Midnight Meme Of The Day!

by Noah

Sunday Thoughts:
The "Chosen One" is getting more out there by the week. The self-proclaimed "King Of The Jews" is only the King Of Fake News, but, you know Trump does seem to speak in tongues. Let the fabulous Randy Rainbow tell you more about it. The Lord's gospel truth is just a click away. It's just a click away. The shelter you seek is just a click away!

Trump Is Leading His Church-Going Fans Into The Arms Of The Virus

Butte County in northern California has about 220,000 people. The closest towns that could pass for cities are Chico (pop-103,301) and Oroville (pop-20,737). After the devastation of the 2018 Camp Fire, the city of Paradise went from a population of 26,218 to just 4,476.Now Butte has another problem its residents never imagined they would have to confront: a pandemic. About a month ago, writing to the L.A. Times, Laura Newberry reported about a Butte County church at the nexus of the county's pandemic. Pastor Mike Jacobsen of Palermo Bible Family Church defied public health officials and held an in-person Mother’s Day service exposing 180 congregants to the coronavirus (71 were infected). In a Facebook post Jacobsen said that an asymptomatic congregant who attended the May 11 service woke up the next morning "needing medical attention," was tested that day and confirmed positive two days later.

While local health officials began attempting to notify every person who attended the service and instruct them to self-quarantine, Danette York, Butte County public health director, issued a statement noting that "At this time, organizations that hold in-person services or gatherings are putting the health and safety of their congregations, the general public and our local ability to open up at great risk... Moving too quickly through the reopening process can cause a major setback and could require us to revert back to more restrictive measures."

Butte County leans Republican-- but not overwhelmingly so. Trump won there is 2016 with 48% of the vote to Hillary's 44%. Gary Johnson, the Libertarian got nearly 5%. Butte was one of the counties Gavin Newsom gave permission to open too early. There is little social distancing in the county and, as in the rest of California, no endorsement of "mandatory" mask rules.

Newberry reported that the pastor "said it’s important for Palermo Bible’s many young, new believers to be supported in their fledgling faith-- and part of that is being able to attend church in person. He compared the act of depriving these congregants of in-person worship to taking 'an infant out of the arms of its mother. We’ve really tried to raise the bar and do a good job with what we’ve been given,' Jacobsen said of virtual services, 'but it’s not the same as being together in fellowship with one another.'"

As of Saturday, just 2 people had died in Butte. Of the 143 COVID cases in the county, only 47 are still active. Coronavirus has spread among church congregations all over the world, famously in Germany and South Korea, but most notoriously here in the U.S., where a dozen churches have sued to overturn restrictions on their freedom of worship.

Reporting for Politico Sunday, Gabby Orr wrote about how Trump has made-- as is his wont-- a bad situation worse. Just a month after the self-serving sociopath ordered all governors "to immediately reopen churches, his administration is facing a difficult dilemma. Clusters of Covid-19 cases are surfacing in counties across the U.S. where in-person religious services have resumed, triggering questions about whether his administration should reassess its campaign to treat houses of worship the same as other essential businesses, or leave them alone and risk additional transmission of the deadly coronavirus-- including in communities that are largely supportive of the president."

An outbreak at a Pentecostal church in Oregon, where hundreds of worshipers resumed gathering over Memorial Day weekend, forced an entire county to return to phase one of its reopening after local officials traced 258 cases of Covid-19 back to the facility. In West Virginia, six health departments across the state have reported coronavirus outbreaks linked to churches. One of them, a Baptist church in Greenbrier County, had 34 congregants test positive for the virus. And in Texas, which hit an all-time high of new cases last week, health officials have received numerous reports of church-related exposures.

The disturbing trend did not stop Trump and other senior administration officials from visiting an Arizona mega-church this week for a “Students for Trump” rally, where MAGA ball caps were far more ubiquitous than face masks. Images from the event-- showing hundreds of mask-less teenagers sitting in close quarters for the president’s remarks-- embodied the predicament Trump now faces: Many of his Christian supporters rushed to embrace the country’s reopening, which has included the return of in-person worship services in many states. Now, re-imposing previous restrictions to protect other Americans could impair the president’s relationship with his own base.

"I just encourage every American to continue to pray. Pray for all the families that have lost loved ones. Pray for our health care workers on the front lines. Pray that by God’s grace, every single day, will each of us do our part to heal our land."

So far, administration officials have declined to single out church-related outbreaks as problematic.

A senior administration official briefed on the discussions said members of the White House coronavirus task force began expressing serious concerns this week about rising infection rates in a dozen states, particularly after Florida reported record-breaking cases last Wednesday-- leading to the task force’s first briefing in two months on Friday. But the same official said the task force does not consider churches to be super-spreaders, or hotspots for Covid-19 transmission, at this time.

Others, including Trump, have chalked up the rising number of cases in places like Arizona, Texas, North Carolina and Florida to expanded testing capabilities, even as White House officials privately acknowledge the volume of newly confirmed cases exceeds that which increased testing would account for.

A spokeswoman for the Justice Department, which intervened in several states to seek equal treatment for churches in the reopening process, declined to comment on whether the agency plans to change its current approach pushing to reopen houses of worship.

...Previous guidelines issued by the Centers for Disease Control and Prevention-- which urged churches to suspend choir activities, eucharistic sharing, the recitation of creeds and other programming-- had roiled Trump aides late last month who felt the public health agency was burdening faith communities with unnecessary restrictions. In updated guidance posted shortly after Trump demanded that states allow churches to reopen, the CDC said its recommendations were “not intended to infringe on rights protected by the First Amendment.”




“Some governors have deemed liquor stores and abortion clinics as essential. It’s not right, so I’m correcting this injustice and calling houses of worship essential,” Trump had said at the time, following public complaints from some of his top allies on the religious right about ongoing church closures.

On the same day Trump pronounced churches “essential” businesses, the lead pastor at Lighthouse Pentescostal, the Oregon church now at the center of the state’s worst coronavirus outbreak, wrote in an Instagram post that he would begin in-person services that weekend “in accordance with President Trump.”

Other religious institutions filed lawsuits against state officials who declined to lift restrictions on church gatherings, calling the rules unconstitutional since other businesses were permitted to resume service.

Now Trump is grappling with the fallout-- unforeseen or not-- of his aggressive push to reopen churches at a time when he can’t afford to agitate his religious supporters.

Polls conducted since the coronavirus pandemic began have shown a steady decline in his favorability rating among white Catholics and white evangelicals, demographics that helped carry him to victory in 2016 and whose backing he will need to defeat Joe Biden, his expected Democratic challenger, this fall.

Despite the outbreaks occurring in churches and elsewhere, the president’s response lately has been to double down on his effort to jumpstart the U.S. economy and reopen houses of worship, restaurants, manufacturing facilities and retail suppliers.

As part of the White House’s efforts to maintain its indispensable bond with religious conservatives, Pence has visited two churches in the past month in Maryland and Pittsburgh, and-- despite postponing campaign events-- still has a planned appearance Sunday at First Baptist Dallas in Texas, which is run by Rev. Robert Jeffress, one of the president’s most visible evangelical advisers.

Republican operatives are starting to circulate a rumor that Typhoid Mary may find an excuse to not run for reelection

How Many Americans Will Needlessly Die Of COVID Because Of Trump's Incompetence And Sociopathic Nature?

Bret Stephens has a long career as a conservative opinion writer, formerly at the Wall Street Journal and Jerusalem Post (as editor-in-chief) and currently at the NY Times. He's also a crackpot Zionist, a racist, a neo-con, a Climate Change denier, a Pulitzer winner and a prominent #NeverTrump Republicano. In yesterday's column, Donald Trump Is Our National Catastrophe, Stephens wrote about a class he taught about heart of political persuasion, using as examples of practitioners Abraham Lincoln, Pericles, Martin Luther King, George Orwell, Václav Havel, Winston Churchill and Señor Trumpanzee-- or at least the Twitter account of Señor T's. "We are, he wrote, "in the midst of an unprecedented national catastrophe. The catastrophe is not the pandemic, or an economic depression, or killer cops, or looted cities, or racial inequities. These are all too precedented. What’s unprecedented is that never before have we been led by a man who so completely inverts the spirit of Lincoln’s Second Inaugural Address. With malice toward all; with charity for none: eight words that encapsulate everything this president is, does and stands for... [G]reat political writing aims to elevate. What, by contrast, does one learn by studying Trump’s utterances?"

The purpose of Trump’s presidency is to debase, first by debasing the currency of speech. It’s why he refuses to hire reasonably competent speechwriters to craft reasonably competent speeches. It’s why his communication team has been filled by people like Dan Scavino and Stephanie Grisham and Sarah Sanders.

And it’s why Twitter is his preferred medium of communication. It is speech designed for provocations and put-downs; for making supporters feel smug; for making opponents seethe; for reducing national discourse to the level of grunts and counter-grunts.

That’s a level that suits Trump because it’s the level at which he excels. Anyone who studies Trump’s tweets carefully must come away impressed by the way he has mastered the demagogic arts. He doesn’t lead his base, as most politicians do. He personifies it. He speaks to his followers as if he were them. He cultivates their resentments, demonizes their opponents, validates their hatreds. He glorifies himself so they may bask in the reflection.

Whatever this has achieved for him, or them, it’s a calamity for us. At a moment when disease has left more than 100,000 American families bereft, we have a president incapable of expressing the nation’s heartbreak. At a moment of the most bitter racial grief since the 1960s, we have a president who has bankrupted the moral capital of the office he holds.

...Trump is responsible for the nation’s wounds. It’s that he is the reason some of those wounds have festered and why none of them can heal, at least for as long as he remains in office. Until we have a president who can say, as Lincoln did in his first inaugural, “We are not enemies, but friends”-- and be believed in the bargain-- our national agony will only grow worse.

And it isn't just Trump's words that are making literally everything worse. His dysfunctional, chaotic and incompetent, venal regime is a colossal failure. The nightmarish coronavirus pandemic is global and wasn't started by Trump. The fact that it is far worse in the U.S. than anywhere else on earth is the fault of Trump, his regime and his Republican Party lickspittles.

I Can't Breathe by Nancy Ohanian

This afternoon we crossed the two million confirmed cases mark in our country. It didn't have to be this way. Even as new case rates start to slow down in states that were hit hard early on-- New York, Washington, New Jersey, Michigan, Louisiana, Massachusetts, Connecticut, Rhode Island, Delaware, other states-- particularly states with governors who emulate Trump, like Greg Abbott (Texas), Ron DeSantis (Florida), Brian Kemp (Georgia), Henry McMaster (South Carolina), Kim Reynolds (Iowa), Doug Ducey (Arizona), Pete Ricketts (Nebraska), Chris Sununu (New Hampshire), Mike Parson (Missouri)-- are watching their own cases numbers accelerate dangerously. States that we're part of the early first wave but where bad policy decisions are fueling severe outbreaks see rapidly growing cases per million today:

• Nebraska- 8,082 cases per million
• Iowa- 6,867
• South Dakota- 6,147
• Virginia- 5,938
• Mississippi- 5,803
• Colorado- 4,862
• Georgia- 4,888
• New Mexico- 4,264
• Alabama- 4,181
• Tennessee- 3,863
• New Hampshire- 3,691
• North Dakota- 3,754
• Utah- 3,764
• Arizona- 3,694
• California- 3,331
• Nevada- 3,133
• Arkansas- 3,123
• Florida- 2,977
• South Carolina- 2,775
• Texas- 2,613
• Missouri- 2,455

Friday, Guardian writer Michael Safi looked into what the contours of Wave II are likely to look like-- warning ominously that "the pandemic’s future will be decided by human action and several unanswered questions about the nature of the virus." Some countries see their curves flatten significantly-- Spain, Italy, Germany, France, Belgium, South Korea, Holland, Iceland, Switzerland, Israel, Japan, Austria, Denmark, Czechia, Australia, Finland, Cuba, New Zealand, Hong Kong-- while others, notably the U.S., India, the UK, Russia, Peru, Mexico, the Gulf states, Pakistan, south Africa and Egypt, are still going in the wrong direction. "The future shape of the pandemic," Safi wrote, will be decided both by human action, in the form of social distancing, testing and other traditional methods of disease control, but also several unanswered questions about the nature of the virus itself. Experts say there are several possibilities."

One is that the virus breaks out and is suppressed in peaks and troughs, until enough of the population is vaccinated or potentially develops immunity.

Antibody tests in most places indicate that quarantine measures were very effective in slowing down the virus. Fewer than 10% of populations in France, Spain and Sweden have developed the antibodies that would be evidence of having caught the virus and, in theory, becoming immune, for at least a short time.

But that also means the vast majority of populations remain susceptible.

If societies reopen before the virus is sufficiently eradicated, it may be that this first wave does not completely go away, says Angela Rasmussen, a virologist at Columbia University.

“In the US, we are lifting lockdowns when there are still increasing numbers of cases in a bunch of states … We may just have peaks and valleys of transmission occurring over and over again as people’s behaviour changes,” she says.

The scale of these peaks could be reduced by making changes such as wearing masks, using public transport in a staggered way and avoiding overcrowded social events-- which are increasingly being blamed for being “super-spreaders” of the first wave of the coronavirus.

If outbreaks grow too large, some governments might choose to reimplement quarantines. “If we’re reopening and we start to see case numbers growing rapidly in a few weeks, we may see rolling lockdowns or shutdowns to try to control the virus in those areas,” Rasmussen says.

...Social distancing and robust testing-- or a lack of it-- will be critical in deciding the future of the pandemic. But its shape will also be influenced by factors outside our control.

The first is whether we can become immune to the virus, and if so, how long that protection endures for.

Sometimes immunity can last for decades. During the 2009 swine flu pandemic, public health authorities were initially confused as to why many older people seemed to be immune. Later, they discovered the virus was structurally similar to one that circulated during the 1918 pandemic. The immune systems of many older people had dealt with a similar virus 92 years ago.

Resistance to some earlier discovered coronaviruses has been thought to fade within a year. If immunity to Sars-CoV-2 is not permanent, a report from Harvard epidemiologists says it is likely to enter into regular circulation, coming in annual or biennial waves or sporadic outbursts.

The frequency of significant outbreaks may also be influenced by the weather. Most influenzas spread more easily in the winter because the virus is thought to prefer dry air over humidity, and because people in cold environments spend more time indoors and close to each other.

Existing coronaviruses also follow seasonal patterns. If this coronavirus behaves in the same way-- and there is not yet strong evidence that it does-- we could see regular wintertime surges of Covid-19.

But with so many people still apparently not immune to the virus, that summer relief may not arrive this year, says James Hay, a postdoctoral research fellow at Harvard’s Chan School of Public Health.

“The factor that most contributes towards transmission is how many people are still susceptible,” he says. “And with so many still susceptible, that’s going to swamp out any climate effect.”

Significant mutations in the virus might also lead to a wave of new infections down the track. So far, scientists say that isn’t a huge concern.

“Even though there are different genomes out there that have changes compared to each other … there’s no evidence any of those changes are in spots that are critical for the immune system to recognise,” Rasmussen says.

But that doesn’t mean we won’t see a significant mutation later. “We’ve only known about this for six months, so it’s possible different strains could emerge in the future, because it does have a higher mutation rate,” she says. “But right now there’s no evidence that that’s happening.”

For countries that are able to implement highly effective interventions such as testing and contact tracing, this first wave of coronavirus cases may be the last they experience, at least for some time.

In New Zealand, which has managed to virtually eradicate the virus and installed robust systems to monitor new outbreaks, there may be no significant new outbreaks or future waves at all, says Nick Wilson, a professor of public health at the University of Otago.

“New Zealand is about to eliminate this virus,” Wilson says. “Even if there are border control failures, I expect that the contact tracing system is now good enough to control an occasional outbreak. So this country should be able to avoid future waves until a vaccine arrives.”

Countries with small populations and isolated geography such as New Zealand and Australia may be able to pull this off. South Korea is another country whose virus detection and suppression systems may be advanced enough to smother any future outbreaks. But it will be extremely difficult for most countries, especially those with large populations and porous borders.

Compared To Trump, Even The Worst Governors Look Relatively Competent To Many People

COVID-pallooza by Chip Proser

This morning, the Washington Post reported that 49 of 50 governors have better coronavirus poll numbers than Trump. If you've been reading DWT even semi-regularly, you could have guessed that. Aaron Blake wrote that Señor Trumpanzee tried taking credit for governors' high ratings, despite the fact that their ratings are all high because voters are contrasting them to him! Some of these governors are actually doing a horrendous job on responding to the pandemic but still look good compared to Trump! Blake noted that last week, the repulsive, murderous Orange Blob "responded to governors' positive coronavirus poll numbers by citing his own federal government's help. 'Remember this,' Trump tweeted, 'every Governor who has sky high approval on their handling of the Coronavirus, and I am happy for them all, could in no way have gotten those numbers, or had that success, without me and the Federal Governments help.' Americans, though, don't seem to be crediting Trump nearly as much as he would like."

New polling data from SurveyMonkey, which were shared with the Washington Post, show that fully 49 of 50 governors have significantly higher approval ratings for their coronavirus responses than Trump does in recent polls. A Washington Post-Ipsos poll last week showed 43 percent of Americans approved of Trump's handling of the outbreak.

The one governor on Trump's level is Georgia Republican Gov. Brian Kemp, whose efforts to reopen his state have proved controversial. In The Post-Ipsos poll, Kemp's approval rating was 39 percent; in the new one, it's a similar 43 percent-- the same as Trump's.

COVID-Kemp

...The data show Democratic governors with an average coronavirus approval rating of 70 percent, while Republican governors are lower, at 63 percent.

But interestingly, most of the highest and lowest approval ratings belong to Republicans.

Among the highest are a trio of moderate Republicans who have distanced themselves from Trump-- Maryland Gov. Larry Hogan at 85 percent, Vermont Gov. Phil Scott at 82 percent, and Massachusetts Gov. Charlie Baker at 82 percent. They occupy three of the top five slots, and six of the top seven are Republicans.

On the other end of the scale, though, are many of their fellow GOPers. Of the 11 governors with the lowest approval ratings on coronavirus, nine are Republicans.

Along with Kemp, they including Florida Gov. Ron DeSantis and Texas Gov. Greg Abbott at 58 percent. Both governors have pushed forward with among the most aggressive reopening plans.

Also among the 11 at the lowest end are four Republican governors of Midwestern states-- Iowa's Kim Reynolds, South Dakota's Kristi Noem, Missouri's Mike Parson and Nebraska's Pete Ricketts-- all at 58 percent. All were among the latest holdouts on issuing statewide stay-at-home orders or were among the few to never issue them at all.

People living in the Wave II states that are starting to get wallopped because of their governors' bad decisions seem aware of who the authors of their misery are. New cases in Wave I hot-spots like New York, Massachusetts, New Jersey, Washington and Louisiana are falling dramatically, while new cases are rising dramatically in states where, in most cases, governors have refused to allow science to play a significant role in their responses to the pandemic. These Wave II states are listed in order of cases per million as of yesterday:

• Nebraska- 5,493 (Now worse off than Michigan and Pennsylvania)
• Iowa- 4,781
• South Dakota- 4,552
• Indiana- 4,197
• Colorado- 3,855
• Mississippi- 3,841
• Virginia- 3,766
• Georgia- 3,638
• New Mexico- 2,907
• Minnesota- 2,903 (thanks Kristi Noem)
• Tennessee- 2,637
• North Dakota- 2,534 (thanks Krist Noem)
• Ohio- 2,437
• Utah- 2,303
• Nevada- 2,242
• Wisconsin- 2,179 (genocidal state legislature enabled by Supreme Court)
• Florida- 2,162
• California- 2,068 (weak governor afraid to stand up to extremists)
• Arizona- 1,947
• Missouri- 1,825
• South Carolina- 1,737
• Texas- 1,713

Why Is Everyone Picking On Dr. Trump?

It wouldn't have surprised me at all to hear that thousands of Trump's moron followers in Wyoming, Mississippi, the Dakotas and South Carolina we ingesting household cleaners. But, remember, even in the bluest states, there are pockets of gross ignorance and Trumpism. Friday, the New Oak Daily News reported "an unusually high number of New Yorkers contacted city health authorities over fears that they had ingested bleach or other household cleaners in the 18 hours that followed President Trump’s bogus claim that injecting such products could cure coronavirus. The Poison Control Center, a subagency of the city’s Health Department, managed a total of 30 cases of possible exposure to disinfectants between 9 p.m. Thursday and 3 p.m. Friday." 9 people ingested Lysol, 10 drank bleach and 11 just reported taking household cleaners in general. As of Friday evening there had been no known fatalities.

More worrying was a report in the NY Times by Ellen Gabler and Michael Keller that prescriptions surged as Trump praised his pet drugs. Prescriptions have to be written by legitimate doctors. On March 19, when Trump first started hyping chloroquine and hydroxychloroquine first-time prescriptions for the drugs "poured into retail pharmacies at more than 46 times the rate of the average weekday... And the nearly 32,000 prescriptions came from across the spectrum-- rheumatologists, cardiologists, dermatologists, psychiatrists and even podiatrists, the data shows.

You would think doctors would have refused prescribing drugs to patients who had neither lumpus nor malaria... but thousands of them didn't. After Señor Trumpanzee's idiotic, dangerous and baseless remarks last month, pharmacies everywhere in the country-- not just red states-- "reported a run on the drugs, which are mostly prescribed by a small subset of medical specialists. Within days, states began issuing emergency orders to restrict the new prescriptions." That's scary.

A new poll released by the Associated Press late last week, shows that just 23% of Americans say they find Trump a trusted source of information about coronavirus. Only 7% of Democrats and 12% of independents trust what he says about the pandemic. Even among admitted Republicans, only 47% are willing to say they trust his information.

Gabler and Keller continued that "While medical experts have since stepped up warnings about the drugs’ possibly dangerous side effects, they were still being prescribed at more than six times the normal rate during the second week of April, the analysis shows. All the while, Mr. Trump continued to extol their use. 'It’s having some very good results, I’ll tell you,' he said in a White House briefing on April 13." That was a lie.

The extraordinary change in prescribing patterns reflects, at least in part, the outsize reach of the Trump megaphone, even when his pronouncements distort scientific evidence or run counter to the recommendations of experts in his own administration. It also offers the clearest evidence yet of the perils of a president willing to push unproven and potentially dangerous remedies to a public desperate for relief from the pandemic.

On Friday, the Food and Drug Administration warned against using the drugs outside a hospital setting or clinical trial because they could lead to serious heart rhythm problems in some coronavirus patients. Days earlier, the federal agency led by Dr. Anthony S. Fauci-- one of Mr. Trump’s top advisers on the pandemic-- issued cautionary advice on the drugs, and stated that there was no proven medication to treat the virus.

As the prescriptions surged in the second half of March, the largest volumes per capita included states hit hardest by coronavirus, like New York and New Jersey. Georgia, Arkansas and Kentucky were other states with relatively high per-capita figures. In absolute numbers, California and Washington, the earliest-hit states, were among the largest. The biggest number in either category was in Florida, where nearly one prescription was written for every thousand residents.

Carmen Catizone, executive director of the National Association of Boards of Pharmacy, said the surge created shortages that “put patients at risk who depend on these medications” to treat other illnesses.

“The fact that people reacted to what the White House said in such a way-- in the 35 years I’ve been in pharmacy and pharmacy regulation, I’ve never seen that before,” he said.

More than 40,000 health care professionals were first-time prescribers of the drugs in March, according to the data, which is anonymized and based on insurance claims filed for about 300 million patients in the United States, representing approximately 90 percent of the country’s population. The data is current through April 14.

Mike Donnelly, vice president of communications for the Lupus Foundation of America, said that the organization received calls and emails daily from patients who were told their prescription could be filled only in part or not at all. A spokesman for the Arthritis Foundation said some patients received their refills only after calling around to as many as a dozen pharmacies.

In the past month, about 40 states have intervened in some manner to quell the frenzy.

Idaho was the first to take a hard line, issuing a temporary rule on the same day that Mr. Trump first mentioned the drugs in his daily briefing. The rule banned pharmacists from dispensing chloroquine and hydroxychloroquine unless the prescription included a written diagnosis of a condition that the drugs had been proved to treat. The rule also limited prescriptions to a 14-day supply unless a patient had previously taken the medication.

The director of Idaho’s State Board of Pharmacy said at the time that many of the prescriptions were being written by doctors for themselves and their family members, a trend reported by other state boards as well.

Some of those writing prescriptions for themselves may have been on the front lines treating patients; the data shows an uptick among health care practitioners working in emergency medicine. More broadly, the analysis indicates a major shift in the kinds of medical practitioners writing the prescriptions, based on prescribing patterns in retail pharmacies since 2016.

Historically, the majority of chloroquine and hydroxychloroquine prescriptions have come out of a narrow band of specialties like rheumatology. That changed last month, when the specialties reflected in the data included larger numbers of those working in dermatology, ophthalmology, podiatry, urology and other areas.

...Trump soon extended his interest to a combination of one of those drugs, hydroxychloroquine, with an antibiotic, azithromycin.

“HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine,” he wrote in a post to Twitter around 10 a.m. on March 21, a Saturday.

The tweet coincided with a weekend flood of prescriptions for the two antimalarial drugs. By the end of the day, the prescriptions had increased 114 times at retail pharmacies compared with the average weekend day, according to The Times analysis.

On Tuesday, the National Institute of Allergy and Infectious Diseases, led by Dr. Fauci, issued guidelines against the combination of hydroxychloroquine and azithromycin except in clinical trials, with experts citing "the potential for toxicities."

Enthusiasm for the drugs has been waning over the past couple weeks, including at Mr. Trump’s own news conferences and among researchers.

A small trial in Brazil of chloroquine was halted after coronavirus patients taking higher doses developed irregular heart rates that increased their risk of a potentially fatal heart arrhythmia. A study of 368 patients in U.S. veterans hospitals found that hydroxychloroquine was associated with an increased death rate; the drug, used with or without the antibiotic azithromycin, also did not help patients avoid the need for ventilators. (The veterans study was not a controlled trial, and neither study has been peer-reviewed.)

Mr. Trump was asked about the veterans study at his briefing on Tuesday.

“Obviously, there have been some very good reports and perhaps this one is not a good report,” he said.

By Thursday, Mr. Trump had moved on to a different subject, raising a question at his White House briefing about the use of disinfectants to kill the coronavirus inside the body. The remarks were followed by dire warnings from state health officials, who were inundated with requests for information about such a course of action. The president’s press secretary tried to make the case the comments were taken out of context by the news media, and Mr. Trump later insisted he had only been kidding.

Poor Dr. Birx; Trump says he wasn't even talking to her... but... but... this video from RepublicansForThe RuleOfLaw.com looks like they have made Dr. Birx look like Trump was talking with her-- and like she wanted to inject him Drano.

Flatten The Curve

OK... What Now? by Nancy Ohanian

In Paris, the Louvre and the Eiffel Tower are now closed to the public. In Orange County, the Richard Nixon Library in Yorba Linda, where elderly people line up to spit or piss on his grave, has announced they will be closing down for the duration of the pandemic.

My most recent favorite restaurant in L.A. is Avra, a seafood restaurant with a distinctly Greek flair. But it is so expensive that I tend not to go there unless someone on a corporate credit card invites me. And this week someone did, someone I liked and was looking forward to get together with as well. But no matter how many times I told myself that the tables are pretty far from each other-- especially in the back room where I always sit-- it's still a restaurant and I'm not eating in restaurants any for the duration. So I called my friend and begged off. I made a delicious 5-bean soup instead-- nutritious, easy and totally yummy.

Starting dinner-time yesterday, according to New York Eater, Cuomo and de Blasio ordered that "all venues in the state seating 500 people or less will need to reduce capacity by 50 percent-- including restaurants and bars." That is something every state should do... if the venue has a capacity of 100 or less. What if a restaurant holds 400 people; why should they be allowed to serve 200 when a smaller restaurant serving 80 people is forced to serve just 40? Better though, a step in the right direction: "Events for more than 500 people have been completely banned." All Broadway shows are also shutting down.

Businesses in New York state that refuse to comply, will be shut down entirely.

I was happy to see Los Angeles and San Diego-- under pressure from unions and despite a lackadaisical attitude from California's corporate governor-- order the closure of all public schools in the two cities. The closure is supposedly for 2 weeks, but there is no indication that two weeks from now could be far worse.

So far 7 states (+DC) have also announced public school closures: West Virginia, Virginia, Maryland, New Mexico, Oregon, Michigan and Ohio. Other states, like Washington, have partial shutdowns, and Kentucky has a recommendation to school districts to shut down. The mainstream media-- including The Post insinuating children are immune to COVID-19, which is a claim derived from faulty Chinese data. Children are contracting the disease and are dying, though not at the rate as the elderly.

Ohio’s governor said Thursday that all of the state’s public and private schools would close for three weeks or more... “We are going to do what we have to do. We are in a crisis,” Ohio Gov. Mike DeWine (R) said. Closures in Ohio will begin at the close of classes Monday and run through at least April 3, DeWine said. “It may be a lot longer.” ... The U.S. Education Department responded to the growing number of closures with new guidance, easing some rules around testing requirements and clarifying responsibility for educating students with disabilities via remote instruction. Ohio was the first state to make the move, in part because the Director of the Ohio Department of Health, Amy Acton, said she believes roughly 1% of the state's population is believed to already be carrying the virus. That's a very conservative estimate but it equates to over 100,000 people.

Few Republicans are as conscientious about the pandemic as the Ohioans. Tom Dadey is a well-known facts-free Trump toady in Syracuse, New York, where he is chairman of the Onondaga County Republican Party. His twitter feed hasn't caught up with Trump's national emergency yet and as of Friday he was still pretending that the pandemic is no big deal.

A friend sent me a read out from a March 10th UCSF panel on COVID-19 hosted by Dr. Jordan Shlain that's worth reading, especially if you've missed the Chris Martenson video-blogs we've been posting everyday for about a month. The panelists were Joe DeRisi, UCSF’s top infectious disease researcher and co-inventor of the chip used in SARS epidemic, Emily Crawford, COVID task force director, Cristina Tato, Rapid Response Director and immunologist, Patrick Ayescue, leading outbreak response and surveillance epidemiologist, and Chaz Langelier, UCSF Infectious Disease doctor.

Top takeaways

At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.

Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve," to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.

How many in the community already have the virus? No one knows.

We are moving from containment to care.

We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.

40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.

[We used their numbers to work out a guesstimate of deaths-- indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]

The fatality rate is in the range of 10X flu.

This assumes no drug is found effective and made available.

The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%

Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did.

I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.

What should we do now? What are you doing for your family?

Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).

How long does the virus last?

On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this.

The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.

Avoid concerts, movies, crowded places.

We have cancelled business travel.

Do the basic hygiene, eg hand washing and avoiding touching face.

Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.

Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.

Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.

We would say “Anyone over 60 stay at home unless it’s critical.” CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.

We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.

Three routes of infection:

• Hand to mouth / face
• Aerosol transmission
• Fecal oral route

What if someone is sick?

If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.

If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.

There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.

If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines.

Why is the fatality rate much higher for older adults?

• Your immune system declines past age 50
• Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
• Risk of pneumonia is higher in older adults.

What about testing to know if someone has COVID-19?

Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.

Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating.”

A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.

The PCR test requires kits with reagents and requires clinical labs to process the kits.

While the kits are becoming available, the lab capacity is not growing.

The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.

Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.

UCSF and UC Berkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.

Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.

How well is society preparing for the impact?

Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.

If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.

School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.

Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.

What will we do to handle behavior changes that can last for months?

Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.

Kids home due to school closures

...Where do you find reliable news?

The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email.

The New York Times is good on scientific accuracy.

Observations on China

Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.

While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.

Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.

Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.

Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicine’s great triumph over infectious disease?

"We’ve been in a back and forth battle against viruses for a million years."

But it would sure help if every country would shut down their wet markets.

As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.

The Dos and Don’ts of ‘Social Distancing’ was carried by The Atlantic yesterday-- "Experts weigh in on whether you should cancel your dates, dinner parties, and gym sessions," by Kaitlyn Tiffany.

Because of so much bad information floating around-- some of it from imbeciles like Trump, Fox, congressional Republicans and Dr. Drew and some from usually trusted sources-- she took questions to a series of public-health experts-- Carolyn Cannuscio, the director of research at the Center for Public Health Initiatives at the University of Pennsylvania, Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, and Albert Ko, the chair of the epidemiology department at the Yale School of Public Health. "If you’re confused about what to do right now," she wrote, "you’re not alone-- even these experts occasionally disagreed on the answers to my questions... There is a general consensus that while young and healthy people who are at lower risk for personally suffering severe illness from the coronavirus don’t have to be locking themselves in their homes for the next month, they do need to dramatically alter their daily lives, starting now."

If I’m Symptom-Free:

Should I Be Avoiding Bars And Restaurants?

Cannuscio: People should avoid gathering in public places. People should be at home as much as possible. The measures that have worked to get transmission under control or at least to bend the curve, in China and South Korea, have been extreme measures to increase social distancing.

Watson: It depends on local context. If we’re in a situation where the disease has been shown to be spreading widely, I think people will start to want to stay home and not go out into crowded settings.

Albert Ko: If you go to a crowded bar where you’re up one against another, that’s a lot different from going to a bar where you’re spread out. The CDC recommendations are to keep six to 10 feet away from other people. Bottom line, there’s no absolute indication not to go to bars and restaurants, but in practicing good public health-- which is kind of a responsibility for everybody in the country-- really think about how we can decrease those close contacts.

Can I have a small group of friends over to my house for a dinner party or a board-game night?

Watson: I think small gatherings are probably okay as long as nobody has symptoms, respiratory symptoms. As soon as someone seems sick, you should probably not get together.

Ko: We’re in a gray zone now. The public-health imperative is to create social distance; that’s the only way we’re going to stop this. Think about having those get-togethers but practicing good public health: not sitting very close, trying to keep distance. Wash your hands; avoid touching your face. There are places on the board game that people are constantly touching-- routinely disinfect [those, as well as] doorknobs, the bathroom faucets, those types of things. There’s no absolute rule about what works, but what we do know is that decreasing the size of those gatherings, increasing the distance, practicing good hygiene will go a long way.

Cannuscio: I would recommend that people minimize social contact, and that means limiting all social engagements. That includes intimate gatherings among friends. I think the exception is if two households are in strict agreement that they are also going to reduce all outside contact and then those two households socialize together, to support one another. I can see social and mental-health advantages to that kind of approach.

Should I stop dating?

Ko: Dating is usually one person and another person. What we’re really worried about in terms of public health are these large gatherings where you have people crowded together, and you can have what we call super-spreading events. The risk of those goes up exponentially the larger the size of the gathering. Dating is at the other end. I think you can still date.

Watson: I think dating is okay, if you believe with reasonable confidence that you’re both well. I think we’re humans and we need human interaction; I think that’s important for our sanity. It’s important to focus on [avoiding] large crowds and indoor activities where you have lots of people touching the same surfaces.

Cannuscio: It is a time to be very cautious about initiating contact with new people. This seems like a great time to get creative with your text messages. [Or] take it to FaceTime or a phone call.

Can I go to the gym?

Ko: If you do go to the gym, again, maintain distances. Disinfect places in the gym people are always touching. Wash your hands regularly. Much of the transmission is person to person with people coughing, sneezing, or touching their nose and mouth and touching somebody else. You can get transmission on surfaces; that’s probably a little bit lower-risk, but we still should disinfect surfaces that we touch.

Cannuscio: If you’re going to go to the gym, try to go at a time when there are very few people there and definitely wipe down the equipment. However, as the weather warms in many parts of the United States, I would instead recommend that people go outside for walks or runs or bike rides in areas where there are not other people. This is really about depriving the virus the opportunity to move from one person to another.

Should I be worried about going to the grocery store?

Cannuscio: I would say try to shop at times when there are very few other shoppers there. That [could mean] going first thing in the morning when the store opens, or late at night. I think many people will rely on delivery, and that’s just the nature of our lives right now. For delivery workers, I would say, leave the food on the doorstep and ring the bell, rather than interacting face-to-face with the person who’s ordered the food.

Should I take public transportation?

Cannuscio: First of all, people who have the opportunity or the option of working at home should absolutely use that option right now. For people who have essential functions and have to be at work, if they have any flexibility in their schedules they should try to ride at non-peak hours. On subways or buses, people should try to stand as far away from other people as possible. I think it’s important for planners to think about, for example, putting more buses on the most heavily traveled routes, to maybe thin out the crowds on those buses. In cities where it’s possible to walk, that would be a better option.

For people who can afford to use ride-sharing services, you’re limiting the number of people you’re in contact with as the rider, so to me that seems like a reasonable step to take. Of course, I worry about all those drivers who have people in and out of their cars all day long.

And of course, everyone should be using good hand hygiene and respiratory etiquette. If you have to cough, cough into your elbow. And I can’t believe I have to say this, but I’ve been in public places where people have been spitting, in parks or on the sidewalk. I would ask people not to spit!

Watson: It’s hard to say “Don’t take public transit,” because a lot of people rely on it to get to work. If you don’t have to and you can drive, it’s probably a good idea. It will help other people who have to take public transit for their livelihoods to do so and do so more safely.

Should my family be canceling events like birthday parties AND weddings?

Watson: It’s hard to ask everyone if they’re feeling sick and harder to know what their exposures have been. I would take a look at who is invited to the party. Are there people who are very vulnerable? Older people, people who have underlying health conditions, pregnant women? If that’s the case, I would err on the side of caution. I don’t want to tell somebody to cancel their wedding. That would be terrible. But I think you have to look at the situation, maybe ask guests who are feeling ill not to come. If it’s being held in a community where there’s widespread disease, then it might be worth [reconsidering the event].

Ko: If those events can be postponed, I think that’s certainly productive. If a wedding can’t be postponed, there are things you can do. Hold it in an open space, where people are spread apart. You have to be really careful about exposures and really practice social distancing from the elderly.

Cannuscio: One of the best ways we can show love to the people we care about is to step back and to stay away. In many cases that takes courage, and it takes speaking out over these social norms that dictate that we should be polite and we should be together and we should celebrate and gather. Really seriously consider whether now is a joyful time to gather family members for a wedding celebration.

Should I stop visiting elderly relatives?

Watson: I think we should start limiting visitation to people who are in assisted-living facilities and nursing homes. I know that’s really tough, and maybe setting things up so you can visit them virtually is a good idea. [That way], they can see you and say hello, [without putting] them at extra risk.

Cannuscio: I think if we are fortunate enough to live near our elders and we get into the mode of seriously isolating our own families, then one person should be designated to go and visit. If we’re not in a situation where we can truly limit our own social contact, then we will be putting that elder at risk by going to visit.

Should I be canceling haircuts and other nonessential appointments?

Watson: Those are more one-on-one interactions. I think there’s a lower likelihood that exposure is going to occur that way. I don’t think that’s a big concern.

Cannuscio: I would say hold off on your haircut and then when you go back, when it’s clear that we have vanquished this foe, everybody please give your hairdresser extra, extra tips. I hope that policies will be put into place to protect the paychecks of people who will suffer during this period.

Should I avoid communal spaces in my apartment building?

Cannuscio: Try to schedule your use of those common spaces so you’re going at times when other people aren’t around. If you know there are not a lot of people in the laundry room or mailroom at 6 a.m., go at 6 a.m. People will be inconvenienced, but it’s important to try to spread ourselves out.

Should I limit physical interaction with my partner, or other people I live with?

Ko: That’s really hard to do. Again, what we’re really worried about is large gatherings. In the home, close contact is almost inevitable.

Cannuscio: I would say if you’re in a steady, monogamous relationship and you and that other person are limiting your social contacts, then be as intimate as you want to be.

Watson: If you get sick, try to maintain some distance. Otherwise, households should go about their normal business.

If I Get Symptoms or Am Exposed to Someone Who’s Sick:

If I am waiting out a 14-day quarantine, can I have visitors as long as they stand far away from me?

Cannuscio: No, quarantine means “stay away from other people.” You shouldn’t have visitors.

Ko: Under quarantine, people really shouldn’t enter the home or be in the same physical space.


Can I walk around outside at all when I’m under quarantine?

Cannuscio: For people who live in areas that are not densely populated, walking around in their yard is probably safe. The idea is that they should not come into contact with any other people. They need to be strict about it. We are not going to defeat this and halt transmission if people loosely interpret what it means to self-quarantine or self-isolate.