Bruce Stanley

★ ★ ★ on The State of Florida ★ ★ ★

COVID-19

Highly-Infectious Disease And Hospital Workers

By Karl Denninger, The Market Ticker

Folks, we have to cut the bull**** right now.

We do work with very dangerous viruses all the time.  We have to.  We use truly extreme measures in doing so too, because the risk of a mistake, if made, is catastrophic to the person involved and, if the virus is person-person transmissible the outcome could be horrifying.

We do this sort of work in labs where strict controls are found.  Think “Andromeda Strain” sort of lab.

There is not a hospital in the world that can maintain that level of isolation successfully.

Hospitals, generally, are not set up much to deal with highly-infectious and serious disease.  Blood-borne diseases are one thing; there you need direct exposure, which means needle sticks and things like that. Diseases where vaccinations are available are another; health workers can be required to have proved immunity in the form of proof of vaccination.  That works.

There are a handful of hospitals that are capable of treating Ebola patients.  So far none have had a breach.  But their capacity is very, very low.  In addition Ebola is not generally airborne and that makes it materially easier.  Ebola-level isolation is actually not enough for this virus to stop transmission to the health care workers yet even that level of protection is simply impossible to provide for thousands of people.  For a handful that present while returning from the US, yes.  For the general US population?  Not a snowball’s chance in Hell; we have neither the facilities or the staff.

There is no vaccine for this and one is never likely to work, despite the screaming.  We’ve heard that lie out of the NIH, CDC and medicine before.  There are times it is truthful but coronaviruses are not one of those areas.  There is no record of such a successful vaccine with permanent immunity for coronaviruses and despite “the flu shot” that fails an awful lot of the time too.

Reliance on such is just flat-out insane.

There’s some evidence that the method of action of this virus in the body leads to the potential for extraordinarily contagious “windows”, likely coinciding with active symptoms, and low but non-zero infection capacity otherwise, at least in droplets.  There is also plenty of evidence this virus is fecal/oral transmissible going all the way back to the first reports out of Wuhan, and that’s nasty because some of the higher R0 viruses historically have been transmitted in such a fashion (e.g. Polio, R0 of approximately 5.)

Health care workers cannot social distance and do their jobs.  PPE is not a panacea; other than a “moon suit” with positive-pressure ventilation it’s inadequate when you have an actively-infectious patient and an easily-transmissible infectious agent.  There’s no way in hell you can run a hospital with everyone kitted up in a moon suit, connected to positive-pressure clean air sources.  Forget it.

We keep seeing the same stats.  A small number of cases which do not follow the expected geometric progression, then a sudden explosion.  When reporting is actually done we see patterns where a huge percentage of the “first infected reports” are in hospitals.  Medical workers in hospitals are a tiny fraction of the entire population and yet they often make up 1/5th to a 1/6th of the original infected population sample.  This has happened repeatedly, beginning in Wuhan.

(FOX 9) – State health officials say one in five of the confirmed cases of COVID-19 in Minnesota are health care workers. 

Of the state’s 503 confirmed cases of the coronavirus, 133 are health care workers, according to the Minnesota Department of Health. 

The data says that what is happening is that this virus spreads in the population but slowly until health care workers get it in a hospital, pass it around and then back into the general population as they are exempt from all of the social mandates.  In cities with strong public transportation systems it’s even worse as they can spread the love on buses and trains.  While doctors may drive their nice cars orderlies and nurses are another matter, never mind that some of them are likely coming to work while sick and thus transmit back to the patient and other worker population, if any don’t already have it, whether they realize it or not.

Minnesota is almost-certain to get reamed

The data proving this is clear.  When New York implemented its “shelter in place” and other towns and cities implemented “social distancing” we should have seen an immediate collapse in the R0 in those areas.  We did not.  We’ve seen a change — about 0.4-0.5 on a national basis and approximately the same in NY, but out of 2.5-3.0 it’s clear that casual social interaction being cut by 90% or more for the common person on the street is not stopping the transmission.

You can work in a warehouse and not get within 6′ of anyone.  You can stock grocery shelves and do likewise.  And if you’re laid off and staying mostly at home, since everything you want to do is closed, well, it’s you and your cat. And so on.

So who’s that leave?

HOSPITAL WORKERS who by definition cannot socially distance and do their jobs.

Singapore identified this immediately and stopped the madness by mandating washing of hands with soap and water, not so-called “sanitizers”, before and after each contact with a person or thing that could potentially be infected.  By doing that they dropped the infection rate of their hospital staff to a statistical zero and almost immediately thereafter the outbreak there was under control.  They still get a case here and there, but the simple fact is that despite the screams of horror about community spread the facts are that it isn’t that easy for social transmission of this bug to take place, except through super-spreading events.

If it was then the mitigating factors would have had an immediate and dramatic impact, and they have not.  Further, Singapore couldn’t have stopped transmission to health care workers by mandating strict hand hygiene standardsbut they did.

We have repeatedly seen this pattern — where you have a case here and there, a few people show up in the hospital and then the sudden exponential explosion occurs after failing to follow the predicted geometric progression for weeks — and it happens in city after city.  “Social distancing” doesn’t stop or reverse it and neither do “stay at home” orders, even when backed up with the threat of fines or worse. 

We must stop the madness; the data on where the spread is happening is clear.

I have posted several times the basic mantra from what Singapore learned: ******n it, wash your hands!

Well, that apparently doesn’t even manage to register.  It also gets me hate mail since I’m “attacking” the “heroes.”

You’re not a hero if you’re contracting, and thus becoming infectious, in a hospital from the bugs the patients have.  You’re a zero because by definition you can be, and probably are, giving it to others — and quite probably a lot of of others.

And don’t tell me medical workers, including doctors and nurses, wash their hands in hospitals generally.  They most-certainly do not.  My dentist’s office is better at it (and yeah, I pay attention to it too) but in no hospital I’ve ever been in attending to family members and friends has every doctor and nurse, when entering the room, washed their hands right there, done whatever, and then done it again on the way out.  Never once.  Not when my mother was in having cancer surgery (!!!), not when I was visiting my sister in step-down, not when other family members and friends have been in a hospital, never, ever, anywhere with that protocol, period.

The only other way to stop this transmission is to arrange so all Covid patients go to hospitals (whether field expedient or otherwise) where nobody is allowed in the building unless actively ill, in which case they can’t leave until not, or proved seroconverted by antibody test and thus immune.

We will not stop the outbreaks until we stop this.  If we’re not going to do it here and now we’re far better to take the hit now coming into the spring and summer than to get hammered in the fall when co-infection with ordinary influenza will kill many more than would otherwise die.

COVID-19

Hypothesis: Hospitals ARE The Vector @RealDonaldTrump*

By Karl Denninger, The Market Ticker

This virus is not being spread the way we’re told.

Social distancing is close to worthless.

NY’s data makes this quite clear.  So does Florida’s.

Both slammed the door; SE Florida and NYC.

The bend should be evident in one viral generation time.  The new case rate should collapse in two viral generation times.  If Community Transmission via bars, restaurants and “social interaction” was more than 2/3rds of the total the effective R0 would go under 1.0 and community transmission would collapse.  If it was half then R0 would be 1.5 and we’d have transmission approximately equal to a bad seasonal flu.

IF you actually bent the curve.

These measures did not bend it to any material degree.  Enough time has passed to know this is true; at most they have lengthened a “turn time” by one day (in other words, R3.0 to R2.5.)  That’s effectively nothing!

Why not?

It’s being spread in the medical environment — specifically, in the hospitals — not, in the main, on the beach or in the bar.

When Singapore and South Korea figured out that if as a medical provider you wash your damn hands before and after, without exception, every potential contact with an infected person or surface even if you didn’t have a mask on for 30 minutes during casual conversations with others (e.g. neither of you is hacking) transmission to and between their medical providers stopped.

Note — even if you didn’t have a mask on and were not social distancing in the work environment, which of course is impossible if you’re working with others in a hospital, you didn’t get infected.

And guess what immediately happened after that?  Their national case rate stabilized and fell.

The hypothesis that fits the facts is that a material part of transmission is actually happening in the hospital with the medical providers spreading it through the community both directly and indirectly.

Remember that all disease R0 is a composite of all the elements of transmission.  If any material part of transmission is happening in hospitals and other medical settings stopping that will stop or greatly attenuate community transmission.  Every medical provider goes home and interacts with the public.

Then the hospital fills up and guess what — they call in more doctors, nurses, orderlies and other people.  In fact they’ve done exactly that; in hard-hit places they’re getting volunteers.  Excellent, they need the workers, except every one of those new workers in the place is also a brand new vector to the rest of the community too unless they wash their damn hands before and after every contact with any item or person as well.

What’s worse is that the data is that if you wind up on a vent you die nearly all the time.  They had a doc on Tucker Carlson last night confirming that we are not doing materially better than Wuhan in this regard.

We’re wrong about how this thing is spreading and we’re wrong about the silent attack rate.  The step functions in the data here in the United States cannot be explained by ordinary community transmission but they are completely explained if the transmission is happening not among ordinary casual contact — that is, not “social distancing”, but rather through the medical system itself.  That explains the step functions that are seen in places like Florida since it takes several days before you seek medical attention after infection and it also explains why NY, despite locking down the city and more than one viral generation time passing — in fact two — has seen no material decrease at all in their transmission rate.

In addition it further is supported by the fact that what we’ve seen here, in Italy, in Wuhan — indeed everywhere is not an exponential curve.  It’s a step-function flat acceleration graph.  Broad community transmission doesn’t happen this way (you instead get a straight and continual exponential expansion until you start to obtain suppression via herd immunity) but if the spread happens as each “generation” gets driven to hospitals for testing and medical attention and the spread is largely happening there what we see here and in other nations in the case rate data is exactly the function you produce in terms of exposure rates.

In other words there should be no straight-line sections in the case rate graphs — but there are.

Fix the protocols in the hospitals right damn now.  PPE is not the answer if your hands, gloved or not, become contaminated and not immediately washed off.  Hand-washing at an obsessive level — before and after each patient interaction and before and after each contact with a piece of equipment that might be contaminated is.  In other words the monster vector (remember, R0 is a composite, not a single number) which I’ve hypothesized since this started is not oral droplets — it’s fecal.

This also correlates exactly with the explosive spread in nursing homes where many residents are incontinent.

Folks, by definition medical facilities concentrate sick people into small spaces.  If what’s wrong with them is not infectious this doesn’t matter.  But if it is you had better not transmit anything between them or between you and them or you instantly become one of the, if not the only vector that matters.

Then as the place fills up you have more people working and thus more vectors into the rest of the community.  Even if you have gotten the virus as a nurse or doctor and recovered and thus are immune if you have it on your hands and go down the escalator to the subway you can still contaminate the railing and the grab-rail in the car unless you wash your damn hands before and after any contact with any thing or person!

The presence of step functions and apparent linear-fit line segments in what should be a clean parabolic curve says this is exactly what has happened.

That in turn explains why the lockdowns are not doing a damn thing — except destroying the economy, that we must do everything in our power to keep people out of the hospital in the first place and that, in turn, means using even potentially-valid prophylaxis and promising (but not yet proved) treatments early in the course of the disease so as to keep people out of the damned hospital in the first place while fixing the protocols in the hospitals so they stop transmitting the bug.

Don’t tell me about all the doctors and nurses doing this already.  That’s a lie.  I’ve been in plenty of hospitals (and worse, in nursing homes) in my years and in exactly zero instances have I seen any evidence that before and after each contact, with zero exceptions, those hands go under a stream of water with soap.

And reopen the damned economy.

Now.