We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population. […]

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) […]

[T]he doubling time will start to slow once a sizable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.

{ Liz Specht | Continue reading }

The median incubation period was estimated to be 5.1 days, and 97.5% of those who develop symptoms will do so within 11.5 days of infection.

{ Annals of Internal Medicine | Continue reading }

related { How the drug industry got its way on the coronavirus }

photo { President Xi Jinping of China, right, was briefed at the Huoshenshan Hospital in Wuhan on Tuesday. The hospital was built in a matter of days in February to treat coronavirus victims. | NY Times }

If you can smell what someone had for lunch — garlic, curry, etc. — you are inhaling what they are breathing out, including any virus in their breath. […]

After numerous people who attended a Buddhist temple in Hong Kong fell ill, the city’s Center for Health Protection collected samples from the site. Restroom faucets and the cloth covers over Buddhist texts tested positive for coronavirus, the agency said. […]

A study of other coronaviruses found they remained on metal, glass and plastic for two hours to nine days.

Whether a surface looks dirty or clean is irrelevant. If an infected person sneezed and a droplet landed on a surface, a person who then touches that surface could pick it up. How much is required to infect a person is unclear.

Coronaviruses are relatively easy to destroy, Professor Whittaker said. Using a simple disinfectant on a surface is nearly guaranteed to break the delicate envelope that surrounds the tiny microbe, rendering it harmless.

{ NY Times | Continue reading }

photo { Franco Fontana, Houston People, 1985 }

Most estimates suggest 80% of COVID-19 cases are mild and feel roughly like a flu. Estimates I have seen suggest that roughly 10-15% of cases will be more significant and may necessitate hospital visits (see also) with 1-3% potentially needing an ICU. The concern of many governments is the peak number of cases that occur in a given moment. […]

The reported death rate has hovered around 2% but may in reality be 0.2% to 1% depending on country and healthcare system. Many estimates tend to indicate an overall expected mortality rate of ~0.5% globally. The current existing fatality rate is biased upwards by Wuhan cases dominating the mix (which are closer to a 3-4% death rate and make up most cases). It is possible the virus is being undertested for in China / rest of world driving the real death rate down (as many more people are infected than is reported). […]

R0 value: The spread rate of the virus seems to be well over 2 and likely ~3. This means for every person infected at least 2 to 3 more get the disease.

{ EladGil | Continue reading }

Experts think there may be many people with no symptoms at all, or such mild ones that they never bother to seek medical attention. Because those cases have not been counted, it’s not possible now to know the real proportion of mild versus severe cases. […]

After viral infections, people generally develop antibodies in their blood that will fight off the virus and protect them from contracting it again. It’s reasonable to assume that people who have had the new coronavirus will become immune to it.

But it is not known how long that immunity will last. With other coronaviruses, which cause the common cold, immunity can wane.

{ NY Times | Continue reading }

The best estimates so far suggest that Covid-19 kills about 1% of people it infects. That number may go up somewhat or fall significantly; either way it could add up to a dreadful toll.

If 60% of the world’s population is ultimately infected, as suggested by Gabriel Leung, chair of public health medicine at Hong Kong University, a 1% fatality rate would kill almost 50 million people — similar to the 1918 Spanish flu. If that falls to 0.1%, it could still be roughly 10 times more fatal than the 2009 H1N1 influenza outbreak, which killed several hundred thousand in its first year. […]

The most severe period of initial infection could soon be fading. Respiratory diseases flourish in the cold season and taper off as the weather warms up. That should cause infection rates to slow in the northern hemisphere, while continuing at a lower level in tropical regions and spiking in temperate parts of the southern hemisphere where winter will be setting in. When a new year rolls around, the bulk of the disease will shift back to the northern hemisphere, to begin the cycle again.

Subsequent Covid-19 seasons probably won’t be as serious. Those who survive viruses should be immune from reinfection (though there have been reports of people being diagnosed with Covid-19 for a second time), and as the share of survivors in the population rises, it gets harder for a disease to spread. […]

In a best-case scenario, it’s even possible that vaccines may be available in not much more than a year.

{ Bloomberg | Continue reading }

The only path to flattening the curve for COVID-19 is community-wide isolation: the more people stay home, the fewer people will catch the disease. The fewer people who catch the disease, the better hospitals can help those who do. […]

Get a flu shot, if you haven’t already, and stock up supplies at home so that you can stay home for two or three weeks, going out as little as possible. […] Here’s a handy, one-page guide on what you need.

{ Scientific American | Continue reading }

related { CoronaCoin: crypto developers seize on coronavirus for new, morbid token }

A powerful antibiotic that kills some of the most dangerous drug-resistant bacteria in the world has been discovered using artificial intelligence.

{ The Guardian | Continue reading }

With about a dozen trucks an hour setting off from the avocado belt in Mexico’s western state of Michoacán for the U.S., armed robbers are zeroing in on the fast-growing, multibillion-dollar industry. The rise in avocado-related crime has turned parts of the state into no-go areas even for the police. […]

Until recently, Mexico’s organized crime groups’ main source of revenues from avocados centred around extortion — demands for protection money from farmers. But the sharp fall in the price of Mexican opium paste has forced them to diversify, according to analysts.

Increasingly they have started hijacking truckloads of fruit for export. […] The rise in avocado crime is thus indirectly linked to America’s opioid crisis. Americans’ increased use of fentanyl, a synthetic opioid used for pain relief, pushed down the price of heroin, which in turn slashed the price of Mexican opium. […]

Demand for avocados jumps ahead of the Super Bowl, America’s biggest sporting event, with Mexico shipping a record 127,000 tonnes to the U.S. for the occasion. Overall production is rising, hitting 1.09 million tonnes in the 2018-19 season, up nearly 4 per cent from the 1.05 million produced in 2017-18. Exports last season rose 5.4 per cent. Sales to the U.S., the largest importer of Mexican avocados, bring in almost US$2 billion a year, much of it going to smallholders.

{ Financial Post | Continue reading }

art { Evan Roth, Landscapes, 2016-ongoing }

For China’s chronically underpaid physicians (the average starting salary for a junior physician was $730 a month in 2018), the best route is to avoid becoming a low-paid general practitioner, especially in the countryside, and opt for a career as a higher paid specialist. And if that career choice doesn’t work, pharmaceutical company kickbacks commonly do. And if kickbacks don’t suffice, many doctors simply accept “red envelopes” of cash to ensure basic services are rendered correctly.

These well-known practices deepen patient mistrust and cynicism, and have led to an epidemic of patient violence against Chinese doctors and nurses, including an attack on an opthamologist last week in Beijing (the weapon was a “vegetable chopper”). As far back as 2008, 48% of Chinese hospitals reported violent attacks against health workers. In a recent survey of general practitioners in Hubei Province, the source of the new coronavirus, 18.9% of respondents reported exposure to physical workplace violence in the preceding year.

Low pay, low status and the threat of violence has predictably depressed interest in the caring professions. In 2018, China had two doctors per 1,000 inhabitants, compared with 2.6 in the United States, 2.8 in Canada, and a world-beating 5.2 in Austria. More alarming, the profession is aging. […]

For now, China can treat Wuhan’s shortage of doctors as a health crisis and mobilize qualified personnel from across China to work in the city. Indeed, 6,000 medical workers from across China have either arrived in the Wuhan area or will soon, and they will alleviate much of the pressure building up in hospital corridors.

{ Bloomberg | Continue reading }

oil on painting { Pablo Picasso, Buste de Femme (Dora Maar), 1938 }

He had diabetes, and he had signed up for a study to see if taking a “statin” – a kind of cholesterol-lowering drug – might help. So far, so normal.

But soon after he began the treatment, his wife began to notice a sinister transformation. A previously reasonable man, he became explosively angry and – out of nowhere – developed a tendency for road rage. During one memorable episode, he warned his family to keep away, lest he put them in hospital. […]

In 2018, a study uncovered the same effect in fish. Giving statins to Nile tilapia made them more confrontational and – crucially – altered the levels of serotonin in their brains. This suggests that the mechanism that links cholesterol and violence may have been around for millions of years.

Golomb remains convinced that lower cholesterol, and, by extension, statins, can cause behavioural changes in both men and women, though the strength of the effect varies drastically from person to person. […]

The world is in the midst of a crisis of over-medication, with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person. [..]

Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.

And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy. […] results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. […] Technically, paracetamol isn’t changing our personalities, because the effects only last a few hours and few of us take it continuously.

{ BBC | Continue reading }

photo { Logan White }

Google is engaged with one of the country’s largest health-care systems to collect and crunch the detailed personal health information of millions of Americans across 21 states.

The initiative, code-named “Project Nightingale,” appears to be the biggest in a series of efforts by Silicon Valley giants to gain access to personal health data and establish a toehold in the massive health-care industry. […] Google began the effort in secret last year with St. Louis-based Ascension, the second-largest health system in the U.S., with the data sharing accelerating since summer, the documents show.

The data involved in Project Nightingale encompasses lab results, doctor diagnoses and hospitalization records, among other categories, and amounts to a complete health history, including patient names and dates of birth.

Neither patients nor doctors have been notified. At least 150 Google employees already have access to much of the data on tens of millions of patients, according to a person familiar with the matter and documents.

Some Ascension employees have raised questions about the way the data is being collected and shared, both from a technological and ethical perspective, according to the people familiar with the project. But privacy experts said it appeared to be permissible under federal law. That law, the Health Insurance Portability and Accountability Act of 1996, generally allows hospitals to share data with business partners without telling patients, as long as the information is used “only to help the covered entity carry out its health care functions.”

Google in this case is using the data, in part, to design new software, underpinned by advanced artificial intelligence and machine learning, that zeroes in on individual patients to suggest changes to their care.

{ Wall Street Journal | Continue reading }

oil on panel { Mark Ryden, Incarnation, 2009 | Work in progress of the intricate frame for Mark Ryden’s painting Incarnation }

Do a country’s inhabitants get happier as it gets richer? […]

In Britain, for example, happiness fell sharply during the two world wars. It began to rise again after 1945, peaked in 1950, and then fell gradually, including through the so-called Swinging Sixties, until it reached a nadir around 1980.

America’s national happiness, too, fell during the world wars. It also fell in the 1860s, during and after the country’s civil war. The lowest point of all came in 1975, at the end of a long decline during the Vietnam war, with the fall of Saigon and America’s humiliating defeat.

In Germany and Italy the first world war also caused dips in happiness. By contrast, during the second world war these countries both got happier as the war continued. […]

A one-year increase in longevity has the same effect on national happiness as a 4.3% increase in gdp. […]

it is warfare that causes the biggest drops in happiness. On average it takes a 30% increase in gdp to raise happiness by the amount that a year of war causes it to fall. The upshot appears to be that, while increasing national income is important to happiness, it is not as important as ensuring the population is healthy and avoiding conflict.

{ The Economist | Continue reading }

Whatever goes down the sink, shower, washing machine and toilet is transferred to one of about 14,000 U.S. wastewater treatment plants. While those plants are good at neutralizing sewage microorganisms that can make people sick or pollute waterways, they can miss chemicals that are linked with our changing lifestyles.

The biggest change since most treatment plants were designed? The explosion of pharmaceutical use by Americans. […] About 60% of American adults take at least one prescription pill every day. Residue from those pills travels to treatment plants and waterways.

{ Axios | Continue reading }

cabinet, wood, glass, metal, paint assorted marine debris, plastic, rope { Mark Dion, Cabinet of Marine Debris, 2014 }

Targeted Memory Reactivation During Sleep Improves Next-Day Problem Solving

Many people have claimed that sleep has helped them solve a difficult problem, but empirical support for this assertion remains tentative. […]

In the evening, we presented 57 participants with puzzles, each arbitrarily associated with a different sound. While participants slept overnight, half of the sounds associated with the puzzles they had not solved were surreptitiously presented.

The next morning, participants solved 31.7% of cued puzzles, compared with 20.5% of uncued puzzles (a 55% improvement). […]

These results demonstrate that cuing puzzle information during sleep can facilitate solving, thus supporting sleep’s role in problem incubation.

{ Sage | Continue reading }

art { John Gerrard, Western Flag (Spindletop Texas), 2017 }

A new drug, created to treat just one patient, has pushed the bounds of personalized medicine and has raised unexplored regulatory and ethical questions.

The drug, described in The New England Journal of Medicine, is believed to be the first “custom” treatment for a genetic disease. It is called milasen, named after the only patient who will ever take it: Mila (mee-lah) Makovec, who lives with her mother, Julia Vitarello, in Longmont, Colo. […]

Milasen is believed to be the first drug developed for a single patient (CAR-T cancer therapies, while individualized, are not drugs). But the path forward is not clear, Dr. Yu and his colleagues acknowledged. There are over 7,000 rare diseases, and over 90 percent have no F.D.A.-approved treatment […]

Tens of thousands of patients could be in Mila’s situation in the United States alone. But there are nowhere near enough researchers to make custom drugs for all who might want them.

And even if there were, who would pay? Not the federal government, not drug companies and not insurers, said Dr. Steven Joffe, professor of medical ethics and health policy at the University of Pennsylvania.

“Unfortunately, that leaves it to families,” he added. “It feels awfully uncomfortable, but that is the reality.”

That means custom drugs would be an option only for the very wealthy, those with the skills to raise large sums of money, or those who gain the support of foundations.

Mila’s drug development was mostly paid for by the foundation run by her mother, but she and Dr. Yu declined to say how much was spent.

{ NY Times | Continue reading }

screenprint on Perspex { Bridget Riley, Untitled [Fragment 3/11], 1965 }

Social media consumption plays an important role in everyday life and, thus, one would expect that this topic is reflected in dreams. […] Social media dreams were quite rare (two percent of all remembered dreams)

{ Cyberpsychology, Behavior, and Social Networking | Continue reading }

Scientists disagree as to what extent dreams reflect subconscious desires, but new research [2009] reported in the Journal of Personality and Social Psychology concludes that dreams do influence people’s decisions and attitudes.

{ American Psychological Association | Continue reading }

quote { NeuroSkeptic | more }

Humans need more than seven hours of sleep each night to maintain cognitive performance. After ten days of just seven hours of sleep, the brain is as dysfunctional as it would be after going without sleep for 24 hours. […]

The best ways to train your body to fall asleep quicker is to go to bed and wake up at the same time every day, even if you don’t have a good night of sleep.

{ Quartz | Continue reading }

photo { Thomas Prior }

There’s been an explosion of interest in the use of psychedelics in psychiatry. […]

Psychedelics have mostly been investigated in small studies run by true believers. […] Some of the most exciting psychedelic findings have already failed to replicate […]

Ketamine is the best comparison for psychedelics. […] Like psychedelics, it got hyped as an exciting new innovation that was going to revolutionize everything in psychiatry (in this case, depression treatment). But it’s been in pretty common (albeit non-formulary) use for five years now, and nothing has been revolutionized. […]

Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it. […]

Even if all of the above are wrong and psychedelics work very well, the FDA could kill them with a thousand paper cuts. Again, look at ketamine: the new FDA approval ensures people will be getting the slightly different esketamine, through a weird route of administration, while paying $600 a pop, in specialized clinics that will probably be hard to find. Given the price and inconvenience, insurance companies will probably restrict it to the most treatment-resistant patients, and it probably won’t help them (treatment-resistant patients tend to stay that way). Given the panic around psychedelics, I expect it to be similarly difficult to get them even if they are legal and technically FDA-approved. Depressed people will never be able to walk into a psychiatrist’s office and get LSD. They’ll walk into a psychiatrist’s office, try Prozac for three months, try Wellbutrin for three months, argue with their insurance for a while, eventually get permission to drive to a city an hour away that has a government-licensed LSD clinic, and get some weird form of LSD that might or might not work, using a procedure optimized to minimize hallucinations.

{ Slate Star Codex | Continue reading }

“In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure […] we have shown that, at the population level, a low intake of healthy foods is the more important factor, rather than the high intake of unhealthy foods”

[…]

more than half of all global diet-related deaths in 2017 were due to just three risk factors: eating too much salt, not enough whole grains and not enough fruit.

{ CNN | Continue reading }

The goal of this study is to determine if thong underwear use is associated with a higher report of urinary tract (UTI) or vaginal infections. […] We found that thong use is not associated with UTI, BV, or VY. Instead, sexual behaviors and hygiene choices are risk factors for these infections. We recommend that providers take a more complete sexual history to identify these risk factors rather than focusing on underwear as a primary risk factor.

{ Site | Continue reading }

unrelated { A man in Chicago attempted to board a plane butt naked }

screenprint on Perspex { Bridget Riley, Untitled [Fragment 2/10], 1965 }

For every 100,000 inhabitants, Okinawa has 68 centenarians – more than three times the numbers found in US populations of the same size. Even by the standards of Japan, Okinawans are remarkable, with a 40% greater chance of living to 100 than other Japanese people. […]

one of the most exciting factors to have recently caught the scientists’ attention is the peculiarly high ratio of carbohydrates to protein in the Okinawan diet – with a particular abundance of sweet potato as the source of most of their calories. […]

Despite the popularity of the Atkins and Paleo diets, there is minimal evidence that high-protein diets really do bring about long-term benefits.

So could the “Okinawan Ratio” – 10:1 carbohydrate to protein – instead be the secret to a long and healthy life? […]

The typical Okinawan centenarian appeared to be free of the typical signs of cardiovascular disease […] Okinawa’s oldest residents also have far lower rates of cancer, diabetes and dementia than other ageing populations. […]

Genetic good fortune could be one important factor. Thanks to the geography of the islands, Okinawa’s populations have spent large chunks of their history in relative isolation, which may has given them a unique genetic profile. […]

It is the Okinawans’ diet, however, that may have the most potential to change our views on healthy ageing. Unlike the rest of Asia, the Okinawan staple is not rice, but the sweet potato. […] Okinawans also eat an abundance of green and yellow vegetables – such as the bitter melon – and various soy products. Although they do eat pork, fish and other meats, these are typically a small component of their overall consumption, which is mostly plant-based foods.

The traditional Okinawan diet is therefore dense in the essential vitamins and minerals - including anti-oxidants - but also low in calories. Particularly in the past, before fast food entered the islands, the average Okinawan ate around 11% fewer calories than the normal recommended consumption for a healthy adult.

{ BBC | Continue reading }

photo { Stephen Shore, New York City, New York, September-October 1972 }

An electronic synapse that fires millions of times faster than the ones in your brain could be used to build artificial neural networks.

[…]

A clinical trial of drugs called mTOR inhibitors found that they boosted elderly people’s immune systems, potentially extending their life spans. Another trial in progress is testing senolytics, drugs that eliminate the senescent cells that make aging bodies break down.
[…]

A team that built a brain-to-brain communication device in 2015 has now expanded it to three people, paving the way for larger groups to transmit thoughts directly to one another.

[…]

An ordinary smartphone can be used to track people on the other side of a solid wall by detecting how their movements distort the signals from any Wi-Fi transmitters in the area.

{ Technology Review | Continue reading }

image { Google hires camel for desert Street View, 2014 }

Study provides insight into the neurobiology of dying. Investigators performed continuous patient monitoring following Do Not Resuscitate - Comfort Care orders in patients with devastating brain injury to investigate the mechanisms and timing of events in the brain and the circulation during the dying process.

{ ScienceDaily | Continue reading }

Oxygen deprivation results in brain injury. For years, researchers have been studying the underlying processes in animals: within 20 to 40 seconds, the brain enters an ‘energy-saving mode’ - it becomes electrically inactive, and all interneuronal communication ceases. Within a few minutes, the brain’s fuel reserves have become depleted that maintain the uneven distribution of ions between the inside and outside of nerve cells, and the ion gradients start to break down. This breakdown takes the form of a massive wave of electrochemical energy release in the form of heat, which is known as ’spreading depolarization’. More vividly described as a ‘brain tsunami’, this energy loss spreads through the cortex and other areas of the brain, triggering pathophysiological cascades which gradually poison the nerve cells. Importantly, this wave remains reversible up to a certain point in time: nerve cells will recover fully if circulation is restored before this point is reached. However, if circulation remains disrupted, the cells will die. Until now, recordings of electrical brain activity obtained from human subjects have been of limited applicability, and experts have been divided as to the transferability of results from animal-based research. […]

“We were able to show that terminal spreading depolarization is similar in humans and animals. Unfortunately, the research community has been ignoring this essential process of central nervous system injury for decades, all because of the mistaken assumption that it does not occur in humans,” explains Prof. Dreier.

{ EurekAlert | Continue reading }

paint on plaster { Eduardo Paolozzi, Targets, 1948 }