13 February 2020

COVID19 Outside China Shows Value Of Early Response

The statistics surrounding the coronavirus erupting out of Wuhan, China, officially labeld COVID19, and more colloquially known as "Wuhan Coronavirus" paint a grim picture. As of this morning (Thursday, February 13), there were nearly 60,000 cases in China alone, and over 1,000 deaths:
In China:
59,804 cases
1,367 dead
5,911 recovered.

Case Fatality Rate ~ 18.7% 
Outside China:
581 cases
3 deaths
75 recovered

Case Fatality Rate ~ 3.8%
While even the fatality rate outside of China is an alarmingly high rate (epidemiologists blanch at any fatality rate greater than 2%), the variance between the cases inside China and outside China are quite remarkable--enough so as to warrant closer inspection as to why.

One thing these numbers illustrate is the importance of early interventions and responses, both at the personal and public health levels.

China Declared War On Coronavirus

China has had, by far the most rhetorically aggressive and demonstrably intrusive response to COVID19.  From the top on down, they have used quite literally the language of war, and evoked patriotic imagery to elicit public support for their containment efforts. Much of that rhetoric is overshadowed by the brutality and even barbarism of some of their efforts--arrests, incarceration of asymptomatic individuals, and even violence and gunplay

China went to war against the coronavirus in a very literal sense of the word.

China also, unfortunately, went to war against the truth and against transparency.  They have consistently manipulated the data they have been reporting, even going so far as to revise the definition of a "confirmed" case to produce a temporary drop in the numbers--only to have to reverse direction and dramatically revise upward their disease counts in Hubei Province just a few days later.

The scale of China's response is staggering: 400 million people under quarantine by February 7, 80% of their economic output and 90% of their exporting businesses completely shut down since around January 23.

The World Watches, Waits, But No War (Yet)

By comparison, other than travel restrictions to and from China, the rest of the world has done comparatively little: only one small Vietnamese town, Son Loi, has instituted community-wide quarantine measures. The United States has quarantined American citizens repatriated from Wuhan, some of whom have since tested positive for the virus. Japan has quarantined a cruise ship, the Diamond Princess, whose passengers are steadly testing positive in increasing numbers.

There have been no mass quarantines of countries.

There have been no closures of businesses.

Yet there have been no mass outbreak of cases internationally.  As I have rhetorically asked multiple times, "where are the cases?"

For a disease that is highly contagious, there have been surprisingly few cases outside of China. There are no cases reported in Africa. There are no cases reported in Indonesia.

It is not for nothing that this disease has received on Twitter the moniker "China flu".

Diamond Princess: A Case Study In The Rough

The Diamond Princess cruise ship provides an intriguing middle ground between China and the rest of the world. When the ship docked in Yokohama, Japan, a single patient presented with COVID19 symptoms. That single patient became ten, which quickly became 70. The most recent count has the number of infected passengers at 218.

There are more cases on that one ship than there are in any other country, although the numbers still pale in comparison to China.

As of this writing, no passengers on the Diamond Princess have died. Japan's first death from COVID19 was someone with no connection to the cruise ship. 

On board the vessel, the disease has been far more contagious than overall internationally, but nowhere near as contagious as in China.

While the passengers have been quarantined, they have also had access to medical care, arguably to a greater extent than in Wuhan, where the disease quickly overwhelmed the healthcare system. As early as the first quarantine, of Wuhan, the city was reporting a lack of protective gear for its healthcare workers. One of the earliest signs that something was amiss with China's reported case numbers was the claim that, with just 850 reported cases, Wuhan was running out of hospital beds. Such shortages have not been the experience of the cases on the Diamond Princess, nor have they been the experience of the US evacuees from Wuhan during their quarantine stay.

Early Intervention Clearly Makes A Difference

As shocking as a pleasure cruise liner being turned into a "plague ship" can be, the Diamond Princess yet provides a bit of bright light into the darkness of this disease.  It shows conclusively the advantages of early interventions. On the ship, as patients have either tested positive or turned symptomatic, they have been removed to an hospital and are presumably receiving fluids, oxygen, and other supportive therapies while their body fights off the disease.

In Wuhan, doctors have been turning patients away for lack of beds and resources. Essentially, some untold number of people have been effectively denied care for the disease, at least until it reaches a level of severity where hospitalization is mandated, if only to limit the spread of the disease further.

Even in Africa, with some of the weakest healthcare systems on the planet, preparations are being made to ensure patient care and comfort against the day when COVID19 finally reaches that continent. Early response is still the best response (hardly an original idea in any area of healthcare).

China Has Been Late Response And No Response

Far from having early and aggressive responses to the disease, China's response has been either tardy or nonexistent.

The disease was first noted on December 26, 2019 (officially). 

The World Health Organization was notified of the disease on December 31, 2019.

WHO identified the disease as a new coronavirus on January 9, 2020.

No quarantine or containment of Wuhan or anywhere else was initiated until January 23. By the time quarantines were intiated in Wuhan, an estimated 5 million people had left the city for the Lunar New Year holiday.  5 million potential carriers of the disease were moving around China and the world--as evidenced by the cases appearing at the time of the quarantines in other countries. With shortages of face masks and other supplies, a good deal of otherwise mundane preventative measures simply have not been done.

Further, China took the step of altering diagnostic criteria deviating from the WHO diagnostic criteria, with the result that fewer patients were actually "confirmed" to have the disease, and thus fewer patients were being treated for the disease, at least until the criteria were revised again to include all patients showing symptoms even without a positive test result. Quite literally, people in China have to get sufficiently sick to warrant treatment before any intervention is done.

The Ounce Of Prevention Still Outperforms The Pound Of Cure

It would be facetious to ascribe all the differences between the disease totals inside China and outside China to the simple steps of early diagnosis, early intervention, and early quarantine. Yet we should not discount these factors either. The Diamond Princess cases prove not only that COVID19 is an highly transmissible and contagious disease, but that it is also a manageable disease, and a containable one--there have been no reports of coronavirus in Japan emerging from the cruise ship. The disease is on the Diamond Princess, but it is staying on the Diamond Princess.

The best time to solve any problem is when it is small. The worst time to solve any problem is when it is big. The best way to solve big problems is to whittle it down to small problems. 

COVID19 is being resolved outside of China when it is small--a case here, a case there, a few cases on a cruise ship easily isolated. COVID19 was not resolved inside China when it was small, and now resolution appears all but out of reach. China must now wait for the disease to run its course, and abate naturally.

The Known And The Unknown

We do not yet know the true origin of COVID19. We do not yet know whether a vaccine will be easy or hard to synthesize. We do not know much about this disease.

What we know about COVID19 is that early interventions produce the best outcomes. We know that early quarantines prevent wider spread of the disease. We know that even developing countries, with less economic stature than China or the United States, and with less developed healthcare infrastructure, can confront and contain the disease (at least so far). The disease statistics we have prove these things in abundance.

We know that China chose not to act early, not to quarantine early, not even to treat patients early. We know that China chose a path of quiescence and inaction rather than aggression and intervention.

Sadly, this means we know something else about COVID19. We know China had the opportunity to prevent this epidemic, and we know that China chose to miss that opportunity.

08 February 2020

Coronavirus Costs Lives Now. China Closure Will Cost Jobs Later

The Wuhan Coronavirus epidemic is not merely a serious public health crisis in China. With currently 80 cities and over 400 million people under lockdown, it is better to think of it as a public health catastrophe.

Wuhan, Guangzhou, Wenzhou, Shenzhen, Shanghai--the list of cities brought literally to a complete standstill reads like the top of the list of China's most populous cities. The Wuhan Coronavirus has quite literally shut China almost completely down.

The official numbers (which are at this point highly dubious) paint a grim picture for China: over 34,000 confirmed cases, over 6,000 of which are serious or critical, and over 700 deaths. Just over 2,000 have recovered from the disease. Against the total number of cases, the deaths represent just over a 2% mortality rate. However, against the number of patients reported as recovered, the mortality rate is a grim 26%--if that ratio holds, as those 34,000 cases resolve towards either recovery or fatality, the ultimate number of deaths in China could easily top 9,000.

Yet, as bad as the disease is, its economic impact is likely to be even worse. Between the disease and the lockdowns and quarantines instituted by Beijing in an effort to contain the disease, virtually the whole of China's economy has been shut down

07 February 2020

Speech Or Silence: Facebook Will Now Decide For You

I begin by reiterating a truth I have stated numerous times, and yet must state again: Free Speech is not merely a legal right, but a moral imperative.

We have a moral duty to speak out on things that matter. We have a moral duty to listen when others speak out. We have a moral duty to ensure others can be heard. This is a duty we owe ourselves, for if we do not speak out, if we do not listen, if we do not enable others to be heard, we have no hope of ever having all the information we need to make good decisions about our lives and our communities.

We must have Free Speech or we can not ever be a Free People. This is the order of things.

Yet, in the wake of the most significant global public health crisis since SARS in 2003, one with the potential to become the worst pandemic since the Spanish Influenza pandemic of 1918, the social media giants Facebook and Twitter have taken it upon themselves to ensure that Free Speech is the one thing we can never have. When it comes to the Wuhan Coronavirus (officially titled 2019-nCoV), they will decide what we can see, what we can year, and what we can think.

06 February 2020

Tencent Proves Legacy Media "Journalism" Not Worth A Dime

Mark Twain pithily observed in his autobiography that "there are three kinds of lies: lies, damned lies, and statistics." China's official reports on the 2019-nCoV coronavirus sweeping that country may very well be a combination of all three--and the legacy media is enabling Chinese mendacity at every turn.

As of this posting, the number of reported confirmed cases in China is 28,023, with 563 reported deaths. The vast majority of cases are in Wuhan, in Hubei Province, where the disease originated: 19,665 reported confirmed cases, and 549 deaths. There are nearly a thousand cases each in two of China's most economically important provinces, Zhejiang and Guangdong--and yet no reported deaths.

As disconcerting as these official numbers are, marking as they do the spread of the disease from just around 50 reported cases a little more than a month, there has been a persistent undercurrent of stories suggesting they are a fraud, and that the real numbers are far, far worse. This was made plain on February 5, when Taiwan News reported that Chinese social media giant Tencent's "Epidemic Situation Tracker" page had, on February 1, briefly showed statistics ten times the official reported numbers:
On late Saturday evening (Feb. 1), Tencent on its webpage titled "Epidemic Situation Tracker" which showed confirmed cases of novel coronavirus (2019nCoV) in China standing at 154,023, 10 times the official figure at the time. It listed the number of suspected cases as 79,808, four times the official figure. 
The number of cured cases was only 269, well below the official number that day of 300. Most ominously, the death toll listed was 24,589, vastly higher than the 300 officially listed that day.

01 February 2020

Coronavirus: The Latest Legacy Media Epic Fail

Whoever said "better late than never" did not work in journalism. They certainly did not cover a fast-moving story such as the coronavirus epidemic sweeping China and threatening the rest of the world.

Yet the legacy media has been tardy if not downright derelict in covering several significant aspects of this ongoing event. It was alternative media and social media that first called attention to the existence of the virus, officially named 2019-nCoV (also referenced as nCoV2019). It has been the alternative media and social media that has highlighted serious shortcomings and outright deceptions by Chinese officials and the state-run media.

19 January 2020

Is Adam Schiff Guilty Of Perjury?

As the Impeachment Trial of President Trump gets underway, Congressman Adam Schiff, the leader of the House Managers arguing the case for impeachment on behalf of the House Democrats, submitted to the Senate his "Trial Memorandum" laying out his theory of impeachment and the case he will be arguing on its behalf.

The memorandum has just one problem: It's a lie. Many of of Congressman Shiff's allegations are simply and demonstrably not true.

It is to Schiff's benefit that the memorandum appears to not have been filed under penalty of felony, for if it were Schiff would be guilty of perjury, instead of merely lying to the Senate. Yet let there be no misapprehension here: Congressman Adam Schiff has without a doubt lied to the Senate as he has lied to the American people throughout this impeachment inquiry. The only thing standing between Schiff and a perjury charge is the status of the Trial Memorandum as not being sworn and subscribed to.

17 January 2020

The Purpose Of Impeaching Donald Trump: Breaking Presidential Power

Nancy Pelosi finally completed the impeachment of the President, signing the articles of impeachment and transmitting them to the Senate. With articles in hand, the Senate officially swore in Chief Justice John Roberts to preside over the impeachment trial, and the senators themselves were sworn in as the impeachment jury--the Senate has now been converted into the Court of Impeachments described by Alexander Hamilton in Federalist 65.

After months of partisan wrangling over hyperpartisan inquiry and investigation by the House, the Senate finally will have its say on the merits and demerits of the case the Democrats have assembled, even as the true purpose of impeachment has already been revealed and acknowledge by those same Democrats: removing a President they do not like, or at least subordinating him to the whimsy of Congress.

11 January 2020

Profiles In Courage

It is rare for a single vote by a single Congressman to be noteworthy, or even remarkable. Recently we have seen several remarkable votes by individual Congressmen--those willing to buck demands for party loyalty and unity in defense of larger principles. With so many politicians of all stripes pandering to their particular political base, we should take a moment to consider those who decided to take step back from the partisan divide.

04 January 2020

Getting The Trump Presidency All Wrong

Within the span of two days, President Donald Trump reminded the world yet again the extent to which the legacy media has completely failed to grasp the essence of the Trump Administration. We are barely into 2020, and already the prevailing narratives surrounding Donald Trump have been completely shredded. Trump accomplished with just two highly surgical air strikes against pro-Iranian Iraqi militias and their Iranian sponsors, the first one resulting in the death of Qassim Suleimani, leader of Iran's Quds Force, and the second targeting part of the leadership of the pro-Iranian Popular Mobilization Forces militia.

(Note: Subsequent reporting suggests the PMF leadership was not killed in this second strike, with the PMF disputing Pentagon claims in this regard. As of this writing much of the reporting is unconfirmed with many details subject to change)

01 January 2020

Happy New Year. Let's Have (Another) War

The image is all too familiar: Anti-American protests in a Middle Eastern capital turn violent, with a US embassy--and the US civilians stationed there--becoming a convenient target of the protesters' rage. Too easily, it recalls the horrific 2012 attack on the US Consulate in Benghazi, Libya, in which Ambassador Chris Stevens and three other Americans were killed.  Thankfully, this attack on a US embassy had a somewhat better outcome, as no one was reported hurt during the attack.