Covid-19, from a reliable source

I received this from a man, Ken, I have known for many years. He is a retired Master Sergeant of the Tennessee Army National Guard. Since retirement he has been a senior director of emergency management in Tennessee. He said he got this "From a reliable friend in the medical field." Well, I trust Ken.

Here is the man's assessment.
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The virus is encircled by an oily, lipid layer that dissolved on contact with soap. Hence the push for hand washing. The virus enters the body through the mouth, nose, and/or eyes and needs cells with ACE2 receptors to attach. These are found primarily in the heart and lungs. ACE2 (angiotensin-converting enzyme) is a protein associated with both diabetes and HTN, both conditions which place an individual at a heightened risk; 40% of patients with HTN experienced severe infections.

The virus then attaches to healthy cells with that fatty, oily layer and hijacks the cells, making proteins to keep the immune system at bay. The immune system mounts a defense and sometimes attacks healthy lung cells. The lungs fill with fluid and dying cells. This can lead to ARDS which is most often fatal, basically an acute, lethal pneumonia. That's what killing people. It's not unlike the Spanish Flu. That flu attacked healthy individuals and created a "cytokine storm" and people drowned from the fluids in their lungs. We now know the virus is found in the bloodstream, GI tract, CNS, and possibly brain. It can cause damage to the lungs, heart, bone marrow, and liver, possibly nerve cells. Should you survive a severe infection because you're young and healthy, you can expect a 20-30% decrease in lung capacity. What this means is that a flight of stairs will wind you. You can expect lung scarring and damage. We do not know the long term effects as this is an entirely new virus. When a virus makes that first jump from one species to another, it is at its most lethal. That is what we are seeing with SARS-CoV-2.

A new study is out that shows the droplets can "hang" in the air for up to three hours. This may mean the virus is aerosolized which answers the question why it appears to be so contagious when it only has an R0 of 2.4. This study was conducted by NIH, Princeton and UCLA and is not yet peer reviewed. This study also showed the virus is viable on plastics for 3 days; on the glass of cell phones 9 days; and on cardboard for 24 hours.

Contrary to the other four coronaviruses that are endemic in our population, this one does not seem to be susceptible to heat and humidity as we had first hoped. The transmission of the virus will go down come summer, but that is a function of schools' closing for the summer break rather than a response to heat/humidity. There will be an uptick in cases once fall arrives due to the close quarters. This virus is not going away anytime soon. There are three courses a novel virus can take - 1. It can appear, be devastating, and disappear unexpectedly like both SARS and MERS. This one did not do that so this option is out. 2. It can cause a global pandemic and a lot of people will lose their lives or be disabled from the infection. May be happening. 3. It can become endemic in our population like the other 4 coronaviruses we see during cold and flu season and account for up to 30% of our "colds." This is highly likely.

Myths:

1. Keep your mouth moist (another version is to spray your nose with saline) and the virus can't "take hold." Staying hydrated helps your immune system. It does not do anything to the virus.

2. Keep your mouth moist and take sips frequently to "swallow the virus."

3. Drink a solution of diluted bleach and water. No. Do not ever drink bleach. Or take acetic acid or any number of the "natural cures" out there. If there was a natural cure, doubtful almost 6k people globally would have died.

4. Take vitamin C. Vitamin C was a great marketing campaign in the 50s by Linus Pauling. It's such a great campaign, it perpetuates today. It does absolutely nothing for the prevention or treatment of colds/viruses.

5. There are antibiotics for this virus. Antibiotics only work on bacterial infections. We don't know which, if any, antivirals work on this novel virus.

6. I'm young and healthy. If I get it, it won't affect me. There can be long term damage or even organ failure due to the virus. We will not know for many years the extent of the damage.

7. The flu shot will prevent the virus. The flu and this virus are completely different viruses. However, getting the flu shot does two things: decreases your chances of becoming ill from the flu and having a weakened immune system making you more susceptible to the coronavirus and keeps you out of the hospitals allowing providers the time and resources to care for victims of the pandemic.

8. Black people don't get the coronavirus. OMG. NO! This is not only racist, it's completely wrong. Africa has over 100 cases.

9. I should wear a mask. No. Just no. (I can elaborate at length why this is not a good idea)

10. Kids can't get the virus. Not only is this not true, it may be deadly. Yes, children can get the virus and many are asymptomatic. So far, thankfully, there haven't been any deaths in children under 9. Newborns have gotten the virus. We just don't know what the long term effects will be. If you can protect your children, do so.

11. Schools are closed; I can take my child to the museum, zoo, theater, etc. NO. The idea of social distancing is to stay home. Do just that. Stay home. If you do not, people will die. It's that simple.

12. Heat (or cold) will kill the virus. Nope. This nasty bugger is strong and kicking our butts. Neither a hot or cold bath or a hair dryer will kill the virus. (Seriously, WHO, who is using a hair dryer to kill the virus??)

13. Garlic. What? No, of course garlic doesn't prevent or treat the virus. I mean, look at Italy.

14. There are medicines to treat the virus. No, there are no specific meds to treat this virus. South Korea seems to have found a sweet spot with a combo of drugs, but we have no idea if that actually works, how effective it is, long term effects, etc. We are years away from a vaccine.

15. Essential oils. No. Always no.

And the big one - 16. "It's just the flu." Nope. At the worst, its 30x more fatal than the seasonal flu (Chinese/WHO figures) at its best, 10x more fatal (South Korea figures). This is NOT just the flu. Seasonal flu has a case fatality rate (CFR) of 0.6% annually. This virus, depending on which country you run the stats has either a 3.4% CFR or a 1.2% CFR. Both are substantially higher than the flu. For comparison, the Spanish Flu had a CFR of 2.5%.
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Read this, too: Influenza kills more people than coronavirus so everyone is overreacting, right? Wrong — and here’s why

Folks, this virus is bad news. Treat it that way.

Why health care is not a human right

I first wrote this in 2009, but it seems relevant to today as well; I have updated it.

Is health care a human right, as the United Methodist Church says? I don't see how. Human rights, as Americans have always understood them (beginning with Thomas Jefferson and the other Founders) are a fact of nature that cannot be rescinded by human beings. Rights are immutable, indeed, unalienable ("Not to be separated, given away, or taken away" Dictionary.com, as Jefferson wrote in the Declaration of Independence.)  As a precursor to his Declaration theology that unalienable human rights are a endowment by God, Jefferson wrote in his pre-revolution essay, Summary View of the Rights of British America, " The God who gave us life gave us liberty at the same time. The hand of force may disjoin, but cannot destroy them."

Since his day, and certainly preceding it, the historic American understanding of human rights is the exercise of individual freedom, especially in the political realm, for both public and personal good. We have historically never understood our rights as encompassing access to services or commodities.

Rights are inherent in each individual equally, they are not divisible. Take the Declaration's famous insistence that among human rights is "the pursuit of happiness." Note that it is the pursuit of happiness that is a right, not the achievement of it. Nor is one person more entitled to pursue happiness than another, no matter one’s station in life. Besides, happiness (what Jefferson meant was not happiness as we use the word today, but a state of contentment in life and possessions) is not something that can be given us, it is something we have to create.

It does sound all high-minded to say that, like rights, health care should be equal for everybody, which I suppose is why clergy are so susceptible to say so. It's more than obvious that no one in the Congress or the White House believed it in 2009 when Obamacare was enacted. If they had, the act would have required members of Congress and the rest of the federal government to fall under the "public option" along with the rest of us proles. But they’ve protected their turf completely and much better turf is theirs than ours. I’ll believe that equal access and care for everyone is a moral imperative when the people who say it is a moral imperative place themselves under the same imperative.

The presumption that health care is a right, and therefore must be equal for everyone, is founded on two critical errors of understanding. The first is that health care is a resource that is simply available for those who need it, or that can be made equally available through proper legislation and regulation. The second error is that medical care and access to it can be rationed by command more equally, economically, and fairly than by demand.

Health care is not a resource to be exploited

Medical facilities and doctors are not phenomena of nature, like water or petroleum are. Hospitals don’t just appear. They are produced. Medical care is not a resource that can be "mined" through more regulation to be more plentiful. Medical care is a service. 

Specifically, it is a contracted service, in much the same way that legal assistance, automotive maintenance or pastoral care are services. Why? Because men and women choose of their own accord to get medical training. Once graduated, doctors, nurses, paramedics and technicians of various kinds reasonably expect that they will be compensated at a rate greater than their costs to enter the profession, greater than their extremely high overhead to run the practice, and enough to make their grueling hours materially worthwhile for themselves and their families.

This fact has very direct consequences under the Medicare and Medicaid systems we have today. The Atlantic's business journalist Meg McArdle explains:

[W]e have a comprehensive national health care plan for seniors. Yet we have a shortage of geriatricians, the one specialty that you would think would be booming. Why? Because Medicare sets a single price for the services of geriatricians, and it is low. Since the field is not particularly enticing (though arguably it really should be, since geriatricians have extremely high job satisfaction compared to many more popular specialties), very few people go into it. It's one of relatively few specialties that consistently has most of its slots and fellowships unfilled.

Moreover, the skills and equipment a doctor or hospital possess are their individual property, not the property, even partially, of the state or public. (There are publicly-owned facilities such as VA hospitals, but in operation there is no difference to the general public between them and private facilities). No one has a natural right to someone else's property. To think we do directly violates the Tenth Commandment. As McArdle says, "People have no obligation to perform labor for others. I may not [justly or legally] force a surgeon to save my mother at gunpoint."

That means that to receive a doctor's services, the doctor and a patient must come to a mutually-agreeable arrangement of what medical care will be provided in exchange for a specified fee. This is a commercial transaction no different in type than hiring a plumber, cab driver or lawyer. That medical services may be life critical does not change the fundamental nature of the contract.

We have access to medical care only as long as a doctor is willing to provide it. No one has to become a doctor or continue in medical practice. If any "reform" of the present health care system reduces the rewards of practicing medicine or complicates the practice, fewer men and women will so choose, as in Britain today (see below). Access will then go down for everyone and costs will inevitably rise, no matter what the rate-payment of the public option is, because access or its lack is itself a cost and also drives other costs.

Health care is a service

As Michael Keehn explains, health care is a service but not a community service. Police and fire departments provide community services. That seems obvious enough, but consider: fire departments do not protect your home individually. The fire chief definitely will let it burn to the ground if firefighting needs are greater elsewhere in the town. Just look at what is happening near Los Angeles as of the date of this post. Police and fire protection are in fact rationed to protect the lives and property of the greatest number of people possible with the resources available. But when the resources (manpower, equipment or money) run out, individuals are exposed to greater danger or loss though the community at large may still be protected.

Individual residents of a city do not contract for their community’s police or fire protection. When you call 9-1-1 because someone broke into your home while you were in bed, you don’t have to sign a contract with the police when they arrive, specifying the actions you want them to take and how much you are going to pay.

In contrast, medical care is an individual service. Doctors do not provide their services to the community as a whole, but to individuals. Because of that, each patient enters into a contract with his/her doctor specifying the medical services to be received and how much it will cost. This is mostly mediated through insurance companies, of course, which greatly simplifies the contracting process. The result is that a patient 's health is protected in a way that their safety or homes are not protected by the police or fire departments.

Interestingly, the Roman Catholic Church rejects the idea that health care is a human right. The Most Reverend R. Walker Nickless, bishop of the Diocese of Sioux City, Iowa, explains.

[T]he Catholic Church does not teach that “health care” as such, without distinction, is a natural right.

The “natural right” of health care is the divine bounty of food, water, and air without which all of us quickly die. This bounty comes from God directly. None of us own it, and none of us can morally withhold it from others. The remainder of health care is a political, not a natural, right, because it comes from our human efforts, creativity, and compassion.

Like any human endeavor, health care is finite. It can be properly understood only as such. Any reform that treats medical care as if it can be made infinitely available is a product of cloud-cuckoo land. Medical care, like every other finite thing, must be allocated. The current buzzword for that is "rationed." That’s the foundation of the second critical mistake people are making about health care, that medical care and access to it can be rationed by the government more equally, economically and fairly than by consumers. 

Philip Barlow, Consultant neurosurgeon at Southern General Hospital, Glasgow, explains why "Health care is not a human right." 

Update, March 2020: In 2009. Philip Niles wrote that the real question is not whether health care is a human right, but "How much health care is a human right?" His essay is no no longer online. It is a good question because since medical care is finite. He says, 

With all of the emotional and financial investment in health care, it is important to address the situation with an actionable approach - not an ideologic one.  My suggestion is to quantify just HOW MUCH health care we believe is "right" to provide, recognize that we should cap public health care spending, and focus the moral/fiscal debate on how high that cap should be set.  Let's achieve our ambitions of providing access for the uninsured with the most likely way of succeeding: by haggling about the price.

There is always a price to be paid, one way or another. What politicians seeking votes seem to do is ignore that price (paid by the consumer) and cost (borne by the provider) are not the same. When a political candidate promises free health care for everyone, they conveniently ignore that free care is simply, literally impossible. 

Look at it this way: as I write, we are in the midst of the coronavirus concerns, with a few thousand died from it worldwide and several in the US, where cases are rising. Now imagine you are a government-employee administrator for Medicare For All the next time such a potential pandemic arises -- and most assuredly there will be a next time. 

You have to choose between funding two heart-replacement surgeries plus rehab routines or funding the testing of 50,000 potential virus infectees for the illness. You do not have the funds to do both. 

Which do you choose? Why? And how do you respond when the untreated persons demand it anyway because it is a human right? 

There is always this question: Who pays and in what coin? One candidate this year had either the temerity (or carelessness) to tell his audience the day before the S.C. primary, "Your taxes are going to be raised" to pay for Medicare For All. How much will taxes be raised? He did not say, but presumably they will raised an amount corresponding to the cost of providing the medical care to the population. In other words, everyone will still pay an insurance premium now called taxes, and the tax rate will never go anywhere but up. Why? Because every other nation with "free" health care finds it over-utilized and under-resourced. 

Take Canada, for example, which many politicos say can be a model for us. In reality ...

... Canadians' out-of-pocket health costs are nearly identical to what Americans pay—a difference of roughly $15 per month. In return, Canadians pay up to 50% more in taxes than Americans, with government health costs alone accounting for $9,000 in additional taxes per year. This comes to roughly $50 in additional taxes per dollar saved in out-of-pocket costs.  Keep in mind these are only the beginning of the financial hit from "Medicare for All." 

Canada's public system does not cover many large health costs, from pharmaceuticals to nursing homes to dental and vision. As a result, public health spending in Canada accounts for only 70% of total health spending. In contrast, Medicare for All proposals promise 100% coverage. This suggests the financial burdens on Americans, and distortions to care, would be far greater than what Canadians already suffer. ...  

More serious than the financial burdens is what happens to quality of care in a government-run system. Canada's total health costs are about one-third cheaper than the U.S. as a percent of GDP, but this is achieved by undesirable cost-control practices. For example, care is ruthlessly rationed, with waiting lists running into months or years. The system also cuts corners by using older and cheaper drugs and skimping on modern equipment. Canada today has fewer MRI units per capita than Turkey or Latvia. 

Moreover, underinvestment in facilities and staff has reached the point where Canadians are being treated in hospital hallways. Predictably, Canada's emergency rooms are packed. In the province of Quebec, wait-times average over four hours, leading many patients to just give up, go home and hope for the best.

The piper must always be paid. And so it shall be for us, but both in currency and in other than money. Medical care is always rationed. Always. And the rationing takes place within three areas:

1. Price to the consumer, presently mediated through 
1. insurance premiums and co-pays, and
2. Medicare and co-pays and Medicaid.
3. Under MFA, those will be taxes and the Dept. of Health and Human Services.
    
2. Quality of the care provided, mediated through 
1. the training of the physicians, nurses, and other medical staff
2. the quality and availability of medical supplies and equipment.
3. costs of the providers as related to price to the consumers.
    
3. Availability of the care, mediated 
1. always through the number of practitioners and where they work, and that is almost always mediated through compensation,
2. and by what medical specialties they practice, noting that this is heavily related to compensation also (see Megan McArdles' observation above). 
3. by limiting or even eliminating medical for some demographics, say by age, as now-suspended presidential candidate Mike Bloomberg said explicitly.

What we are falling into in this debate is the "Do something!" fallacy: 

1. The status quo is deficient, so something must be done!
2. This is something.
3. Therefore, this must be done. 

Absolutely anything can be justified by that template - and is being justified. But remember: medical care is always rationed, either by price and cost, or by quality, or by availability. When we go to the polls in November, we will not be voting for free health care for everyone. We will be voting only for how we want health care rationed in the coming years, and we will be merely hoping without any evidence anywhere in the world that it will be better than what we have now. 
  

Finally, The New York Times in 2009: "Why We Must Ration Health Care."

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it.

This is not where are now except for the VA. Which should tell us something.

Forbes covered the way health care works (well, doesn't work) in Britain: "Britain's Version Of 'Medicare For All' Is Struggling With Long Waits For Care."

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That's well below the country's goal of treating 95% of patients within four hours -- a target the NHS hasn't hit since 2015. Now, instead of cutting wait times, the NHS is looking to scrap the goal. ...  

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of "limited clinical value." It's hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients' vision to worsen -- and thus put them at risk of falls or being unable to conduct basic daily activities.  

"It's shocking that access to this life-changing surgery is being unnecessarily restricted," said Helen Lee, a health policy manager at the Royal National Institute of Blind People.  

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same "limited clinical value" label on them. Patients face long wait times and rationing of care in part because the NHS can't attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That's a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied.

But don't worry. We will be promised that we will do it different. But there is zero reason to believe that American politicians and bureaucrats are magically more generous, more compassionate or smarter than Britain's. 

Or for that matter, Canada's, where the government determines medical care, and so uses that power to favor selected constituencies. In Canada, rare but expensive medical treatments go grossly underfunded while the government spends enormous sums on cheap treatments and meds that vast numbers of voters use. Like this:

A girl who died of leukemia was given a final send off after her friends signed her casket with loving messages on January 30.  

[…]Laura might have experienced a few more milestones if a Hamilton, Ontario, Canada, hospital had been able to accommodate a bone marrow transplant for the young woman. Numerous donors were a match with Laura and ready to donate, but Hamilton’s Juravinski Hospital didn’t have enough beds in high-air-pressure rooms for the procedure. Hospital staff told her they had about 30 patients with potential donors, but the means to only do about five transplants a month.  

[…]Dr. Ralph Meyer, Juravinski’s vice-president of oncology and palliative care, told Ontario’s TheStar.com there are plenty of others facing the same situation as Laura in Canada.

Free birth control immediately? Check. Free needles to inject illegal narcotics? Check. Free condoms? Check. Free abortions on demand? Check. Life-saving operation for a single leukemia patient? Not a chance. Leukemia patients are too few to form a voting block, so let 'em die. 

Then there is the Catholic-run hospice in Canada that the government is requiring closure because it refuses to kill its patients. 

A hospice in Canada has lost its funding and is being forced to close after refusing to offer and perform medically assisted suicides. The Irene Thomas Hospice in Delta, British Columbia, will lose $1.5 million in funding and will no longer be permitted to operate as a hospice as of February 25, 2021. 

Fraser Health Authority, one of the six public health care authorities in the province, announced on Tuesday that it would be ending its relationship with the hospice over its refusal to provide medically assisted deaths to its patients.

Anyone who thinks that none of this can happen under Medicare For All is living on a different planet than the rest of us. The only way the Democrat party thinks of goods and services is by in-groups and out-groups. And that is where they will allocate funds, spending bite-size on as many people as they can, because the real purpose of Medicare For All is not medical care. It is to enhance and keep political power. 

"Medicare for All" - as goes the UK, so will go USA

Want to know what medical care will be like if we get so-called Medicare for All (MFA) that Democrats are proposing? Well, here ya go: "Why the UK Suddenly Is Suffering from a Physician Shortage."

Why? Because MFA's costs are so incredibly high that massive tax raises will be enacted in the vain hope they will pay for it. They won't, but the taxes will still be levied. And as goes the UK will go the USA:

The NHS is in a state of perpetual crisis characterized by doctor shortages, long wait times, and rationing. The UK lost 441 general practitioners last year and had 11,576 unfilled vacancies for doctors as of last June.

The respected Financial Times explains:

An investigation [in March] by the Financial Times found widespread evidence of consultants refusing to take on extra work to clear patient backlogs fearing extra pay would bust tax allowances on their pensions contributions, triggering five-figure tax bills. …

[T]he Department of Health conceded that around 3,500 consultants and GPs had retired early over the past three years due to pension tax charges.

The tax system is so labyrinthine that some doctors discover they actually have negative income flows - it costs them more out of pocket to stay in  practice than to leave it.

Doctors respond to these perverse incentives the same way many rational actors would: by closing up shop. All parties agree the UK’s progressive tax policy triggered this cascading medical shortage.

But fairness, comrades! Onward to the future!

Sincere congratulations to New Mexico Democrats

Some of them anyway: "Pro-abortion New Mexico governor shocked as Democrats sink bill to kill born babies," a bill that would have legally authorized infanticide. It passed the NM House but failed in the Senate, where Democrats hold a decisive majority.

No one was more surprised by Thursday night's vote than Governor (and abortion extremist) Michelle Lujan Grisham (D). After the House had sent the bill on with a 40-29 vote, the Democrats' stranglehold on the Senate was supposed to mean that the New York-style H.B. 51 was a done deal. But despite the party's 26-16 edge, the vote fell far from party lines. In a stunning victory for pro-lifers, eight Democrats crossed over — killing a bill that would have legalized infanticide and given abortionists the right to destroy babies up to the moment of birth.

Governor Grisham, who hadn't counted on the intense lobbying from pastors and state conservatives, was astounded. "That... it was even a debate, much less a difficult vote for some senators, is inexplicable to me," she told reporters. By a 24–18 tally, Democratic Senators Pete Campos, Carlos Cisneros, Richard Martinez, George Muñoz, Senate President Pro Tem Mary Kay Papen, Ramos, Clemente "Meme" Sanchez, and John Arthur Smith proved what a complicated issue abortion is becoming — even in liberal states.

Infanticide has been argued as justified and morally unobjectionable for many years now. As I documented in 2012, "First, we kill all the newborns."

Academic philosophers Alberto Giubilini and Francesca Minerva—shockingly working in Australia, a land where commonsense was once held sacred—have written a peer-reviewed paper in which they say that killing newborns is A-OK, and even in some cases to be encouraged.

Their “After-birth abortion: why should the baby live?” is in the Journal of Medical Ethics.

Much more at the link.

This must not be allowed!

This cannot be allowed! No minor should have the right or to undergo any kind of non-emergency medical treatment without parents' consent!!!

Except abortion, of course. No problems there. Parents must have nothing to do with that.