Category Archives: Covid-19

Realism in the Time of Covid

I walked down the broad, sandy track, distracted. The path was built for motorized traffic, so it required no attention to route finding, and my mind could wander elsewhere, in places far from plagues and Gumby revolutions. But I did not stray for long. Behind me, I heard barking. The noise was the sort of high-pitched yap which a dog makes when something frightening, yet fun, is in progress.

I had assumed that a dog made the sound, but I began to doubt as the yammering grew closer at an unnatural rate and became accompanied by a growl that fluctuated in uneven gasps. I stepped off the track, waiting nervously. But of course, no extraordinary monster appeared around the last bend. What did roll into sight was a standard, biomechanical amalgamation. The dog, a German Shepherd mongrel, sat lashed to the vehicle frame up front, shaking and yelping. Behind the mutt, a lumpy man in a down coat steered the buggy from the comfort of its silver roll cage. He gunned the engine over little rises, and coasted around the curves. He gave a little smile and a wave as he passed me. A small American flag fluttered from the apex of his sun-shade.
The commotion rapidly faded, and I turned my attention back to the walk, and the granite towers at the walk’s end. I could see the formations now. Poking up from the slopes of the Little Valley, they were squat spires, the color of the sand beneath my feet. Most were not monoliths, but stacks of huge blocks, each brick 40 feet or more on a side.
At the apex of a small rise in the trail, a single, rhomboidal flagstone, and a small prickly pear with three leaves marked the turnoff to my objective. They looked as if they had been placed there, but they were no more intended for my purpose than the track of hoof prints which led away from the landmark towards the climb. A dotted line, stamped in the sand by deer and elk, and punctuated with mounds of pellets along the way, wove through the Manzanita until it intersected with a line of Cairns leading to a gigantic stack of boulders.
I dropped my pack at the base. I could not tell if the staging area had been manufactured or not, but it was a perfect little patch of dirt, sheltered by cypress and laurel. I fished the rope out from the bottom of the pack and donned harness and helmet. I carried no more gear, because my goal for the day was not to climb the 4 inch wide crack above me from the bottom up. My goal was to find out if I was still a climber, and if so, to begin to claw my way back to a respectable condition. To those ends, I would crawl through gaps between the blocks above, anchor the rope to a pair of unseen bolts, descend the rope, and climb back up to the bolts as many times as I could.
With the rope tied to my back, I made my way around the side of the formation until I could tunnel through the cracks. The way led down and across to a small alcove. A scraggly alder tree grew there, apparently supported by a very shallow bowl of sand alone. In retrospect, it had made a mistake. Though the spot was secure, the soil was too shallow, and the tree’s highest leaves could only catch sunlight for a couple of hours every day. It could never thrive, but it was a pleasant decoration for the time being. From the alcove, a short, awkward squeeze led to a hidden ledge, and the anchor. I secured my rope to the two bolts.

After descending back to the base, I loaded my self-belay device and began to climb. I moved methodically, not at all like I would climb with a partner belaying from the base. I used a single device for fall protection. This was on purpose. The set up relied on hands and feet as my first line of protection, with the rope and device as backup only. Having a second chance put an edge on the whole project which was lacking in the case of third chances and single chances alone. With a third chance in play, the focus shifted to the equipment and allowed for some slop in the climbing. Committing to one chance only demanded fatalism, and fatalism shifted the focus to the mental equipment needed to accept one’s fate, at the expense of free movement.
I climbed through the route, slowly convincing myself that I could still move smoothly. The effort meant ignoring the grind my left shoulder when I loaded it in extension, and the stiffness in my leg on the right when I tried to step high.
I made it through an acceptable number of laps and pulled the rope. The sun was now as high as it would get in midwinter, and it illuminated a small tuft of leaves poking from the alcove between the boulders above.
I turned my back on the formation and wandered down past the Cairns, the elk pellets, the rhomboidal rock, and the three-leaf pear. With the full warmth of the sun on the Little Valley, the trail was now bustling. A grade school child teetered over a bump on his motorbike. A parent followed, riding a matching cycle nearly on the kid’s back tire. Groups of people, some wearing facemasks, some not, nodded to me politely as I stepped off the trail to let them by.
As usual, I could gauge my distance from the trailhead by the age and attire of passing hikers. I first passed those kitted out with boots and daypacks, then the sneakers lot with their coats tied around their hips, then the shorts and flip-flops crowd. By the time that the expensive homes which flanked the start of the trail were visible, the vast majority of passing travelers wore boat shoes and elastic waistbands and would plainly go only a few more steps beyond the gate. What they sought by this activity, I could not imagine.

The parking area had filled up since my departure, and in the usual fashion. When I had arrived in the morning cold, the only other cars parked in the lot were a dated Subaru and a Toyota truck. The Subaru had a Sierra Club sticker on the back window. The truck was covered in dust. Between morning and afternoon, cleaner vehicles had filled in the rest of the parking spaces. A few of these had American flag decals, and one of the flags was blue with a prominent blue line through the middle of the stripes. One rear window bore a red white and blue “Q”.
I wondered who belonged to those stickers. Nobody on the trail looked crazy. Certainly, nobody looked like a revolutionary, and if my fellow travelers that day really were the sons and daughters of the Revolution, then the revolution would be over as soon as the propane and Slim Jim’s ran out.
I had them entirely wrong, though. What a person trusts depends on what a person wants. What a person wants depends on the depth and breadth of their perception. The revolution was against the untrustable unseen. They revolted against rumors of an invisible pathogen. They revolted against the idea of murky social, political, and personal depths. Most of all, they revolted against a start in the cold and dark which they had somehow been convinced that they were entitled to avoid.

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For Anyone

…who believes that, “we have more cases because we have more testing”.

Testing for an infectious disease is like counting the number of balloons in a dark room by tossing darts through the doorway. Say you throw 10 darts in the room and hear two pops. There is still a good chance that a number of balloons remain uncounted. But if you throw 40 darts in the room and hear two pops, the likelihood of a two-balloon scenario soars. When the rate of pops drops below a certain proportion, you can be sure that you have counted most of the balloons in the room. A low percentage of positive tests is what you’re after.
Once you have established the adequacy of your testing, you can sort out what the results reveal about containment. The raw numbers don’t tell you that much. In the case of national case counts, it is reasonable to expect a country with a large population to experience higher numbers than a country with a small population given similar degrees of disease containment. A true measure of containment is cases per population, or in our analogy, how crowded the room is with balloons.
So when a pinhead like Trump says that we have more cases because we have more testing, that standalone statement is pure bull shit. What’s worse, it’s a distraction from what really indicates the adequacy of our understanding of the outbreak’s extent and the effectiveness of our efforts to contain it: percent positive tests and infections per population.

How is the US doing?

Top of the heap with >15,000 cases/1 million persons (European Centers for Disease Control)

Percent positive tests: 7.9 (an adequate percentage is less than 5%)

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H plus or minus the A

Wee Donnie loves his Plaquenil. He says that hydroxychloroquine may be a game changer. He is not a doctor, and he is certainly not an academic, but he says that he has common sense to guide him. His common sense tells him that the drug might have some beneficial effect in Covid-19 infections, times are desperate, and so why not give it a go – what do you have to lose?

Of course, common sense is what tells us that the earth is flat and the sun goes around it. Shockingly, common sense is just as dependable when it comes to bio-statistics. Trump has no idea what he is talkiing about (as usual). Let me heap a fair helping of scorn on his contentions. To do that, Donnie’s argument has to be split into its two components; otherwise, the load would collapse the full-length argument before even a third of the deserved disparagement were dispensed.

Part one concerns the effectiveness of hydroxychlororquine for corona virus. There are a couple of observational studies from China suggesting that moderately ill people given the drug may have been less likely to progress to severe illness. There are also in vitro studies of viral replication which show hydroxychloroquine to be inhibitory. Finally, there is a study examining viral shedding in patients given the drug versus patients not given the drug. This last study is open label, not randomized, and examines a surrogate endpoint – what we want to know is whether the medicine makes people get better, not whether it makes their nasal swab get better.

All of this evidence generates a hypothesis (that hydroxychloroquine may improve clinical outcomes in coronavirus infection) but doesn’t yield any conclusions at all.  To illustrate how this can be so, witness research on the use of this very same drug for influenza treatment. Because, hydroxychloroquine inhibits replication of the influenza virus as well, in vitro. When given to patients in a randomized, controlled trial however, it didn’t make anybody any better, any faster.

But why let the perfect be the enemy of the good? We can go on hope and the possibilities implicit in the observational studies. The med is safe, right? Just give it. To clarify the consequences of such proposals, lets say that the putative cure for Covid-19 is not a Q/T – prolonging antimalarial. Let’s say, it’s a chocolate brownie. The instructions are: chocolate brownies cure corona. That’s it; that’s all we know.

Now, some people are going to take a tiny pinch of brownie, and secure in its protection, head off to the church picnic. They will get the virus and wind up in the ICU.

Other people will eat 5 brownies per day, sending their triglyceride levels through the roof. Those in this group who are also taking certain medications, will develop pancreatitis and wind up in the ICU (drug-drug interaction).

Some will go beyond the 5 brownie dose, to 7 per day. Among this lot are bound to be some latent diabetics who will subsequently land in the unit with hyperglycemic hyperosmolar non-ketotic coma (drug -disease interaction).

Finally, a few true believers will bump the dose to 10 brownies daily. They will experience nausea, vomiting, and diarrhea with subsequent dehydration and acute kidney injury, buying them an ICU bed right beside the Covid patients (adverse drug effect).

The point is: common sense sees no farther than its own nose and is blind to all these eventualities. Scientific method is not, largely because it admits that we can’t know all the eventualities. That’s why good clinical trials measure hard endpoints, like death or time to hospital discharge, and not surrogate markers, like the presence of virus on nasal swabs.

Don’t rely on that nitwit shyster Trump, his toadies, and their common sense. Rely on scientific method instead.

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