Covid – by Galaxy Jane

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Covid – by Galaxy Jane

As a medical provider (PA-C with ten years of practice and a focus in Adult Primary Care and Occupational Medicine) who was recently the poster child for physically fit, middle-aged adult with zero co-morbidities hospitalized with a severe COVID-19 infection, I’ve been given an unusual perspective on the disease process from the inside with lots of good colleague conversation and education from the doctors, respiratory therapists, nurses and others that have been on the front lines of the pandemic during the course of my stay. I came out of it with a strong desire to counteract the constant media fear-mongering by demystifying a highly-predictable disease process and help people understand what they may experience if they fall ill and some of the progress we’re making with treatments.

I’d also like to offer some practical tips that can help you make the best recovery possible.  We are almost certainly going to be living with this disease for a while and I think greater understanding can help us be appropriately cautious but less fearful as we go about our lives during this outbreak.

Nothing said herein should substitute for medical advice and care from your primary care provider or other medical specialist. I would also note that treatment protocols will continue to change as more data comes in, so any comments about current treatments is a snapshot in time reflecting practices in a specific East Coast hospital in mid-July 2020. All remain in stage 3 clinical trials, so are being implemented under experimental/compassionate use.

COVID-19 is a three-stage disease, following a predictable pattern and course over time. Each stage lasts approximately one week. Most people will not experience all three stages.

The first stage is the Viral Stage. These are your asymptomatic and mildly symptomatic people, who may never realize they had COVID-19. Symptoms are generally non-specific and include sore throat, low grade fever, post nasal drip, generalized aches and pains, nausea or diarrhea. The symptoms of this stage that are most specifically associated with COVID-19 are a fever higher than 100.3 F (38 C), and profound loss of the sense of smell and taste. Approximately 80% of those infected will not progress beyond this stage and will recover in approximately one week without further health issues.

The second stage is the Respiratory Stage. This is when cough develops, usually after about a week of non-specific illness, although it can be the initial symptom noted. The cough is usually dry and hacking, but can sometimes be productive. For most people who enter this stage, this is as far as the disease will progress and cough will remain mild. Mild disease simply means that you have good oxygen exchange on room air (i.e. without supplemental oxygen) and can range anywhere from a slight dry cough through mild viral pneumonia without respiratory compromise.  So you can be quite uncomfortable while still being “mildly ill”.  Most people who enter this stage will continue to be able to care for themselves at home and will make a full recovery without lasting side-effects.

The important thing about this stage is that this is where things may take a bad turn and if they do it will most typically happen around day 8-10 from the original onset of symptoms. This is the time to be extra scrupulous about monitoring your symptoms for worsening shortness of breath, chest pain, and to use a home pulse oximetry device (a small tool that clips to the end of your finger and measures the percentage of oxygen in your blood)  if you have access to one. Worsening symptoms or a sudden drop in oxygen levels should prompt you to seek immediate care through your local hospital emergency room.

If you require admission to the hospital during this stage, you may be treated with a steroid called dexamethasone that has been shown in European trials to significantly reduce the risk of death and may also prevent future complications by reducing inflammation in the body. If the latter is borne out over time, this is going to be the real game changer. Preventing deaths is important, but preventing lung, heart, and other organ damage in the survivors will affect more lives long-term. Fortunately, dexamethasone is also cheap as chips and readily available. If you are sick enough to require supplemental oxygen, you could also be treated with something called convalescent plasma, which is an antibody rich blood product from a recently recovered patient, that can help directly fight the virus.

The respiratory stage also lasts approximately one week and most people who enter this stage will recover about day 14 without any additional care. This is what they mean in the media when you hear that people with mild disease will fully recover by about 2 weeks.

The third stage is the inflammatory stage. Entering this stage is rare but very dangerous. This is the stage where inflammatory markers rapidly increase causing blood clots in small vessels throughout the body and other sorts of lung, heart, blood vessel and other organ damage if not controlled. This is also the stage where patients develop ARDS (Acute Respiratory Distress Syndrome) due to damage to small vessels and alveoli in the lungs and may require intubation and ventilatory support. If this becomes necessary, outcomes are generally poor with both high mortality and lung damage in survivors.

If you enter this stage you may be treated with an anti-viral drug called remdesivir if it was not started earlier for decompensation (worsening ability to for the lungs to take in oxygen) during the respiratory phase. In an ideal world, we would start this medication even earlier, even before dexamethasone, but high cost and limited availability means that it is currently being reserved here for the sickest patients. It is given IV over five days (sometimes extended to ten), so if you are put on this medication you will have to stay in the hospital for the full course of treatment.

This stage also usually lasts about one week and is what is meant in the media when they say that severe cases usually resolve in a total of three weeks (although recovery in critically ill patients may be protracted). Even here most folks will recover, albeit possibly not without high level medical care and long-term health effects.

My own illness followed this pattern slavishly. For the first eight days, I still felt perfectly well and healthy, despite some mild aches and pains, nausea and the inability to smell or taste (which both sucks and is really, really, weird). Day nine, I developed a pertussis like cough which worsened rapidly over the next two days, but as my oxygen levels remained normal I continued to care for myself at home. Day twelve, I woke up feeling “not right” although not short of breath per se and when I used my pulse oximeter, discovered that my oxygen levels had dropped quite low overnight (normal is 95% or greater, mine was 88%), prompting an immediate trip to the local ER from where I was admitted.

According to my in-hospital pulmonologist, I presented right on the line between the second and third stages. I was developing respiratory decompensation, but while my inflammatory markers were high and rising, I was not yet to the point of irreversible inflammatory cascade. I received my first dose of dexamethasone upon admission and within twelve hours my markers were trending back towards normal. While my respiratory status did continue to worsen  and my oxygen requirements increased steadily over the first 36 hours of my hospitalization, the second night saw the beginning of rapid improvement in lung function and I was able to be released home without oxygen on hospital day four (day sixteen of my illness) to complete my dexamethasone treatment there while I recovered. By day twenty-one my cough had resolved and my lung capacity had returned to near-normal although I was still somewhat short of breath and extremely fatigued (also crazy from the steroids).

I’m now five weeks from my first symptoms, my chest x-ray has returned to normal and I started running and weight training again last week. While it will be a little longer before I am all the way back to my previous fitness level, I can say with some confidence that I am fully recovered and my PCP has no worries about long-term health effects because I turned the corner before I showed any signs of organ damage.

Very few COVID-19 patients are requiring ICU treatment here in East Coast City now, because slowing things down back in March and April not only succeeded in keeping the system from ever being overwhelmed, but it has allowed time for treatments to be developed and deployed so local patients are now pretty evenly spread between the Medical/Surgical ward (this is a general hospital ward, basically where you go for observation to ensure you are stable), the Intermediate care or Step-Down unit (so called because it is a “step down” from the ICU and is for people like me who need closer monitoring and telemetry, but do not require critical care nursing) and the ICU/CCU (An Intensive Care or Critical Care Unit, for patients who require close round the clock monitoring. This is also where any ventilator patients will be).

About 2/3 of those admitted here now are not getting sick enough to reach the need for ICU/CCU. They are also admitting patients now for observation that would have been sent home to care for themselves earlier in the pandemic, when we were worried about overwhelming hospital resources. While the hospital ICU was fairly full during my admission, I have it directly from staff that very few patients were there for COVID-19, it was simply full of the normal ICU things that ICUs are typically full of this time of year.

I am not going to talk about things we can do to keep from catching COVID-19 as I feel we are all well aware of risk mitigation at this point. The constant drumbeat of the last five months has been, “don’t catch it, don’t catch it, don’t catch it”. But with sustained community spread, it is important that we have get comfortable with the idea that eventually a lot of us are going to be infected, no matter what precautions we take. So what practical things are within our power to reduce our chances of a bad outcome? And hopefully also reduce our stress about the parts we can’t control.

Start exercising today. Just a walk around the block if that’s where you are. Then add a bit every day. I know a lot of us went into lockdown thinking it was going to be a few weeks at home baking sourdough and drinking wine (no judgement from me!) and now it’s 5 months gone and we haven’t set foot outside the house except to work or get groceries. That’s OK, start where you are. The better condition your heart and lungs are in, the faster you will be able to recover. And better lung health will better enable you to withstand the respiratory symptoms of the second stage of disease. I do believe that going into this with a high level of aerobic fitness contributed to my rapid and complete recovery.

Exercise, fresh air and sunshine also naturally boost immune response, making you more resistant to becoming ill and hopefully helping you throw off disease more easily. And let’s face it, outdoors is probably the safest place you can spend time right now, no grotty surfaces or enclosed air circulation to spread the virus around, and viruses don’t like sunshine. Take advantage while the weather is still good, because colder days will be around the corner before you know it.

Corollary to the above. Other than age, the greatest risk factor for a bad outcome with COVID-19 is diabetes, the next greatest is obesity. These outweigh even chronic lung conditions such as COPD and asthma. While exercise alone will not necessarily help you lose weight, it will help keep your blood sugars in a safe and healthy range. Blood sugars spike uncontrollably even in some otherwise healthy people during the course of illness and this is associated with significantly worse outcomes. Make sure all of your diabetes medications are optimized and that you are checking sugars daily to stay in the ideal range, this is not the time for poor blood sugar control.

Lose weight if you can. I know we always say that when you come in the office, but this time instead of it being an abstract thing that may lengthen your life ten or twenty years down the road, during this pandemic it may make a difference next month. No crash diets right now, but a steady controlled weight reduction program with the knowledge of your primary care provider  is a really good choice. I’m agnostic about how you choose to lose it, the best diet is the one that works for you.

Make sure you have all your chronic conditions under the best possible control. Diabetes, Blood Pressure, Heart Disease, Asthma, COPD, etc. Make sure you are staying in close contact with your PCP, even if this is telephonic or virtual, and ensure all your medications are up to date, you have any refills you need and that all your dosages are optimized for best overall health. Any co-morbidities need to be managed aggressively before you become ill.

As far as supplementation goes, if you do get sick, the supportive care regimen from the local ER for patients who can care for themselves at home is Tylenol for aches and pains, plus 500 mg Vitamin C and 220 mg Zinc Sulfate both taken 3 times a day for 10 days. I also was prescribed these during my admission and upon discharge. These supplements may have properties that slow viral replication and they are both readily available and unlikely to cause harm, so it’s not a bad idea to have them on hand to start taking if you become ill.

There is also growing evidence that low Vitamin D levels are associated with adverse outcomes. Most Americans are Vitamin D deficient, so in addition to daily walks in the sunshine I suggest supplementation with 2000 IUs Vitamin D3 daily. This is in addition to any you may be getting from a standard multivitamin. This you need to start now, and not after you are sick as it will likely take 8 weeks or more to get levels close to normal if you are currently deficient (and you probably are).

If you get sick with anything you believe could be COVID-19, no matter how vague and non-specific, STAY HOME, even if you choose not to be tested. CDC guidance for patients with symptoms is to stay home for a total of 10 days from onset of illness. At the end of that period if respiratory symptoms have improved (they do not have to be completely resolved) and you have had no fever during the last 3 days of your quarantine, you can return to work or school. This may seem obvious, but I was surprised how few people know the guidelines. Staying home if you are sick is the single most important thing any of us can do to slow the spread of this virus.

I do advise going ahead and getting tested if you develop symptoms, even if you are fully able to take care of yourself at home. This is both to give yourself peace of mind and because I suspect that in the next few months there are going to be situations where proving you have already been infected will just make your life easier. No, I’m not talking about “immunity certificates” per se, just that if my choice is between showing some business (say, an airline representative, or a conference organizer) a copy of my positive test result, rather than having a swab shoved halfway into my brainpan again 48 hours before some event, I know which I’d prefer. I would also get tested if a family member or close contact becomes ill, even if you remain asymptomatic. This can keep you from spreading the virus unknowingly and may actually allow you back in society more quickly if you test positive than if you don’t. The Virginia Department of Health guidelines for those exposed, but not symptomatic can be found here https://www.vdh.virginia.gov/coronavirus/local-exposure/ I think this breaks it down better than the CDC page and I include it here as the guidelines for asymptomatic contacts are actually more complicated than for those who get sick.

Testing options are going to vary by geographic location. Locally, we have one pharmacy chain that will test anyone, usually within the hour and another which is still using criteria from back in April and turning down most of those who ask.  If you have kids, be aware that many of the drugstore chains are unable to test under 18s and they may require a trip to the local Urgent Care instead. The best advice I have is to check websites or call ahead about requirements and see if you need to make an appointment wherever you plan to be tested.

Also be aware that, again depending on location, results may be coming back really slow right now. Mine took eight days (by which time I was already hospitalized) and I understand that the average in my state recently reached ten days, which is not super practical from a contact tracing perspective. It is still valuable information to have for yourself. As contact tracing cannot function when tests are this untimely, I urge you to do the right thing, and if you have any suspicion you may be infected, reach anyone you came in close contact with (defined as within 6 feet for more than 15 minutes) in the 48 hours before you developed symptoms. The faster you do it, the faster they can take precautions, and waiting for your local health department to be notified of a positive result may mean it’s two weeks before they have any clue they were exposed. You are most infectious in the 48 hours before and the 72 hours after developing symptoms.

If you become ill, and particularly if you enter the respiratory phase of illness, a home pulse oximeter (pulse ox) is a really useful tool for knowing if your cough is just annoying or becoming something dangerous. Always listen to your body first. If you are short of breath or having chest pain, go straight to the ER, even if the numbers look fine. Don’t be afraid of wasting their time, that’s what they are there for.

A normal oxygen saturation level (the percentage of oxygen dissolved in the blood, also referred to as sat) is between 95-100%.  If your levels are in this range you are most likely safe to care for yourself at home, but should keep in touch with your PCP so they can help you stay on top of your symptoms. They may also be able to prescribe medications to keep you more comfortable while recovering at home.

If you are between 93-94%, reach out your PCP, Urgent Care, or your local ER (who should have a COVID hotline) right away to let them know of the change and see what steps they want you to take next. If there is no response, go to your local ER for further care.

If your sats are 92% or lower, go straight to the ER. One of many weird things about this disease is that oxygen levels sometimes drop dangerously low without subjective symptoms of shortness of breath, so this may be the only early warning sign you get that things are going bad. In my own case, this was how I knew it was time to go to the hospital and upon admission, I was told that I had come at exactly the right time. A day sooner and they’d have sent me home, a day later and I would likely have been much further down the path of inflammatory cascade.

A very important part of this, is that you need to get the pulse oximeter before you get sick, and learn both how to use it correctly and what your normal is, in order to use it effectively when the time comes. Some important things to note are that nail polish or artificial nails can interfere with getting a good reading, your hands should be warm before you apply the device and you should give 30-60 seconds for the reading to settle before taking the result. But they cost around 20 dollars on Amazon or at your local pharmacy and should be sitting right next to your thermometer in your medical toolbag.

I don’t want to underplay that COVID-19 can be a severe disease with serious consequences. I am living proof that even the lowest risk can have an unpredictably bad course and there is very little we understand about why that happens. But I think the overall picture is encouraging and looking better by the day as we learn more about how this thing works. If I had been ill even a few weeks sooner, I would have had a far more protracted recovery, and possibly long-term health issues as dexamethasone was not yet being widely used outside of a handful of academic medical centers nationwide.

Getting as sick as I did was pure bad luck, rather like being struck by lightning, but my ferocious recovery was not accidental. It was the work of really good doctors and medical care team members who knew how to treat me, and the fact that I knew when to seek care instead of waiting to get sicker. And probably a little bit because I was in really good shape prior to my illness.

My hope is to give some knowledge and tools to aid in understanding what COVID-19 is, how it typically presents, the latest in treatments, and what steps you can take to ensure the best possible outcome if you get sick. It’s time to move from a place of fear to a place of cautious confidence. There is still a lot we don’t know, but we really are making progress.

257 thoughts on “Covid – by Galaxy Jane

  1. One more caveat about those cheap pulse oximeters: they’re sometimes randomly inaccurate.

    I have one, and it’s usually right on track. Pulse rate about what I’m used to, oxygen percent hitting right on 97%.

    …but everyone once in a while, it throws a crazy number at me. It dropped to 80% one night, and I panicked. But I felt fine, my respiration rate was normal, and my pulse rate was okay (but suddenly a little higher!). So I hit the sensor and LED with a bit of air from a spray duster, wiped them with a tissue, and the number popped right back to 97% for multiple samples.

    1. I think that’s an issue with touch-sensors, period.

      The doctor’s office has one that they wipe with a disinfectant before putting it on your hand, which would clean off the sensors. My sports watch needs to be cleaned off sometimes, too, or I suddenly have no heart.

    2. yes. Son, when he was scribe in ER (while in high school/college) used to say they got more panicked people coming in because of those meters….
      Mine — and reason I’ll eventually go low-altitude — tends to hover in the eighties. (And I have to talk new doctors into not hospitalizing me.) Which is why I don’t/can’t wear masks.

      1. Which definitely goes along with having to know what is normal for you before you rely on one. They are imperfect tools, but one of the few relatively objective ones that anyone can get access to for home use.

        1. Back when I worked in bicycle shops in the NOLA area. A few of the guys and gals had Docs freak when they were admitted for injuries (usually car door strikes, one lawyer hit the back of a city bus . . . don’t draft stationary objects!) and their heart rate was “shockingly low!” and they or friends/family had to reassure the doctors, that, no, 30 or lower was the normal rest heart rate (iirc Moser and Indurain had at rest rates around 22 – 24)
          At one time I could get 28, but 1985 is long ago and far away, as are the 150+ mile/week bmx commute and just out riding of my youth.

            1. were not sure because he was a bit loopy (this was 93 or so . .. Doc- “Who’s President?” his answer “Um . . .Nixon?” We’ve had a few since him “Oh Yeah. Um . . .”) but we think he thought it was an express, as it hadn’t stopped for some time, but he might have just not noticed it was stopped as the speed limit is 45 on that part. He was known to draft the Vet’s Hwy busses.

                1. when the 5’1″ 140lb pretty lady is there with her 25″ thighs and well toned arms, you might consider she could possibly be in good shape and NOT obese just because she tripped some silly metric when you weighed her for a physical.

              1. I get weird looks when my BP now. What is excellent for my age & weight (I am overweight & not in shape), is high for me. Which is scary because what if they are missing something?

                Ran into that at the 2005 National Jamboree with all the heat issues. I didn’t hit the medical tents until really late. Wouldn’t have gone then, had gone to bed (night, but early-ish), but apparently I wasn’t making sense when the our tentmate, a Rabbi made the rounds checking on all the female staff. She made me go to the medical tent. Still overweight then, was actually down 30#s, and a lot better shape. Med staff took my BP, it was 120/80. He stated, looks good. I said … uh, that is high (it was, normal then s/h/b 102/60, especially half asleep). He looked at me and checked my BS levels (40). I had to eat a Banana, and drink water, in front of him. He tried to give me a glucose tab. Even then I knew that was a long term bad idea. Even if I didn’t know the numbers. (Now I know low treated with sugar = 90 minutes & the crashed low will be worse. Dang roller coaster).

                I’m Reactive Hypoglycemic (mentioned here before). Back then I didn’t have a glucose meter, just if I felt crappy, likely a BS crash & sleep it off to let BS raise naturally. I do bounce back, with a BS crash, just it was way, way, slower than it was suppose to be, being active/under stress made it worse/slower. No one told me any different when I was diagnosed back in 87. It was “you have to live with it, don’t eat anything with sugar on an empty stomach.” I never knew then, the danger I was putting myself into (don’t think the doctors did back then too, or even now).

                Used to be when my BP was taken, nurses would take it, look at the numbers, & look at me. The joke would be “Yea my BP reads I’m almost dead.” It still can read low, but not as frequently.

                1. I’m frankly leery of getting myself formally diagnosed, since most of the advice I’ve seen for low blood sugar is ‘avoid sugar’ in a family of diabetics. I’ve had folks think I eat a lot of carbs and sweets, and then people get oddly upset when my blood sugar tests come back on the lower side of normal, or ‘low. you need to eat.’

            1. I’ve had a few cases of arrhythmic fun. Mostly around 21 to about when I got fat. Normally from going to full speed/exertion from sitting in a second or so
              doesn’t happen any more, but then getting up takes longer for the joints to respond (~_^)

          1. I had that when I cycled a boatload one year. (14,000 miles on a repurposed mountain bike.) Went in for some ear surgery, and they did their damndest to get my pulse rate up to where it “belongs”.

            OTOH, I’m running low now, but that seems to be due to long term heart issues, including AFIB. Cardiologist thinks sooner or later (who knows?), I’ll need a pacemaker. Right now, it speeds up as necessary, so not a problem.

            FWIW, AFIB generally means you can’t fully trust automatic pulse measurements. The funky rhythm drives the counters nuts.

            1. Had an aunt with a pace maker and an artificial valve. She ticked loudly. Uncle used an old alarm clock to sleep when he was at camp , had to have the tick tick.

        1. North Carolina gets as high altitude as you can on the East Coast … which is lower than any altitude you can reach (above ground) in Colorado.

  2. Thank you for this. There’s been so little accurate information since our only source,unless we actually know someone with a severe case, is the press.

    My doctor had mentioned that we didn’t use steroids early on because the Chinese data said not to. No conspiracy theories, but it’s just another way it all went wrong.

    1. That is absolutely true, and made worse by the fact that the WHO then amplified and persisted with the “don’t use steroids” message, even as European studies were proving it wrong. It’s the reason that, outside of a handful of academic medical centers, US hospitals refused to switch to steroids until the Recovery trial actually published, which was literally 6 days before I initially became ill. Which is why I point out that my outcome would likely have been much worse had I become ill only a few weeks earlier.

      1. things have gotten completely stupid. I read some group, in an attempt to discredit the drug (and likely you know who), just listed HCQ as a poison. This will come as a shock to all those who have and are currently taking it as prophylactic against Malaria, and for other things.
        Youngest Sis has been sick and last week it the test result finally said WuFlu. She was going on the second week of quite sick and a week of “you know, I might be coming down with something”. After this past weekend she was feeling well enough again to consider going back to work this week.

          1. thanks. Now if Mom and Dad can avoid picking it up. Dad has had one test during her illness for sure, maybe a second (having eye surgery at the VA), and passed.

        1. I appreciate that Mr. Trump has kept quiet about steroids and ccpherpes. The only time I actually was torqued off at his tweets was when HCL turned out to be safe and effective.

        2. I took it for Malaria. You could get as much as you wanted from any Indian Pharmacy. I still live

          Why don’t they ever pay a price for this BS?

        3. listed HCQ as a poison

          This reminds – I was wondering what had become of that couple who “drank” the fish tank cleaner “because Trump recommended” the drug.
          Has anybody seen any follow-up? It seemed like a really BIG news story at the time.

          1. Well, he died. And I believe she was at least investigated for murder. I read she had mental health issues and I remember reading that his friends were really puzzled about the idea that he would decide to drink fish tank cleaner. They said he wasn’t that stupid.

          2. She also has quite a history of leftwing activism. After that made alt-right media, LSM put the entire thing into the memory hole, though on occasion the “Trump caused it” resurfaces. (Apparently followed by JournOList quietly telling the creature to damp it down…).

            OTOH, we haven’t seen much in the way of old discredited crap being recirculated by people who should know better. Today, anyway. OTOH, it’s 4AM here. /sarc

  3. Thank you for the inside perspective. I think I have been lucky so far. I am taking two 1000 mg. Vitamin C per day, morning and night. Is 500 mg. 3xday a better regimen? Although I have been doing quite a bit of outside work, I have been considering starting on D supplements. Is D3 sufficient? Is Dexamethasone OTC or prescription-only? Do you have any experience with/exposure to the hydroxywhatsis-ZPac regimen?

    1. D3 is the kind you want. As far as the Vitamin C, goes, I think either is probably fine, they are more using it here after folks become symptomatic rather than as preventative. Give me a second and I will address my thoughts on the hydroxychloroquine in a stand-alone comment. I didn’t discuss it because it simply isn’t being used here since they switched to dexamethasone, and I was sticking to current standard of care. I can say that the hospital I was at was using it right up until the Recovery trial was released and had much worse outcomes with it.

      And yes, dexamethasone is prescription only and studies are suggesting it it most beneficial only after inflammatory markers start to rise, we will see how that bears out over the next weeks to months as this is a rapidly developing area of medicine.

      1. Huh. I’d been supplementing with C and D before I got sick – probably why I never got past stage 2.

        I suspect I wouldn’t have gotten nearly that sick if my immune system hadn’t already been hammered by dealing with family medical crises. Getting enough sleep is critical!

            1. Oooh, ooh, one of the few jokes I can tell really well.

              ************

              Dude, dude, you wanna hear a joke?

              *cautious yes, because they know Fox*

              Sleep!

              *blank expression, maybe a few blinks*

              *Sigh, nod* Yeah, I know, I don’t get it, either….

              *few more blinks, chuckles usually start*

              1. I think I’ve heard of that joke. Sometime back in the realy nineties, I think? *chuckle*

                Once this next batch of trainees gets settled in, and the crisis-a-minute-generator in the office moves back to corprorate, maybe I will look in to this. So long as nothing else breaks.

                Have you heard the one about vay-kay-shuns, though? Couldn’t stop laughing for days, that one. *grin*

          1. It’s something that the dogs think must be done with at 2:30AM, at least when it’s hot in the house. Dammit, Al Gore, come visit us. We need a cold spell!

    2. I can get one of ’em!

      Dexamethasone needs an RX.

      There’s D2 (mostly?) from mushrooms and D3 that’s mostly from lanolin; both are treated the same by the body.

      Odd thing that popped up while I was looking this up, one of the problems caused by a lack of D is testosterone deficiency. Which, once you go past the knee-jerk sex stuff– is a steroid. Possible vector for the worse outcomes?

      1. Yep, I only learned that in the last couple years from the MD I was working with. Whenever he checked a testosterone level he’d always get a Vit D as well and if it was low, treat the low D first, which inevitably raised the testosterone, often back into normal range. So that’s definitely a thing. Vitamin D is a precursor for a lot of other things and the current RDA is far too low being based on 1950s studies that determined that it was the minimum amount required to keep a white child from getting rickets, without an understanding of all the other things vitamin D does. But the push to raise it has been going on for over a decade with no action.

        1. Holy crud. Also did not know that D is related to testosterone. Probably one reason why so many guys today are a quart low on testosterone, then — because they’re not getting enough D from food and not going out enough in the sun.

          1. I’ve been carefully neglecting the sunblock when I’m doing the over-done garden shed. Have to cover sensitive bits (hair, I have some, just not much), but my arms have an impressive farmer’s tan. I needed to wear shorts yesterday (expected to get a back X-ray because reasons), and the contrast is amusing.

            Back tested out OK; seems I pinched a nerve in the area. A short course of steroids should help, but I need to talk to my retina guy next week. I know steroid eye-drops sends me into glaucoma-level eye pressures, but the regular doc and I don’t know what ingested steroids do to the eyes. OTOH, no guarantee the retina specialist knows either. Moar Research!

            Normal body reactions. I’ve heard of that. Didn’t come with the new-product accessory package.

        2. I take a Vitamin D supplement (5000iu) at my doctor’s direction because mine was just on the normal side of low, and Vitamin D levels are an issue with MS patients; the preference is for it to be towards the higher end of normal.

  4. For the first eight days, I still felt perfectly well and healthy, despite some mild aches and pains, nausea and the inability to smell or taste (which both sucks and is really, really, weird).

    That’s what killed my great aunt, over a decade back– she lost her ability to taste anything, and basically starved to death (over years) because there was no point to eating beyond “oh, yeah, I should do that.”

    1. Loss of taste? Zinc depletion, often a result of a cold, can have that effect. Diet supplements can help there, although a little research will likely turn up some dietary choices that are high in zinc. The popular cold medicine Cold-Eeze has zinc as a primary ingredient.

      It is also a common accompaniment of depression, although that can be a chicken/egg kind of issue. Light exercise, such as walking, is a recommended therapy for depression if only because it gets you out of the house (and off your family’s nerves.)

      1. I can safely say this is nothing like losing your sense of taste with a cold, where it is usually diminished, but still there. Or the loss of smell from sinus crud. It is absolutely complete. I couldn’t smell anything *at all* despite no congestion. Pulled out every stinky essential oil anyone ever gave me and absolutely nothing, not a hint. Everything tasted like salted cardboard except my brain tried to fill in the missing input with sweet, so there was a cloyingly gross sweet taste to plain water or anything not actively salty. Like I said it is *weird* and unmistakably different from any other way I’ve ever lost my senses of taste or smell.

        I was lucky, mine started coming back after about a week, although it took a while longer for things to taste exactly right again. Some folks have reported having it months ago and not getting it back yet.

        Probably not related to zinc in this case, evidence suggests the virus actively attacks the nerve cells of the olfactory bulb. There are also suggestions that there is a genetic component to who experiences that symptom.

        1. Wait, a nasty sweet smell?

          Was it kind of like when you get a very faint whiff of rotten pork? It’s sweet…technically…sort of… but gagworthy?

          The cold from hell that made us miss Christmas had that, although I only had it a week. I was going to go in after the holidays to get tested for strep, last time I had a funky taste that wouldn’t go away and overpowered everything, it was strep. (that was sour broccoli, but similar enough to be creepy)

          1. Nope. No smell at all. Zip. Nada. Nothing.

            It was that I tasted sweet in anything which wasn’t salty (the only thing I could actually taste). Plain water was cloying.

    2. That reminds me, I should do that. Forgetting to eat stinks. Why am I getting headaches? Why am I so tired? What’s that, my stomach hurts? Dagnabbit.

      1. My DIL always asks me the same when I’m feeling off “Have you eaten? When have you last had some water? Have you eaten a vegetable today?
        What can I say. I’m a geek….

      2. For a few years, any time I got anxious or panicky, husband would look at me…”you haven’t eaten have you?” or “Let’s get some food and then talk about this.” Yeah. Now, I make sure I eat and eat a lot of protein.

  5. Accurate comprehensive information about the COVID19 virus? Is that legally allowed?

    Thank-you for this.

    1. You are very welcome. I had a decision to make the first day in the hospital, when I wasn’t sure what the outcome would be, was I going to let myself be used as a horror story to perpetuate the fear, or was I going to stand up and use what I was going through to educate and make people less afraid of what is happening. You can see which I went with (actually that implies a choice, I don’t think I really had one, so much as got handed a sudden mission that I hadn’t expected).

  6. I have chronic atrial fibrillation – my heart is in a-fib as I type this. I am fortunate at 70+ years old in having essentially zero artery disease, so I am fine. But an interesting little known fact from my cardiologist puts even more emphasis on activity. The veins in the long muscles in your arms and legs have one way valves, keeping blood flowing back toward your heart. If the muscles are in good tone, they squeeze the veins with every motion, actually pumping blood back toward your heart. This takes some of the load from your heart. If it is already compromised, when it gets stressed by covid, or whatever, the more help it gets, the better.

  7. Thank you for the informative-yet-not-panic-inducing information about this disease. I only know of three people who tested positive, and all of them were in the “stay home and take tylenol” group.

    When this whole thing started, back when it was only for a couple weeks, we started my husband on a dose of Airborne (that stuff you take before you travel), D3, and Zinc every day. He’s obese, diabetic, has COPD, and if any of us are going to get sick, it’s him. He says he feels better now than he has in years, since all those meds are keeping the low-level crud from getting to him. (I just need to find a substitute for the Airborne, since that’s a chewable tablet so it’s a good portion of the RDA of sugar for a diabetic.)

    1. Well, if they take the sugar out they’ll just replace it with one of the artificial sweeteners. Some people have really bad reactions to Stevia or aspartame.

      1. Stevia : May cause Intestinal Distress
        boy howdy
        until I found it in the fruit juice I was drinking (who the F uses artificial sweeteners in apple juice?), I thought I caught a stomach bug

        1. This is why I never buy any juice unless it’s labeled “100% juice” (with the possible exception of cranberry, and even then, you can get a very drinkable cranberry juice by mixing with apple or grape). I once had a roommate from Africa. Great guy, but at first he wasn’t all that used to America; he went to the store for orange juice and came back with Sunny D. I explained to him that under American product-labeling law, the term “fruit juice drink” did NOT mean the same thing as “fruit juice”, and that the think to look for on the label was “100% juice”, and after that, he bought the actual fruit juice he had intended to buy.

        2. I think the sugar alcohols (maltitol is common) can have a similar effect. $SPOUSE and I tried some no-sugar ice cream from Baskin-Robbins before seeing a play in town. We made it through the play, but when we got home, each of us made a beeline for the toilets. Never again.

          I can handle a reasonable amount of sugar alcohols, knowing it has a laxative effect, but two scoops of the “special” ice cream (for me, $SPOUSE had one) was about three too many. Used to like BR, too.

  8. Reblogged this on Head Noises and commented:
    Needs to be spread far and wide.

    She definitely is very medical professional in this, but there’s a LOT less Lord Farquaad type reasoning than most noisy folks are deploying. (“Many of you may die for something that doesn’t actually prevent transmission, but that’s a price I’m willing to pay to feel like we’re All In This Together, even if it objectively makes outcomes worse.”)

  9. Thank you for this – lots of great insights, and your perspective from both sides of the treater-treatee divide is invaluable.

  10. Since I know folks are going to ask, I did not address the issue of hydroxychloroquine as it is not part of the current US standard of care for treatment, although it was being used (under the Ford Foundation protocol, I believe) up until about 3 weeks prior to my admission in the hospital where I was treated.

    It did not work nearly as well which is why the quick pivot to Decadron +/- remdesivir and convalescent plasma once the Recovery study dropped, which had been working very well at local Academic Medical Center through the late spring and early summer (and I at suspect the local VA hospital as well as it shares MD staff with said Academic Medical Center and they have had an astoundingly low mortality rate despite a patient population that is almost entirely extra-high risk) when everyone else was still afraid to use it due to the WHO’s stance on steroids in COVID-19.

    I’m agnostic on the whole thing. There’s evidence that hydrochloroquine (with or without azithromycin and zinc) does work if given early. But it has to be given really early, when you don’t actually know which patients will benefit. I’m not nuts about that sort of shotgun approach, given the small but very real risk of a really nasty deadly cardiac arrhythmia called torsades de point. Alone it is reasonably safe in standard dosages (although I would want an EKG first to rule out preexisting conduction issues) but definitely dangerous if given in combination with the azithromycin as both cause the same cardiac conduction problem, so the effect is additive. That specific combo is one I was warned against way back in PA school. So I would not necessarily risk the 97-99 percent of patients who will not need any care to recover on their own to prevent the few that will progress.

    If I were in a third world country without access to advanced medical care, respirators or shorthanded medications like remdesivir I then might consider giving it to everyone as soon as they had a positive test, as the risk/benefit ratio would be different.

    I am very glad that I got sick late enough to get the better treatment for late disease and that I don’t appear to have any sequelae. Also that I don’t live in a third world country that may not have any better option.

    I hate that it got politicized as soon as the President endorsed it, because that has made good data hard to get (whether either in-favor or against, if I am being honest). The fact that there was a large contingent of folks that wanted to prove it didn’t work more than they wanted to help patients makes me ill.

    1. Well, HCQ can’t be that bad for people’s hearts, or they wouldn’t be passing it out like candy as an anti-malarial. Or as a livestock drug in the US, or for small animals. They don’t worry about the heart thing in lupus patients unless they’ve been taking it for lupus for, like, five years.

      Shrug. I would like to know if HCQ works better as an antiviral, or as a specific against COVID-19, in some populations than others. Because its use seems to have been almost miraculous for some groups of doctors and not super-successful for others, and it might not be just a matter of following the same protocols. Or it might be that people in, say, India had already gotten their bodies experienced with taking HCQ and not fighting it, and therefore got better results than people taking it for the first time.

      I am just BS-ing, as I am interested in medicine but don’t know nearly as much as Galaxy Jane!

      1. I’m not sure about your first statement (having heart arrhythmia to begin with…). I’ve read Kim duToit’s comments on travel to Africa, and one take I get is that you should be in fairly good health before you consider it. Take a drug, get a bad reaction there, and it might just get chalked up to “Africa wins again”. For people in poor health, they might just say the best antimalarial is to not go there.

        We’re reasonably sure we got mild cases in March. I got the 102F fever and a day or so of respiratory distress (not unusual for me, anyway), but we did the “stay at home, take Acetaminophen and rest” bit. So, HCQ is a moot point for me…

        From what I’ve read, though, HCQ is valuable in that it allows zinc to enter the cells more readily. It also looks like there are other things you can take to achieve the same goal.

    2. I rarely see anything that says it (HCQ) works well at all alone. With just Zinc it was for some time showing better than remdesivir, but I think back then it was too often remdesivir alone (which looks to work far better as a portion of a course as well), and later stuff is showing remsdesivir working better than first thought by many. As a cocktail with azithromycin (or that other one, forget what) and zinc, early seems to be the best bet for HCQ, and if further along (like your case) it seems to be a toss-up to slightly favoring the remsdesivir course. Though that might be because so many places don’t go the HCQ route no matter what. As a Type O, not in a high risk sort of level, I likely will attempt to just get through with my zinc/d/c etc regimen if I do catch this. I do tend to suffer side at a high proportion (don’t get me started on Prilosec)

      1. As I wondered elsewhere- for people who HAVE been taking it long term for other things- what’s their covid infection and death rate? This would be an easy number for the medical establishment to come up with- if they wanted to.

        1. I’ve thought the same thing.
          I know India credits it with stopping a spread in one of their bigger slums (650,000 people packed into a small section). When it was turning up they started issuing it and zinc to everyone they could and they had a rather low infection and death rate for the numbers of people packed together like they are. Some speculation the lack of AC helped too.

      2. Basically the way it was explained to me by my in-patient pulmonologist was that trials showed that the remdesivir shortened hospital stays (i.e. helped you recover faster), but didn’t necessarily have as big an effect on mortality, while the dexamethasone was shown to be better at reducing the number of deaths, so yes, a combination approach. Like other anti-viral drugs, remdesivir may also may work better when given sooner, but the combination of short supply, expense, and needing to be administered inpatient by IV over 5 days means that locally it was only being approved after inflammatory markers hit a critical level or if oxygen status worsened beyond a certain set limit. Fortunately, I responded to the dexamethasone fairly quickly and both my markers and then my respiratory status turned around before I hit that level, saving the big guns for someone who needed them more.

        At this point I am more curious about whether either or both will be shown to reduce long-term sequelae, since that has proven to be an issue for those with the more severe forms of the disease. But right now, naturally, the clinical trials are very much focused on the mortality question. It will be interesting in 5 years to see in which treatment arms patients have the best long-term outcomes. I have hypotheses, but not enough data yet to make predictions. I am, after all, only a single data point.

        1. one of the supporters for HCQ pointed out its low cost and ease of dosage made it a go-to for early treatment and leave the pricey stuff for the later stage people who either didn’t get early treatment, or don’t respond to or are allergic to HCQ. This was when HCQ wasn’t showing as effective at later stages as remdesivir (it later was again touted as just as good then better, then nearly as, but it has been back and forth and back and forth. suspect politics weighs too heavy in some of those, both ways)
          I saw someone point out worries about long term effects after taking HCQ and was asked about the probably millions who’ve taken it before (shocking how so many think it is some new untested thing) and shouldn’t they be a good start to what to expect? As for the disease side, yeah, be interesting if one or the other does better at preventing or lessening physical issues down the road. I wonder if either will have different psychological sequelae as well? time will tell

          1. Don’t forget, FAUCI ran an agency that released a study in 2005 touting HCQ for SARS and other known corona family viruses.

  11. Any thoughts on other supplements? I’ve seen some persuasive cellular biology arguments that suggest N-acetyl cysteine would possibly help and otherwise not hurt.

    1. Honestly, those are the only ones I have first hand info on. That doesn’t mean there aren’t others that might be valuable, just that they aren’t making it into our protocols yet.

    2. If my issues in February/March were covid related, NAC may have been one of the supplements I was taking at the time. Not taking it currently.

      Definitely get a lot of zinc, and I’m pretty sure I was getting a lot of D3.

  12. Thank you for this post. I really appreciate the straightforward, no-drama tone, and the concrete examples. I am also very grateful for the list of practical things we can do to reduce our chances of a bad outcome. That is far more helpful than a lot of what we’re seeing in the news.

  13. pertussis like cough


    Said it before. This is what I had December 2019, week or so after Thanksgiving through a few days before Christmas. To the point I was ready to move Christmas Eve dinner, but I started feeling better just a couple of days before.

    Started achy all over, dry sinuses, down to dry sore throat. Don’t remember lack of smell or taste. Really more over sensitization, more than I normally do; and it is a huge problem. That lasted 7 to 8 days. Transitioned into the pertussis like cough, but not quite as bad as true pertussis cough. It has been only 29 years. Yes that is a long time for someone who had it as an infant, or even young teen (son, same period), but I had it as an adult. There are reasons it is remembered.

    From pertussis like cough to swelling of tissues, especially sinuses, which I took as a full blown sinus infection/cold. Had the associated fever. High for me, but not high per medical personnel (with all the temp taking, my temp runs “cooler”). Well below the “to (usually) emergency right now” levels. 99 to spikes of 101 degrees. Took NyQuil for sinus swelling (shouldn’t because of glaucoma but I like to breath through my nose). Plus alternated between Tylenol, Aleve, and Advil, for headache & other aches & pains. Took Vit-C.

    But, per political climate, I obviously could not have had CV19, as it wasn’t a thing, let alone in the US, December 2019. I call BS. But hey, not medical, what do I know? Common sense is not a medical tool when used by a non-medical person. Haven’t had any tests. No reason to. “Hey I think I had it Dec 2019” isn’t a valid reason … not until I have to have the test & I get told I must have been asymptomatic. They may still not listen, but I will call BS, loud & clear.

    1. There’s plenty of evidence that WuFlu started in October in China, and was over into the US by November and December for sure. Most notably that Seattle flu study that went back and looked at their flu swabs for COVID. But yeah, I probably had it right before Christmas too, and so did almost everybody in my workplace. There’s probably still threads on some of the grocery worker discussion groups, complaining about the flu in November and the mysterious creeping crud in December.

      Glad I never had the loss of taste or the oversensitivity.

      1. I sure wasn’t eating much. Then I don’t when I have the type of sinus crud caused by sinus swelling of the last stage. Don’t know about over sensitivity symptoms. By the last week, what I was taking put me out, out. I’d open an eye enough to respond to hubby’s “Are you going to live?” so I could glare, grunt, wave in his general direction, and plop back down. Would get up to shower, eventually, take NyQuil (took way more often than I should have, it hits me hard), shower, eat a bite of something, because I should, then back to sleep.

      2. My wife had the crud that wouldn’t go away in February complete with loss of taste/smell/ One time megadose Vitamin D with zinc and it finally went away.

        My youngest came home from college for the spring break that turned into the rest of the year- and came down with symptom including loss of taste and smell. After speaking with 5 doctors on the phone during the course of the day, the fifth one told him to self isolate at home for 2 weeks. Again, one time megadose of D and zinc. a few days later was fine- except do the taste/smell which took a week to return.

        My middle son came home from work, with symptoms, refused to take the megadose until he was swabbed (didn’t want to interfere with the test), then took the megadose, and the swab was negative. Got that result on Monday after a Friday swab. By Friday he was worse, admitted to the local hospital after his O2 level dropped like a rock every time he stood up, swabbed again, and put on oxygen overnight. Faster results- negative. Released the next day- and told by the doctors he had it even with 2 negative results, and Dictator Cuomo’s edicts forbade them from swabbing him again. Apparently the first tests here gave more false negatives then false positives, at least according to his doctors. Took almost 3 weeks for his symptoms to abate. Based on lifestyle/diet, he likely had the lowest Vitamin D level at the start.

        Me? Nothing so far. I perform nasal irrigation daily- in addition to supplementing such that my Vitamin D level is at 40 ng/ml. My VA doctor keeps track- she’s deathly worried about Vitamin D intoxication. I remain thoroughly convinced that the nasal irrigation- which I can’t convince anyone else in the family to practice- is a huge factor in URI prevention. Each rinse lowers the viral load- allowing the immune system to catch up to the virus before it gets bad. I started doing it for allergies- and haven’t taken an antihistamine in over a decade.

        The megadose used was 300,000 iu D3 given in three 100,000 iu doses 8 hours apart, with a a 50 mg zinc tablet each dose. NOT a recommended dose for long term use. I was surprised to find 50,000 iu D3 capsules are available on Amazon. Not in any local pharmacy I’ve looked at. I have upped my daily Vitamin D from 1,000 iu to 2,000, half from D3, which I was taking, half from D2 made, as mentioned by others, from mushrooms. When my wife was given a large dose of prescription D because of a low blood level test given after her bone density scan was less than optimal- it came as D2.

  14. very glad you got thru it …

    I am curious about stage 1 …

    is there any medical treatment ? “CDC guidance for patients with symptoms is to stay home for a total of 10 days from onset of illness” is not treatment, its waiting to see if you might end up in the ER and maybe die …

    It seems that the fight over HZA is not about “effective” vs “not effective” but about dangerous vs not dangerous …

    if someone said aspirin might help in stage 1 everyone would try it because, what the heck, its not dangerous …

    so it seems to me the anti-HZA crowd is jumping the shark claiming its “dangerous” becasue if they just claimed “its safe but ineffective” alot of people would try it … and they don’t want people to try it … for some reason …

    1. The national health organization in Germany said you should make sure to drink a decent drink’s worth of strong liquor, so the WuFlu would get killed on the back of your throat and never make it down into your lungs.

      No, I’m not kidding.

      1. I think they suggested that you take a drink two or three times a day, just to be sure.

        I don’t remember if they wanted you to eat sausage too. But it sounded like a pretty good regimen, as long as you’re not taking a lot of acetaminophen.

        1. I went back and found the guy. It was a virologist named Dr. Juergen Rissland. He was kind of joking, but he said that alcohol definitely did dissolve the fat on the outside of the virus and would kill the virus’ innards, so he suggested that drinking whiskey would be a possible to destroy virus that you had just ingested. Although he noted that you couldn’t drink it every fifteen minutes or anything like that. This was back in April.

          Of course this was a Very Bad Thing to say, even though there are a fair number of studies about the good side of drinking alcohol when you’re sick.

          Drink responsibly, blah blah blah.

          1. I wonder if these hysterical ninnies realize that they are training people to be exactly what they claim to be fighting?

            “Oh, we must flip out at this not-bad thing because someone might do (thing)^10, and that’s bad!”

            Which means all the warnings are…worthless, because they are so far below “dangerous if you triple it” that they aren’t effective unless you violate the warning.

            1. Well, Official Expert Warnings are currently at “step on a sidewalk crack, break your mothers back” level logic for masks and grandmothers, so perhaps they have reason to think their Official Expert Warnings won’t be heeded at this point.

              I just saw a short paper* in The Lancet transparently attempting to repair some of the precipitous slide in Official Expert Warning Deference for Health Care Modelers by dredging up a few somethings they could claim as positives stemming from all those crap models, while simultaneously flinging blame chunks about at various parties other than pandemic modelers.

              I think the Official Experts are getting desperate.

              * https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30196-5/fulltext

          2. I ran across a Home Medical Techniques from the ’50s era. It seemed that the first step in every remedy from the common cold to the traumatic amputation of a limb was, “First, drink a shot of Whisky’.

            1. Hey, if you get your blood alcohol high enough, it’ll make your entire body, lungs included, into an environment inimical to any invader.

            2. The paternal grandmother of $SPOUSE$ started every day with a shot of vodka.

              She lived to somewhere around 101 to 105 (uncertainty there because the family Bible disappeared someplace between Poland and New England).

              1. I can relate. Great-grandad on my mother’s side lived to at least 103. Lifelong moonshiner. Though he did slow down a bit around his mid eighties.

                The drinking. Not the everything else, mind.

      2. I had kidney stones in Germany in the mid-90s. They recommended I drink 1 liter of beer a day to prevent recurrence. Which may just mean that the Germans don’t believe there is any problem that can’t be solved with alcohol and maybe a little gemutlichkeit.

  15. “ because slowing things down back in March and April not only succeeded in keeping the system from ever being overwhelmed, but it has allowed time for treatments to be developed and deployed ”

    Remember when you (Hoyt) were downplaying the virus (to this day actually) and we’re talking about your liberties being taken away and that you should do what you want?

    See the benefits that staying on your couch have brought? Next time have some more empathy for you fellow Americans, your doctors and nurses who work hard in the hospitals and research labs

    Nobody during the Blitz of 1945 said “I will leave my lights on if I like to, you are infringing my liberties, what bombs, those little mosquitos”

    You dumb woman

    1. Hi insane person.
      The Blitz was obvious and killed a ton of people.
      THIS IS THE FUCKING FLU.
      Yes, I remember when I said the fucking bullshit we’re doing wasn’t effective against a RESPIRATORY virus.
      It was this morning, at breakfast.
      The death rate, despite grossly inflated is “Bad flu”
      I have a memory and can think. You on the other hand, are the sort of vermin who can’t.
      Fuck off.

      1. Instead of the usual skim-until-offended, was this supposed to be skim-until-i-find-something-that-if-I-squint-hard-enough-fits-my preconcieved-assumptions-and-allows-me-to-be-a-screaming-asshole?

        1. Seems like.
          I mean, seriously. I never said this virus doesn’t EXIST. I said “it’s not dangerous to the vast majority of people, except in freak cases” (which yours was. Actually a lot of those are health care providers, leading people to wonder about viral load from REPEATED exposure.)
          And that the way we were combating it was if not exactly backwards not the sanest thing to do in the long run.

          1. Well, now, there you go, looking for sanity. It’s the government, and the Democrats, remember?
            ———————————
            “Oh, no. You can’t-a fool me. There ain’t-a no Sanity Clause!”

          2. … the way we were combating it was if not exactly backwards not the sanest thing to do in the long run.

            Governor Cuomo begs – nay, DEMANDS – to differ. And if you say anything about dumping carriers in long-term care facilities he was just following Trump Administration guidelines, any investigation of the policy is just wasting taxpayers’ money and besides, it’s all political!!! Not only that, only vile racist Rethuglicans demand policies be effective; Democrats know the important thing is that they be DRAMATIC!

            So please, please come back — he’ll fix you breakfast! you want a schmear on that bagel?
            (Let’s eschew discussion of cultural appropriation of foods)

    2. On your head be every suicide, every ruined life, and everyone who died because of closed hospitals.
      Do you hate the US so badly you want us destroyed if we don’t let you have the Green Nude Heel?

    3. She was right though. You must grant that. This is nothing more than a flu and we never shut down for a flu before. None of the actions taken, lockdowns, masks, paranoia, helped at all, all they did was damage. You know that old, obsolete thing first do no harm. How’d that work out for you.

      The blitz was 1940. The buzz bombs of 1945 weren’t aimed so lights didn’t matter one way or another.

      My liberty does not end where your fears begin.

      I’m actually at the point where I enjoy your little posts since they show me that no matter how dumb I might be, you’re dumber than me. Thank you for that.

      1. And Chris doesn’t have anything to say about how he was calling Trump a racist for stopping the China flights. His kind just want to make us all slaves, and I’m not in a mood to treat them charitably any more.

        1. I enjoyed his Germans bombed Pearl Harbor moment, didn’t help his case there The other thing is that people did in fact protest In WW II about their loss of liberty and they weren’t wrong to do so. The state expanded massively and we never got all our liberty back. that’s the way it works.

      2. While I agree that the lock-downs and mask orders are an outrage, looking at a chart of new cases I did see an upswing two weeks after the start of the BLM riots where I am. That makes me wonder if some of it is effective even if both evil and not worth the damage.

        1. I don’t know your area, but if you look at the charts, most of them have had the second bounce when smoothed for 3 to seven days looking a lot like the chart headed down.

          Well, the ones that don’t flatline for the 4th of July weekend, and then show a jump. (of course the labs shut down!)

    4. *head tilt*

      The words you do are (mostly) grammatically correct.

      But you seem to be responding both to a different post, and to different proposed behavior, than Sarah has said.

      Miss Galaxy describes what boils down to a nasty flu that has known complications which are bad if you don’t get treatment; she even specifically mentions it’s basically bad luck. She obviously wasn’t doing anything against best practices.

      Sarah’s proposed solution was “stop flipping out and stomping on us” and let people act like they are avoiding… a really bad flu.

      You appear to be declaring it’s dangerous to lockdown as you interpret Sarah to be suggesting. And also that people are dead and/or maimed because of Sarah’s crazy advice.

      Shorter:

      1. Reading the original comment, my first thought is that this “Chris” person may not speak English as a first language. Does that mean we have a foreign troll? It’s like the poster didn’t read the post, let alone comprehend it.

        Which Internet rule is it that invokes Moon Ferrets? Because I just saw some Moon Ferrets summoned into the argument. Maybe a bit of Monkey Excrement as well. Add in the Skim-Until-Offended and my bingo card is almost full!

          1. Nah, its just chronic Marxism, which among other symptoms causes delirium and inability to distinguish fantasy from realty.

        1. Larry I think mentioned it once, as an example of contrived nonsense. I think I may have then started raving about the need to keep the moon rabbits under control.

          I suspect the Chinese are using French and German assets to interfere in our election, and that we should kill them all.

          Seriously. There are fairly obvious foreign trolls showing up on apolitical sites to push back on covid, and to inflame US internal tensions. And hearsay from Germany implies that Merkel has very definitely picked a side. If we wind up fighting certain powers in the next world war, sparing them in previous wars was a mistake that we should not repeat.

            1. I laughed so hard over “Common Internet Shitgibbons” that I got a headache and had to go lie down, so thank you.

              I read Monster Hunter Nation sporadically, so I’m kind of counting on you guys to point out the best stuff over here.

    5. Hold yer horses there, bucko. “Downplaying the virus”? Ye blobs and little fishes. Compared to the hair-on-fire shrieking you’d see in the common media, perhaps. It would not take much to “downplay” it when set beside folks that got things wrong from the get go. Or does anyone else recall the “its racist to cancel flights from countries with *known* widespread outbreaks, including the one the virus actually came from”? The mask flip flop that got unmasked just recently? The seriousness with which we are to take social distancing at church- but ignore at protests? And so it went.

      I have great empathy for my fellow man, as do many of us here. So great, in fact, I bid them do as they will- so long as their freedom does not impinge upon the free will of others. I have no issue with others choosing to act foolishly in a vain hope to “flatten the curve” or some such nonsense. I have a rather larger one when they want to flatten *me* in pursuit of pipe dreams.

      Attempted murder of an entire country’s economy is a pretty big “untintended consequence.” As are the suicides from the suddenly unemployed- wait a couple of years to get the full impact of the numbers, but you will see I am right. The deaths due to criminally stupid acts of politics- vis. the nursing homes in New York.

      I have even more problems with the dire precedent being set of shutting down via political fiat private businesses. This is a bad thing. It should not be repeated. It should never have been allowed to happen in the first place.

      Have some empathy instead for the working men and women who are suffering through this, bub. I travel a bit for my job- an “essential services” job- and see it in big cities and small towns. People need to go back to work. They *want* to go back to work. And they should. Doctors and nurses who work hard in hospitals and research labs want to go back to work, too. Or do the ones who aren’t in this sham-demic theater play related jobs not important? Or not *as* important? Dentists, hair stylists, restaurants, gyms and more. Hell. Plumbers are getting short of work. Plumbers are bloody essential, not just “essential.”

      Small business are nearly *half* of GDP. That nearly half is being *destroyed* by lockdown theater. That means the economy is tanking. Government is borrowing more money, because of lockdown theater and the economy tanking. Your dollar is worth less today than it was a year ago. A signigicant percentage less.

      IF this virus was as deadly as first reported AND lockdown/mask kabuki/et cetera was *effective,* it MIGHT temporarily be useful. It ain’t been. Seeing as it ain’t, and the above negative effects have happened, are happening, and will continue for a good bit even if we clean up our act *today,* I fail to see any point in continuing this farce.

      We will get through this, as we have previous such things. Or course we will. Despite all the damage that’s been done, and the foolishness we’ve indulged in. A proper way to look at it is to see what things worked- and what did not. What sort of worked, and what caused problems elsewhere. There are lessons to be learned here for those with eyes to see.

    6. It was one thing to flatten the curve by temporarily restricting liberty for a couple of weeks — and even then the strictures imposed were excessive, but after a brief interval (e.g., less than five months) you have to take your knee off the national throat. The Dems and the MSM are George Floyding the nation.

      Nobody during the Blitz of 1945 demanded “Turn off your lights” because the Germans had lost the ability to bomb London before the middle of 1941. You could look it up.

      1. Also, on the serious, the VIRUS IS NOT A SENTIENT ENEMY, spying for the single person without a mask.
        If masks are effective, they’re effective with 70% of people wearing them, and universal mask mandates are useless.
        If they’re not — spoiler, this is true — effective at all, then mandates are theater AND counterproductive.
        Dear Lord, this critter is a deep well of stupid fuck.

    1. Same. Forty cases over a not-small-at-all area, and four hundred in the larger tri-state area. I work with the public daily and am outside at least ten hours a day on a *very* good day.

      I’m more worried over the people getting sick from their dirty masks than the new flu at the moment.

  16. There are those who say that 2000 units a day of D3 is too little to significantly raise your D3 blood levels to the amount needed for robust health. Check out books by Judson Somerville, M.D. and Jeff T. Bowles on Amazon.
    I have taken 5000 units a day for 10 years with no ill effects, and have had only 1 or 2 colds during that time, when I used to get 2 or 3 colds a year.
    30,000 units a day, what Sommerville calls “the optimal dose” sounds like a lot, but it only amounts to 750 micro-grams. Bowles’ contribution is emphasizing the importance of co-factors, especially magnesium and vitamin K2 in property utilizing and balancing out the body’s utilization of D3.
    The “toxic” effects of D3 overdosing consists of hypercalcemia, which usually resolves quickly by backing off on the D3. Both Sommerville and Bowles say that they have seen very few who ever reach that level.

    1. Depends entirely on your body. And- your sun exposure. When it comes to vitamins and supplements everyone is different. Same with medicines- and especially painkillers. Seems the hypercalcemia can in some people occur at lower Vitamin D levels than what is considered Vitamin D intoxication- but that can be foerstalled by additional Vitamin K supplementation. Seems if the body has the Vitamin D- it uses it in the calcium cycle- which depletes Vitamin K…. It’s almost like here’s not one magic ingredient, they must all be present….

    2. Without knowing any individual patient’s Vitamin D levels or how deficient they are or aren’t, I cannot recommend higher level supplementation (individual situations may vary, always consult your PCP). And 30K a day is close to what we would use as a once a *week* prescription dose in those with *severe* deficiency, and even then only for about 8 weeks to replenish reserves, before dropping to maintenance dosing.

      I will point out that Vitamin D is fat soluble, meaning it builds up in the body over time until used (unlike water soluble vitamins, where any excess is urinated out, making the majority of what one gets in any given multivitamin mostly only useful for producing very expensive pee), so simply “backing off’ will not make your levels drop very quickly. That is also why lower levels of supplementation can still be effective over time. As far as your idea that hypercalcemia is not a serious condition, complications can include, osteoporosis, kidney stones, kidney failure, neurologic problems, and arrhythmias.

      1. making the majority of what one gets in any given multivitamin mostly only useful for producing very expensive pee


        Lots of folks have got that going on, like the ones taking 500 milligrams of vitamin C every day.

        complications can include, osteoporosis


        Wait a minute, vitamin D deficiency causes osteoporosis. You’re saying an excess of the same vitamin can cause the same condition? That’s weird and wacky!

        Then again, the Democrats say they are eliminating all our rights to make us free.

        1. It is weird and wacky indeed, but true. Basically because too much circulating Vitamin D will pull calcium from the bones as well as from the intestines.

          1. Although what I actually said is that a side effect of hypercalcemia was osteoporosis, that’s not necessarily from excess vitamin D, there are other and more common causes for hypercalcemia which may cause more bone loss.

        2. And of course there are other causes of hypercalcemia than vitaminosis D, but since most at least partially involve calcium moving from the bones into the bloodstream (aka bone resorption), you still get osteoporosis.

        1. What, peeing Mountain Dew yellow so you can watch all those nice B vitamins go straight down the drain doesn’t appeal?

          I used to work in a facility where we did a lot of drug testing, and you could always tell who took a daily multi-vitamin.

          1. In my case, I seem to run low on d despite massive 10k a day dose. I figure I’m made to be a barechested roofer in FL, but Dan disagrees.
            I also gain weight if I don’t take a B. Which is bizarre since I DO eat meat.
            Eh.
            I am not human.

              1. Better off?
                On being told that “if you hear hooves think horses,not zebras” son returned it with “Unless it’s my mom. Then embrace the zebra. Or probably the ostrich wearing a zebra costume.”
                People looked at him and he gave them JUST A FEW of my peculiarities.
                Until they said “Oh. Okay, remember your mom isn’t human, and you’re trying to look after humans.” 😀
                <Suspects the problem is high-level input from Neanderthals.

                1. Okay, yeah, some of your outlier aspects are great but I do recognize that the medical ones could stand to lay off.

            1. Yeah, that is always the issue when you talk to a general audience, you have to be careful to stick with what is appropriate for the ‘average’ person.

              But, individuals are not the sum of human averages. Something we don’t always keep in mind in one in one encounters in my profession, despite knowing better. But it’s also why I always tell folks to talk to their own damn provider when they corner me in social settings for specific advice. I don’t know the history and I sure don’t have the labs, so please talk to the person who does!

              1. Funny, totally different area but this is why I never, ever give investment advice. I’ll tell you what I’m doing but I don’t know your circumstances, your tolerance for risk, or whatever other quirks you have.

      1. Given her method for political advancement, that puts Joe’s Claims of Experience in Congress in a new light.

    1. They COULD have picked AOC…

      Although I suspect that would have made their Clown Car completely break down.

      At least now, when they call Trump a racist, he’s got the perfect lead-in to shoot back at Biden’s record up until about 15 years ago.

      Maybe the Republicans can point out that the Democrats have been the racist party for 200 years. Or mention that the first black Presidential nominee was Frederick Douglass in 1888, although Benjamin Harrison wound up winning the final Republican nomination.

      Hell, the Democrats were all buddy-buddy with the Nazis, until they became unfashionable. FDR lifted half of his campaign speeches from Mussolini.

      1. They couldn’t pick AOC- she does not meet the minimum age requirement under the Constitution, although her supporters were arguing for nullification of that constitutional provision as well.

        1. Well, it isn’t clear how the protests are going to play out. The black shirts are apparently objectively fairly white, and pro white supremacist.

          AOC’s brand of hispanic may be seen as too white hispanic to be very trustworthy to black voters. Dunno.

          1. “White hispanic” would be the best option– because if she comes across as Mexican-or-close-enough hispanic, that brings in the gang related conflict. Three directions, minimum– black gangs do not like cartels, other way around, and the “nice” types that Dems need for fund raising and cover don’t like either one due to first hand exposure, and are likely to respond poorly to any attempts to make the first two feel happier. Maybe pissed enough to take the out I’ve been hearing about how Joe is being used by extremists….

        2. They couldn’t pick AOC because they’d have to keep reminding her that Biden is the top of the ticket.

          They’d have to keep reminding Biden, too.

          More seriously, imagine the traditional shot of the presidential and vice-presidential nominees standing together — putting her alongside him would make him look the senile dotard he is.

          1. That runs into that diversity of viewpoint that Biden went on about. Can’t see how being Puerto Rican would resonate with the Mexicans. it certainly doesn’t with the Dominicans here in NYC. get hold of either, give them a beer, and duck.

    2. What choices did he have? Trump has been steadily gaining support among blacks, males in particular, and if the Democrat’s share drops from 90% to 70% of the black vote they won’t win another election for a generation. Rasmussen has Trump at 35% approval. It had to be a woman because he shot his mouth off, so who does that leave? Susan Rice, Mooch Obama, Oprah. They need the black vote to show up and vote for them. Biden won’t make that happen.

      My wife thought it would be Rice because she’d bring back the Obama feel-good feels. I thought it would be Rice to keep her out of jail given what we know about Obama Gate. still, With all the BS, Rice scares me less than Harris does. Rice is stupid and lazy she’d be a foreign policy disaster, but we can probably survive that. Harris is stupid and aggressive. von Hammerstein-Equord described her perfectly. She could destroy us.
      Even the lefty women I know don’t like her. She gives off a vibe and women are better at picking that up than men are. My God! Her father threw her under the bus and her sugar daddy Willie Brown, told her not to run.

        1. Already started. Trump campaign came out with their first add within minutes. Slow Joe and Phoney Kamala. The Gabbard clip is already viral. look for Twitter to squash it.

          It did actually wish Trump was a little more restrained. Not any more. Trump Acting in a target rich environment, it’s gonna be epic.

          1. You know they must have had several different ads prepped, one for each of the likely candidates, with all that lead time. But even without all the lead time the Biden campaign gave them, they would have had the Kamala Harris ad prepped long ago, as she was the choice of least surprise. (Would have been far more surprised to see Biden pick anyone else).

            1. And the reaction of some of the leftists I know is “President Harris has a nice ring to it.” They know Joe isn’t the candidate in any way that matters.

      1. Well Brown told her not to run so that she could become AG in a Biden administration because being AG “has real power”, i.e. so she could use the AG’s office as a political weapon the same way Obama’s AGs did.

        1. What I like about Kamala is how she followed the traditional female path to power. Find a powerful man and seduce him. Much like Hillary that way.

          1. That’s unfair — to Hillary. When she hitched her wagon to Bill he was hardly what could be deemed powerful.

            Or are you suggesting the way she played Vince Foster?

        2. I wonder if she’ll show the confidence Biden’s lead deserves and resign her Senate seat to run with him.

      2. I imagine there will be many Black men thrilled, thrilled at the presence of a nagging Black woman on the ticket, reminding them of all that they love about their culture.

    3. Today Biden’s handlers conceded the election


      I hope so. Make sure everyone you know doesn’t relax. Make sure they go vote. Unless they are *woke* them can stay home. But President Trump can’t win if we don’t go vote.

      That includes those of us in states that aren’t likely to swing to Trump no matter what we do. There might be a miracle or dozen out there. Praying that the Portland mess has that corner mad. But no matter how Oregon swings it’s 7 electoral, know I Will Not Vote for Biden/Harris.

          1. California is not in play and never will be as long as Democrats have the ability to assure themselves victory through ballot harvesting and votes by illegal aliens.

            1. Right here in San Diego there are at least 70,000 voter registration entries that are required BY STATE LAW to be removed from the lists — and they have been left there FOR YEARS. If no vote is cast in three consecutive statewide elections, state law requires re-registration.

              “But that’s RRRAAACIIISSST!!!” Don’t ask why, it just is.

              Most of them are people who moved, and are still registered at their old addresses. When I vote, I can see that the folks who moved out of the house next door 12 years ago are still on the list, even though a number of other people have rented that house since then. All of them are probably still registered at that address.

              How hard would it be for the same political hacks that won’t update the lists to provide ‘somebody’ with that address, and one of those names? ID checks are RRRAAACIIISSST!!! after all.
              ———————————
              Leo Bloom: “Well, if we assume you’re a dishonest person—“
              Max Bialystock: “Assume, assume!”

        1. We don’t actually know how the business around the fraud will play out this time, so we don’t know whether the California, Illinois, etc. stuff is truly pointless or not.

          1. That’s the key point. Asking “will there be fraud?” is like asking a Southerner “will there be food?” Of course there will be fraud. There already is. It’s baked right in. *How* many voter ids siezed at airports so far? Are you surprised which cities we found them in? …Didn’t think so.

            They want to remove signature verification. No *bleep.* That. Is. Crazy.

            1. The dismissals of the ID thing are a hoot.

              Yeah, there’s usually fake IDs seized; you can find news reports of a really big bust from December… of one thousand fake IDs.

              Yes, 20k is a jump!

          2. One of my fantasies is the Democrats spend Election Day busing people from precinct to precinct and at each stop they go and vote for Trump. After all, nobody has to know who you voted for.

      1. Vote! Even if you live in a “my vote will never matter” state. We spent years hearing about how Trump “lost the popular vote” and “wasn’t democratically elected.” Even if your vote won’t flip your state, it will still help flip the popular vote, and maybe it will make all those enthusiasts for the “Popular Vote Compact to Destroy the Electoral College” think again.

        Oh, and if you see someone in a libertarian forum saying either “don’t vote, it only encourages them” or “don’t vote, we need to bring the whole system crashing down” — that person is a troll being paid by the other side to suppress votes. Perfectly legal, but shady as h***. I’ve seen versions of this for the last four elections, and I’m not going to take it any more. If you see them or hear them, call them out on the spot.

        1. that person is a troll being paid by the other side to suppress votes

          I can see that being the case sometimes, especially in this particular election. But as a general rule….. no. The moral argument against voting is pretty sound; its primary fault consisting of being a couple levels up the idealism scale from where most people typically think. And the pragmatic argument against voting is absolutely airtight: voting anywhere above local scale is provably irrational behavior purely on the mathematical issues. Which is of course why voting is handled as a religious matter with a veneer of logic draped over it.

          As for the rest, I come from a mostly non-voting family, so it comes down to whether the desire to deliver a meaningless middle finger is greater than the hassle of registering (while also means getting put on the jury rolls).

          1. … voting anywhere above local scale is provably irrational behavior purely on the mathematical issues.

            There’s an assumption in that argument which I don’t think you’ve examined. The assumption is that other people aren’t doing the same analysis. But if they are doing the same analysis, and everyone else acts rationally (according to the “just one vote won’t make a difference” argument) and stays home, then suddenly a single vote would mean that candidate would win with 100% of the vote (1 vote for him, 0 votes for everyone else).

            And that leads to the argument by induction that proves that voting is rational behavior, and that not voting is the irrational behavior. (Assuming that you care about the outcome of the vote, which you will, most of the time. Your ideal candidate may not ever be running, but almost all the time, you’re going to prefer candidate A over candidate B). If zero other people are voting, then your vote will decide the outcome. If one other person is voting, and you don’t know whether they’re voting for A or B, then either your vote will prevent B from winning (thereby changing the outcome) or your vote will cause it to be 2-0 for A instead of 1-0 for A. So you have a 50% chance of affecting the outcome, but if you don’t vote your chance of affecting the outcome is 0%. Therefore if there are only two voters, it’s better for you to vote than for you not to vote. If there are three voters, then there are four ways the other two people might have voted: 2-0 for A, 2-0 for B, or two ways of a 1-1 split for A and B. In two out of the four cases, your vote will cause it to be 2-1 for A, thereby changing the outcome. So you still have a 50% chance of affecting the outcome if you vote, vs. a 0% chance if you don’t. With four voters including you, the three others could split eight ways, and I’m not going to write them all out but your chance of affecting the outcome is still non-0. (Rough back-brain math says 25% chance, but maybe I missed something and it’s higher). And so on; keep increasing the number of other voters and your chance of affecting the outcome keeps decreasing slowly, but in a way that asymptotically approaches zero. Which means that the only way your vote truly has a 0% of affecting the outcome is if the number of other voters is infinite, which has never been the case in any election.

            And even if you say, “Yeah, but I live in Illinois, so it’s useless to vote because my vote is guaranteed to be drowned out by the sea of Democrat votes”, well, if that was the case, then Illinois would never vote for a Republican governor either, right? If the Democrats always win Illinois’ vote, then Illinois’s gubernatorial elections would never be won by a Republican, at least not recently. Oh, wait, in 2014 a Republican (Bruce Rauner) won the Illinois governorship. What about Illinois’ Senate seats? One has been held by Durbin (D) since 1997, but the other one (currently filled by Duckworth (D)) went to a Republican, Mark Kirk, in 2010. Yes, both Rauner and Kirk lost their first re-election, so Republicans have a much worse chance of winning Illinois statewide elections than Democrats do. But a nonzero chance is still nonzero; if you argue that your Republican vote was guaranteed not to count in Illinois, then the 2010 Senate or 2014 gubernatorial elections are both counterexamples (where just one counterexample would be enough to disprove the theory).

            Yes, your vote has a very small chance of affecting the outcome of the election. And voting does carry a small but non-zero cost (besides time & effort, there’s the cost of gas to drive to the polling place unless it happens to be practically in your back yard). But the payoff if you do affect the outcome is huge: look at the difference between the Trump presidency and the Obama presidency. That means that voting is like gambling. Say you’re offered the chance to bet $1 on a jackpot of $1 billion. The odds of winning may be low, but if they are better than 1-in-a-billion odds, then the rational course of action is to take the bet. Similarly, voting involves a small cost in effort and money, but the jackpot payoff is immense.

            Besides all of that, *every* election is a local election as well as a national one. I have never yet voted in a national election where there weren’t also many local races on the ballot, for the city’s legislature for example. And since you already know that in a local election, the chance of affecting the outcome is (relatively) large and you already agree that it’s worth voting in local elections, then the added cost of voting in the national election is zero. If you’re voting in the local election, then you’ve already paid the cost of gas to get there, the time cost of registering and showing up at the polling place, and so on. So at that point, the additional cost of voting in the national election printed on the ballot you’re holding is truly zero. (If you quibble about it costing a few extra seconds to fill in one more bubble, and that being a non-zero cost, I’m going to blow a virtual raspberry at you. Thpppth. *grin*) So why not do it? It costs you nothing and has a chance, small but non-zero, of mattering.

            1. you already agree that it’s worth voting in local elections, then the added cost of voting in the national election is zero.

              *May* be worth voting.

              Small town of 500 people? Sure, probably worth it; the outcome is likely to directly affect you, and you have at minimum a 1/500 chance of affecting the outcome. Which begins to illuminate the issue at hand.

              Also you aren’t adding up the costs correctly. There are actually two different categories of product being produced here: cheap votes and expensive votes.

              A cheap vote is where someone goes to vote and decides who to pick based on hey this guy has nicer hair. Or flipped a coin, or that is who all the people they know will vote for, or one of a thousand other reasons that most pro-democracy people will rail against. In this case the vote has cost only the gas, registration, etc. And the voter is paid for their trouble with a vague sense of Did The Right Thing in the civic religion.

              An expensive vote is what everyone claims they want people to do: carefully study the issues and carefully analyze the candidates to produce a Best Option. Here the cost is all the research and thinking (can be mitigated if the person loves politics), the paymeny is the 1/N chance of effecting the outcome in the way they want it to go, and the sense of DTRT (possibly enhanced if they are devout in the civic religion).

              If you’ve had any decent economics training then right about now you should be noticing that this is a classic example of Market Failure. Individually rational action does not lead to the group-rational outcome. This should not be surprising; after all “Market Failure” while a temporary aberration in markets is the law of the land in the political sphere.

              Unfortunately the American system has become sufficiently warped that for the most part no one gives a crap about locals, and everyone wants to be in on the national.

              Also the costs of “You side losing” (assuming you even have politicians that are on your side) have become high enough that it is starting to be justified to vote purely you you aren’t on the wrong side of the boot.

              There’s an assumption in that argument which I don’t think you’ve examined. The assumption is that other people aren’t doing the same analysis. But if they are doing the same analysis, and everyone else acts rationally (according to the “just one vote won’t make a difference” argument) and stays home, then suddenly a single vote would mean that candidate would win with 100% of the vote (1 vote for him, 0 votes for everyone else).

              It isn’t a binary choice. The actual outcome is that everyone runs the iterative game, observing turnout and developing deep seated pre-decisions (things like voting / non-voting families) until an equilibrium is reached.

          2. The argument against voting is not idealistic. It’s retarded.
            SERIOUSLY. Heinlein pegged it. If there’s no one to vote for, there’s someone to vote against. And in this case the vote against are international socialists, ready to CREATE votes if needed.
            THey’re not “not going to vote to show the people are displeased.”
            Libertarians who believe that crap are useful idiots or plants. The result is the same. THe commies win. And none of those people will see freedom again.
            Seriously, Ian. THINK. Not about the world and people as you want them to be but about how they ARE.

            1. That isn’t the idealistic argument I was talking about.

              It is the one that says participating in the vote is condoning it, and therefore you are now responsible for every crime the politicians commit. I don’t hold to that, but the question of the voter’s use of abstracted force and their responsibility for the outcome because they accept the outcome even when it is horrible is a real one.

              Not about the world and people as you want them to be but about how they ARE.

              If I went full-ideal I’d have to reeee incessantly against Trump. For now I’m happy with The Enemy getting wiped out and leaving us with a better starting point.

              And then there are deeper / more autistic issues…. certain interpretations of certain verses about being Separate yield a result that any engagement with a political system is evil.

              1. Sort of reminds me of that excerpt I keep seeing from The Good Place where basically you’re held responsible for everything that can possibly be construed as a negative consequence of the decisions you make and apparently none of the positive ones, regardless of whether there was a better option, whether you could have known about it, and whether some of them actually resulted from other people’s decisions.

                I have the hazy impression that the speech might’ve been going for the idea that “all have sinned and fall short of the glory of God” was unfair, but it also sounds like the arguments for “there is no ethical consumption under late capitalism”. I suppose this illustrates that I need more context for proper interpretation, but I admit that in this case, I am not sure I care enough to obtain it.

                1. everything that can possibly be construed as a negative consequence of the decisions you make and apparently none of the positive ones

                  An easy and tempting path to take. If you aren’t sensitive to it (or weren’t sensitized as a child) it is very easy to not see or take for granted when things go well. By contrast things going badly is obvious, and often urgent. Combine knowledge of the 20th century’s butchery and the excuses made for it, and the omnicidal position starts looking mighty sane.

                  That is/was one of Jordan Peterson’s greatest strengths: he could tease out the good in even seemingly pitch black situations, while also being cynical enough to not come off as yet another saccharine freak. His point about Ebay as proof of honesty being a good example.

                2. Sort of reminds me of that excerpt I keep seeing from The Good Place where basically you’re held responsible for everything that can possibly be construed as a negative consequence of the decisions you make and apparently none of the positive ones, regardless of whether there was a better option, whether you could have known about it, and whether some of them actually resulted from other people’s decisions.

                  It’s textbook emotional abuse where the abuser wants to make sure the target doesn’t do anything without the abuser’s say-so?

              2. NOT participating in the vote also makes you responsible for every crime politicians commit if you are carrying the logic to that extent. Failure to act to prevent crime is tantamount to condoning the crime, after all.

                OTOH, i a nation of over 100 million voters I think it likely your share of the responsibility for any crimes by politicians is probably rather slight, and the possibility some politicians will feel greater responsibility to not commit crimes because they know they’re accountable to voters (if not G-d) suggests that by joining your fellow voters you are at least contributing, however slightly, to reining in politicians’ proclivity for criminality.

                Now, if you could demonstrate that polities in which nobody votes have less political criminality you might be able to support the argument of voting just encouraging them.

            2. Seriously, Ian. THINK. Not about the world and people as you want them to be but about how they ARE.

              Also I was taught that not only is the pragmatic irrelevant, but doesn’t exist and is evil if it did. Except for when it isn’t practical. Bleh.

            3. It’s one thing to not vote if you have reasonable cause to think you might be murdered for it.

              Beyond that, discouraging voting is a viable strategy for the Democrats.

              Like with the ‘big, faceless corporations’ stuff, where arguing is persuasive that too many people are involved for one person to matter a disorientation and sense of helplessness are created. Which is an emotional need that religious leftism provides answers to fill.

              The strategy of generally discouraging voting, because “it is futile” and encouraging people to engage with religious leftism would have the effect of suppressing right wing turn out, and helping the Democrats.

              There’s a point, in so far as you fear reprisal. If you do fear reprisal, you should look forward to how you will get out of that situation.

              The important refusal is to believe that working with specific other people at the very small scale can bear worthwhile fruits, and that you do not need a theoretical understanding of those fruits, especially not in advance of doing anything. Leftism is about taking action with advance theoretical foreknowledge of the results, and doing nothing otherwise. It doesn’t matter that the theory is objectively wrong, because when they make their choices they assume the theory is correct. The Christian contrast is in trusting that the Lord may deliver results that are beyond a human’s theoretical understanding. (Okay, theology is an attempt to theoretically understand the mechanisms of God’s results. Christian theology predicts a Divine mind that can function in ways that are qualitatively different from what I understand Turing machines and human minds are capable of.)

              Sure, maybe the GOP is a scam. There’s a tradeoff between spending the least effort on political decisions, and making sure the least offensive option pays for your support.

        2. Yes. I’m nagging my husband, son, mom, sister, BIL, hubby’s brother & wife, anyone I know who will vote for President Trump, to vote. Doesn’t matter that Portland carries our state … Oregon legislature (not legally) voted to take the electoral college votes with popular vote. I want the popular vote to be shoved up their assets. With a loud “So. There.”

    4. Has anybody on that side figured out that Comrade Joe is about as much in control of the campaign as those monkeys we sent into space back in the 1950’s?

      All they need him to do is blow hot air so they can spin it.

      Joey ‘Albert II’ Biden, Monkey Candidate! (Have they told him what happened to the original Albert II? Check your parachute, bub, check it good!)

    5. I concede I feared he might choose Duckworth — who would be terrible but less obviously so than Harris, who is arguably the worst possible person from his prospect pool he might have chosen.

  17. Indiana removed signature verification from absentee ballots 8 years ago, and (IMO) because there was outcry from the voting precinct staff, removed the actual verification, examination, and recording the vote of the absentees from the precincts 3 years ago.
    John in Indy

  18. Sarah, thanks for bringing Galaxy Jane in to write clearly and thoughtfully on the WuFlu.
    Jane, thanks for sharing your knowledge and experience.
    John in Indy

  19. As I stated above, because it isn’t being used here anymore. This is strictly about the treatments that I was offered and which are current standard of care.

  20. Recent study published in JAMA about why children seem to be so resistant to COVID infection. Turns out COVID uses the angiotensin converting enzyme 2 receptor (ACE2) to bind to cells, and children don’t have many ACE2 receptors. The amount goes up with age. Since ACE2 also effects blood pressure, that’s one reason why older people, such as myself, get hypertension if not controlled. I take an ACE inhibitor, Lisinopril, for that. So between social distancing, masking when necessary, O+ blood type, and blood pressure medication, my chances of catching COVID are probably in the single digits. By the way, not all blood pressure medications are ACE inhibitors. Also, it’s not known how much of the drug needs to be taken for prophylaxis, and like most drugs, Lisinopril does have some annoying side effects (like a dry, unproductive cough, possible mood alteration, and dizziness when standing.)

    1. I have type A blood. I’m convinced I had it in January and it sucked.
      BUT whether I did or not, I’ve had other Covid viruses before, and I’m willing to risk it.
      House arrest sucks.

  21. TRIED TO LEAVE THIS YESTERDAY – but WordPress hates my login – and if you don’t get it ABSOLUTELY CORRECT the first time, forget it… the comment is lost in limbo.

    This is a great article, and I hope people take heart that docs are getting a much better handle on how to treat the disease.

    I want to do a bit of follow-up on the “long lasting effects on heart and lungs” aspect. There’s a recent scientific article on the matter that concludes that there may be permanent damage to heart from even mild COVID. I’ve read and dissected the paper with a scientific journal editor’s eye, and it really doesn’t conclude what the headlines claim.

    Short answer – yes, there will be long-lasting effects on heart and lungs from COVID. However, there are long-lasting effects from pneumonia, COPD, heart attack, etc. The common factor is that for a period of time, the blood oxygen levels drop, and muscles don’t get as much oxygen as they need. To quote the cardiologist of a friend “it’s no wonder those effects show up in the hardest working muscle.”

    Long answer – the study showed lasting effects based on (1) elevated troponin – a molecule released by “distressed” heart muscle, (2) decreased “ejection fraction” – the proportion of the blood filling the heart that is pumped out with each heartbeat, and (3) elevated “T1 and T2 signal” in magnetic resonance imaging (MRI) of the heart. The thing is, these are (again) effects that would show up if the blood oxygenation levels are low and the body is stressed for days to weeks.

    Regarding troponin – docs used to diagnose heart attack by the presence of enzymes in the blood that shouldn’t be there unless heart muscle was damaged or dying. The problem was that there are versions of those enzymes in heart, lung, liver, kidney, and the presence in blood didn’t necessarily mean they came from the heart muscle. Enter troponin – it’s a heart-specific enzyme, and it’s presence means that heart muscle was ischemic or anoxic (shortage of oxygen getting to the heart muscle). Usually this comes from a clot blocking blood flow as in classic heart attack. However, troponin can be released by the lung tissue when the lungs have trouble exchanging oxygen with the blood. In addition, of blood oxygen levels are low, the heart muscle may still release troponin. So, pneumonia, severe lung disorders, etc can elevate troponin. This can be a problem when (as was the case with my father one year ago) the docs diagnose a heart attack when the problem was in the lungs in the first place.

    Regarding ejection fraction – when the heart relaxes, the ventricles fill with blood. There is a low-pressure pumping from the atria, but mostly the fill is from relaxation of the heart muscle. Then the muscle contracts, and the bllod in the ventricle(s) is ejected. Ultrasound imaging of the heart can measure the volume at full relaxation/filling, and again after contraction/emptying. The ratio: (Full-empty)/full is the ejection fraction, and it should be above 55% for healthy heart. However, structural abnormalities, stiffening of the ventrical walls, weakening of the muscles, etc. all lead to reduced ejection fraction. Again, if the heart has to work harder because of low blood oxygen (needs to pump more blood, faster, forex) then the heart muscle might thicken, stiffening the walls of the ventricle and reducing ejection fraction. Other factors could be that the heart is pumping against increased blood pressure due to fluid retention or inflammation, or atherosclerosis and blood clots. Again, given what we know of COVID19, these are some expected consequences.

    Fianlly, regarding the MRI. Magnetic resonance uses a large magnet to create a spinning magnetic field. Hydrogen atoms to align and spin around their attachment to other atoms, and when hit with a radio signal, they flip alignment and spin in the opposite direction, releasing energy that is detected by the imager. “T1 signal” is tuned to detect hydrogen atoms comprising fat molecules, and “T2 signal” is tuned to detect fat and water. Normally, the two signals are compared to examine soft tissue and differentiate fat (high T1, high T2), water (low T1, high T2), protein (low to no T1, moderate T2) and bone (low to no T1 & T2). In some cases such as fatty tumors, only the T1 is necessary, because a tumor shows up bright in the image. In other cases, only the T2 is necessary since the doc can see a lot of detail. And of course, the combination of (or even the difference between) T1 and T2 is most useful. Once again, anything that stresses the heart will alter the T1 and T2 signal.

    The *problem* with the conclusion of “long lasting effects on heart and lungs” is that any disease – COVID19, penumonia, severe influenza, pleurisy, heart attack – will have those exact same effects. Another issue is that they tried to make a big case of changes in the T1 and T2 signals *in isolation* without reference to the other signal (or at least without differential assessment). This is alomost never conclusive, and unfortunately, they made it the primary conclusion of the report.

    …and yeah, being REALLY sick with breathing complications is going to stress the body. In the case of my father last Sept. he had fluid surrounding his lungs – a thoracentesis procedure to remove it drained nearly two liters of fluid from the pleural cavity. A “normal” amount would have been 1/100th as much. It stressed his heart to the point of releasing troponin, leading the cardio docs to diagnose a heart attack (but the EKG and ultrasound said no) and the overmedication stressed his kidneys by dropping blood pressure to the point of inability of the kidneys to effectively filter toxins from the blood. So that was a stress, and his recovery has been nearly a year so far and he isn’t back to normal BUT HE IS RECOVERING!

    So any studies that stress “permanent” side effects from COVID19 are way premature.

    The take-home is really what Galaxy Jane said – early diagnosis and treatment is the best course of action. Our docs have systems in place and know what to do. It is unfortunate that so many were lost in the early stages as we figured this out, but it could have been much worse if we hadn’t learned from the lessons of SARS, MERS, and various severe viral pulmonary diseases.

    Be not discouraged. We are beating the disease even without a vaccine.

    [Caveats: I know Sarah’s blog atracts people who love to argue, and more that a few who think they know more than experts… So, for my credentials, I’m a PhD physiologist with 35 years experience in the field, a professor, an active researcher, and active teaching faculty at a medical school. As for counterarguments – unless you are a pulmonary doc, immunologist, systems physiologist – you really don’t have the credentials, the knowledge, the training or the credibility to argue here.]

    1. THANK YOU on that long term effects thing.
      I KNOW. It took me ten years to recover fully from pneumonia, and even now, 24 years later, they’re not sure if I have early stage COPD or not, because damage was left behind, and might or might not progress to something worse.
      So every time they scream “bad stuff left behind” I go “What, like all pneumonia?”

    2. Thank you, this is great information!

      I will clarify lightly (and I think you understood) that when I was talking about long-term issues above, I was speaking of physical damage to lungs, heart, kidneys and vasculature from the disseminated clotting and inflammatory damage if a patient actually enters the third stage of infection, and the resultant cytokine storm. Or ventilator-related lung damage. That isn’t going to heal quickly. Not the ‘permanent effects of mild COVID-19 infection’ that seems to be making the rounds of the latest breathless press releases.

      Quick technical question, as I haven’t seen the article. Did they have both before and after echos and MRIs? Because without a baseline of comparison, I am not sure how you draw the conclusion that the reduced EF or MRI changes were related to the virus or were already present in these patients from some other condition. My EKG never changed (I checked) and my troponins never bumped, although some other labs got hairy, so I haven’t worried about my heart to be honest. I’m running again and hate it, but hating it was my baseline before I got sick.

      1. Good question, and I’d have to go back and check. Unfortunately, my actual work-office computer doesn’t have the links. This is my first time in the office in 3 weeks because I went to visit my 91-year old father and 87 y.o. mother (BTW, Mom says Hi! Sarah.) and then self-quarantined for 2 weeks (work requires it).

        I think they did have pre-covid scans, because there was the “increased signal” finding. Frankly, though, that’s still a relative measure and could be caused by a different tech for the two scans. My big take home was that what they were talking about was precisely the type of … normal … after effects of respiratory illness. You are absolutely spot-on that the effects of the cytokine storm an “end-stage” COVID19 are not going to resolve except on a timeline of years (if at all). Furthermore – the article was NOT about those effects.

    3. A report in today’s NY Post says doctors are having good fortune using medically induced hypothermia to get patients off of ventilators. Apparently when your lungs are being operated by machine the muscles normally tasked to do that atrophy — which would account for the fact that very few people make it off ventilators alive. Cooling the body, slowing it down, reduces the damaging effects.
      https://nypost.com/2020/08/13/doctors-find-hypothermia-can-help-get-coronavirus-patients-off-ventilators/

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