for a lot of things has “social distancing” gone too far? Dieting to lose weight is a good thing if one is overweight, but can be a bad thing if taken too far. Likewise, exercise is a good thing, but it also can be taken to extremes , and this extreme is not a good thing.( For example, exercising alone running X-plus miles every day is a self-defeating thing if taken to extremes.)There is little doubt that social distancing helped slow the spread of this corona virus pandemic. Keeping a distance of six feet between yourself and strangers will afford you some protection, as droplets with the virus apparently do not travel more than six feet in the air. To me, crowded places like New York City, where it is very difficult if not impossible, to always be at least six feet from all other people, is likely to have an increased incidence of droplet viral contagion. Likewise, as was the case in that Washington State nursing home, a Mardi Gras party on Ash Wednesday, no less, that brought many older susceptible people into very close proximity was the antithesis of social distancing.

Now here I am purposely avoiding the quandary of the benefit of the social distancing extremes on virus spread versus the economic disaster that this extreme social distancing is causing. I do have my thoughts on this but this is not the place nor is now the time. 

Rather is this concept of forced social distancing encroaching on some of our fundamental liberties, especially when common sense is not taken into consideration?

Close by there is a lake, actually a city reservoir, with a walking path around it. Lately the few times I had walked around on this path everybody was being quite careful about keeping at least six feet between themselves and others. Common sense social distancing! Parents were also being cognizant of how close their children were getting to strangers, as they did not want their kids to catch anything. Again common sense! So after closing all the entry gates to traffic, the next thing was to stretch yellow “keep out, crime scene “ tape across sidewalk entrances. One day this week there was actually two police cars prohibiting entrance to this public land. This almost sounds to me like something I would expect in a totalitarian place. (“KEEP OUT!” . . . This is for your own good. We know best!)

Okay, so the next day instead of trying to cross the yellow police tape at this lake, I decided to do my walking at my local park where four laps is about a mile. I have walked there many times in the recent past, and there is usually two or three additional walkers – all keeping well outside the six feet social distancing parameter. So of course when I approach my local neighborhood park . . . approaching as a tax paying citizen, my local piece of public property, lo-and-behold yellow “keep out, crime scene” tape is stretched across the sidewalk entrances! (“KEEP OUT!” . . . This is for your own good. We know best!) 

Now it seems to me that if there is a minuscule chance that I will catch something while walking out in the open air with no one in 100 feet of me, I should be able to take that miniscule chance. I am a big boy!

BTW: I stepped over the yellow tape, and had a nice leisurely isolated walk!

In 2009, Ram Emmanuel said,” Never let a good crisis go to waste.” In other words if there is a crisis, take full advantage so that you can squeeze in as much of your pork as you can! My reaction . . . They are scum!”

Well, as everybody is aware our country is now in a another crisis – the Wuhan flu crisis, and lo-and -behold, the Dems  . . .the blood-sucking Dems, are at it again! South Carolina Democrat James Clyburn referred to this crisis as  “a tremendous opportunity to restructure things to fit our vision.” My reaction, “He is scum!”

WhileSenate  Republicans were busy trying to figure out a way to help the struggling economy, and thus help the American workers, the Dems were busy trying to push their own agenda.
Writing for USA Today, James Robbins writes that Nancy Pelosi wants the following Liberal policies to be included in the bill:

She wants “racial and gender pay equity provisions, diversity on corporate boards, increased use of minority-owned banks by federal offices, and a grab-bag of other diversity-themed requirements. It increases the collective bargaining power for unions and cancels all the debt owed by the US Postal Service to the US Treasury. For the global warming crowd, there are increased fuel emission standards and required carbon offsets for airlines, plus tax credits for alternative energy programs. For the kids, there is a provision for student loan payment deferment, and for the education bureaucrats who overcharge them a $9.5 billion giveaway to colleges and universities. It gives $100 million to juvenile justice programs, and suspends various aspects of enforcement of immigration laws.So far this proved that . . . She is scum!
But she was not done! 
Again from U.S.A Today:“Perhaps the most troubling sections of the bill are under the rubric ‘American Coronavirus/COVID–19 Election Safety and Security’ or ‘ACCESS’ Act. This section would impose requirements on states for early voting, voting by mail, required mailing of absentee ballots to everyone, ballot harvesting (i.e., having third parties deliver absentee ballots), online voter registration, same-day registration, and other practices which undermine confidence in the integrity of the ballot.” Even U.S.A. Today said, “In these days of increasing threats to election security, we should be moving rapidly back to in-person paper ballots, but this bill would be a radical step in the wrong direction.”
As I may have mentioned before . . .She is SCUM!
3/24/20

Those of us in California, Illinois, and New York are on lockdown. Is it just coincidence  that at this time, that those states which are the most affected by this Wuhan virus are blue states? Now before you go off thinking that I am some sort of anti-blue-ite, my answer is “not likely a coincidence at this point as places with a higher population, or more accurately a denser population are higher risk areas . . . Los Angeles, San Francisco, New York, Chicago, Seattle, etc. However, we do not know what the actual incidence is in these places. In certain places we know how many cases there are, and how many have died, but we can only estimate what the actual incidence is. How many have this virus, but have little if any symptoms? We don’t know. Statisticians can give an estimate, but how good is the estimate? We don’t know.

I think that a random estimate should be done, perhaps a couple of times per week, to more accurately access the progress, or lack thereof, of this deliberate strangulation of our economy. For instance, I would suggest a random sampling of the people in, let’s say, in Los Angeles County. If 100, or perhaps 1000 random people were tested, we would then have an estimate of the actual incidence of infection in Los Angeles County, and then we would then be able to compare this incidence to the incidence last week or next week to see if any progress has been made. If the incidence is not decreasing or even increasing, then perhaps the logic of these lockdowns should re-considered. Likewise if the incidence were decreasing, then perhaps the pain from these lockdowns is worth it. 
In the future, at some point, a decision will have to be made to lighten up or not lighten up on lockdowns. When that time comes, how will we know if a relaxation is a good idea? To me the answer is obvious . . . test 1000 random people and see if the decreasing incidence is maintaining or not.
There is no segue here . . . just a few more random thoughts:

-In the Midwest, there are lines outside the doors of stores that are selling guns!

-When this is over, there will be a lot of thinner dogs (having been walked multiple times a day), and a lot of heavier people (having been trapped inside, snacking incessantly)!

-Companies will learn that a lot of people can work very efficiently from home. Some may ask, “Why have large office buildings with all of the overhead that goes along with these large offices?

-A lot of parents will discover that home-schooling is very efficient, and the kids actually like it, and some learn more.

-College students and their parents will ask, “Why are we paying these outlandish tuition costs when a significant number of classes can be done on-line, and then be repeated again and again for years with no additional input from the professors?”

-Does anyone else find it ironic that those who are going to suffer the least health-wise from this virus (the young) are going to suffer the most economically from this remedy (shutdown), and vice-versa, those who will potentially suffer the most from this virus (the oldest among us) will suffer the least economically (I haven’t heard any rumors about the stopping of Social Security checks).

-Is it also somewhat ironic that this so called, “vindictive” President appears to giving the most help to those states whose Democrats have called him such!

If you were to advise your children/grandchildren what to take in graduate school, what would you advise them? The obvious hackneyed response is “Make sure that you go into something that you like doing.” No one would disagree with that. Practically speaking, one obviously shouldn’t get an MBA, if he/she really doesn’t like numbers. Likewise, practically speaking, for the most part, one should not go into medicine or dentistry, if he/she doesn’t  like interacting with people, as for the most part, that is what they will be doing all day.

However, these days the college loans and the paying back of these loans is a big deal. One may enjoy the arts, but it is wise to rack up huge debt with a Master’s in the arts . . . and as a result not be able to afford a house? I guess one could get a Master’s in Social Work, for instance, and hope that “President Warren” will forgive all education debts . . . not very realistic or practical!

As far as graduate degrees are concerned, which are best in terms of indebtedness compared to median earned income after three years? The average income at three years is a measure, albeit not perfect, which in essence helps determine how rapidly one’s education loans can possibly be paid off.

Consider the following graduate degrees, and rank them according to the median debt incurred vs. median income three years down the road:

-Law

-Medicine

-Dentistry

-Pharmacy

-MBA

-Master’s (science, engineering)

-Master’s (arts)

-PhD

Remember getting a degree in a lot of the higher paying occupations will also cost much more meaning more debt.

The following (median debt – median income at three years) is from Earnest.com :

For a Master’s (arts)($57k -$64k),Medicine ($200k-$204k), and Law ($122k -$121k). With these the salary at three years is about the same as the debt incurred.

For a Master’s (science, engineering) ($61k-$87k), a PhD ($65k-$91k), and an MBA ($$64-$115) the median income at three years is much better than the average debt incurred.

The worst bang for the buck . . . Pharmacy ($$132k-$122k) and Dentistry ($220k-$155k). Dentistry incurs the largest imbalance, and it’s not close.

So practically speaking, brush and floss regularly, starting now, as in years to come,  it will be significantly more and more expensive to go to the dentist.

Today somebody asked me my opinion of the Wuhan flu. I will start out by saying that I think that it is similar to what influenza was like before we had flu shots. Prior to flu shots everybody was at risk for the flu, and many who were older and more infirm, died as a result of the flu. How is that different from the Wuhan flu of today? I do not think that it is much different. 
There are three basic differences:

-This flu is much more contagious than in prior years. On average a single person with this Wuhan flu will infect more than two others.

-The incubation period is much longer, and so a lot of the person to person spread occurs before the one with the virus is even aware that he/she has it. This long incubation period just adds to the spread.

-The world is a much smaller place than it was years ago. Travel is much easier, and because individuals can go from China to the U.S. to Europe in just a day or so.

But in the end the Wuhan flu is still the flu. A bad flu . . . Yes, but the flu, nonetheless. Will people die from it? Yes, and like basically all illnesses, the older you are,  the less likely that you are going to do well. At my age my mortality rate is statically about 7% if I catch it . . . but this means that I have a 93% chance of recovering.
I have had the regular flu in the past. I did not like it. I felt like crap for weeks. If I catch this one, I will not be a happy camper. Don’t get me wrong, I am doing all of the usual things to prevent me from catching it      .  . . hand washing, purell, etc., however we are still watching our grandkids and going shopping for groceries. Our life style will take a minor hit, but que sera,sera.

Right now my biggest concern is the an economic one. I am not sure at this point in time if the economic damage that is going to be done will be worth it. Many people will lose their jobs, and a lot of these jobs will not come back in the near future. IRAs and 401K are being destroyed. In 2009, the Swine Flu, H1N1, started off like gangbusters. Lots of people died, including children. The economy took a hit, but the country survived without the draconian measures that are being taken today. I sometimes wonder if the difference is that 2020 is an election year, and 2009 was not.

In the end, go with the flow, say your prayers, and stay safe., and as someone I know said, “Use gloves to get your mail!”

In my last blog I talked about the importance of the denominator when talking about the incidence of and the mortality of the Wuhan flu.  
(Incidence of Wuhan flu = # of people infected/ total number of people). The dilemma: Is the denominator the total number of people or the total number of people tested ?The true incidence should the number of cases in the total population, not the total number of people tested. If the denominator is only the number of people tested then the “incidence” will be estimated to be falsely high. If we use the total population, then the true incidence is actually very very low. Look at the following numbers:       
U.S.A.: 3813 cases/331,022,651 population = 0.0011 % incidence. Washington State: 769 cases/ 7,800,000 population = 0.0098% incidence. California: 458 cases/ 37,253,956 population = 0.0012% incidence. New York: 740 cases/ 19,440,469 population = 0.0038% incidence
One of the critical points in today’s Wall Street Journal article by Neeraj Sood  addresses the question of the true incidence of this Wuhan flu. First off let’s be clear, Mr. Sood is a professor at U.S.C’s Schaeffer Center for Health Policy and Economics, not some schmo like me!  He suggests random testing to estimate the actual incidence of the Wuhan flu in certain populations. 

The other issue in this article: “Is the Wuhan flu actually much different from the typical influenza that we see in the U.S. virtually every year in the fall and winter?” Certainly this Wuhan flu seems to spread faster (RO > 2), and it is especially deadly for the elderly, especially those with other medical issues, and especially-plus for those in the close confines of nursing homes. But is it such a scourge that basically all of the Western world (basically all of Europe and North America) should come to a standstill? Is this Wuhan flu threat worth the economic disaster that is coming . . . a major economic disaster!
I guess the answer is: “Yes it certainly is to the elderly!”

But what about to the rest of us?  
(BTW: I am in one of the higher risk groups,  but I have to finish this now because I am going to the gym.)

In the Wall Street Journal on 3/14/20 there was an article comparing the Wuhan flu (coronavirus) in South Korea vs. Italy. The main drift of the article was comparing the populace of an Eastern culture with that of a Western culture. To paraphrase, the influence of Confucianism in Eastern cultures emphasizes respect for authority, and the good of the nation above individualism. In contrast in Western cultures there is widespread skepticism  toward authority. Take for example, the public pressure that forced the relaxing of a 6 p.m. curfew on bars in Milan. Oops!

The other significant thing that I noticed in this article was “ the influence of the denominator,” which turns out to be a very significant influence of any statistics. For those of you who are somewhat math handicapped, I will try to explain. It is actually a very simple concept. Basically, if the denominator increases while the numerator stays the same, the resultant percent decreases. 

Italy and South Korea have comparable populations. although Italy has about 15% more people. . . . Italy = 60 million, South Korea = 52 million. In Italy, initially, testing for the virus was restricted to those with symptoms (about 3,000 tests per day) whereas South Korea was performing more than 15,000 tests per day. The incidence of the Wuhan flu was the following:

Italy = 17,660 cases/ 97,488 tested for incidence of about 18%. So.Korea = 7,979 cases/240,668 tested for incidence of about 3%. So what is the true incidence of infection? . . . it depends on the denominator. Likewise, for the mortality:
Italy = 1,286deaths/17,660 cases for a mortality of about 7%. So. Korea = 67deaths/7,979 cases for a morality of 0.8 %. So what is the true mortality? Here it is a bit more complicated, as it depends on who is included in the denominator. If the denominator includes all of those tested, many of whom were minimally symptomatic or even asymptomatic, (South Korea) then the number of cases in the denominator will be skewed, and the mortality will be much less. Likewise, if the denominator is made up mostly of older, sicker people, (Italy) the denominator will also be skewed, but in the opposite direction. The same will apply here in the U.S. . . . what is the denominator? If, as is the situation in Washington State, the denominator is predominately made up of those in nursing homes and their close contacts, then the mortality will be much higher than the overall mortality once drive-through testing becomes widely available and the denominator is drastically increased.

So how dangerous is this Wuhan flu? It depends on the denominator!

From now on I am going to refer the the present outbreak as the “Wuhan flu.” Why? Well basically it is a variety of influenza similar to what we get every year. Obviously, there are some significant differences. The most significant is its ability to spread rapidly, because of two things. First,the RO, (which tells us how many are likely to be infected from a single individual) is above 2.0. In other words it is likely to be easily spread from person to person. Adding to its “spreadability” is the fact that it has a significantly longer incubation period than the typical virus, upwards of two weeks, and so people can spread this infection for a long time before they realize that they are sick.
How does the Wuhan flu measure up with yearly and other more serious past flu epidemics? 
Seasonal influenza is bad enough. It is estimated that kills between 3,600 – 49,000 people in the U.S In a year, and between 250,000 and 500,000 globally.
We know that the present outbreak is not as deadly as the SARS epidemic of 2003, which killed about 10% of the 8,098 confirmed cases of the respiratory illness In 2012. And the Wuhan flu is far less deadly than the 2012 MERS, which killed about 34% of approximately only 2,500 confirmed cases.

In 2009-2010 it was the Swine flu (H1N1), which infected 61 million Americans and killed about 12,000, which included 282 children. To me this is a quandary. Why are children and young adults either less susceptible to the present Wuhan flu, or perhaps, better said, less likely to have a severe form of Wuhan flu? For instance, in China the mortality for those <40 years old was 0.2%, and similarly in South Korea, where in those younger 60 years the mortality was quite low. In other words this Wuhan flu appears to be significantly less severe for those < 60, and even progressively less severe, the younger one is. Why?

Follow me with this logical presumption . . . a large percent of common colds are due to garden variety corona viruses (obviously different strains). Could it be that because young children are “sick, just about all the time with snotty runny noses,” they have a lot of antibodies and thus a relative immunity to the Wuhan strain of the corona virus? If this postulate is true, then I would expect that pre-school and kindergarten teachers would be less likely to get this variety of flu. 

We’ll see.