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Get Real

Since this is going to be a post about the coronavirus, let’s start off with this PSA: wash your hands. These viruses have a lipid envelope that is crucial to their structure and function, and soaps and detergents are thus very effective at inactivating them. It’s fast, it’s simple, and it’s one of the more useful things that any individual can do under these conditions.

OK, either tomorrow or Friday I hope to do a post on all the things that are going on in the biopharma industry for a possible coronavirus treatment. But this morning I need to talk about what’s *not* happening. What’s not happening is the advent of any drug, vaccine, antibody or anything else in time to keep this epidemic from becoming a very big problem. That’s because it is already a very big problem, and because there is no way that we’re able to get anything pharmacological off the ground fast enough to keep it from getting even bigger.

And “getting even bigger” is very likely what’s going on right now. Not that we know much, because the US has been very slow in testing patients, for a number of reasons that do no credit to anyone involved. Here is the situation as of March 2 (see table at right). Note especially the “tests per million people” column, and also note the asterisk next to the US number. That’s because that pitifully small number is actually as of March 1, and that in turn is because as of March 2 this statistic was removed from the CDC’s web site. The agency says “Now that states are testing and reporting their own results, CDC’s numbers are not representative all of testing being done nationwide” and fair enough, but perhaps as a national center focusing on disease control they could track and aggregate such numbers? As the other countries on that list have managed to do? Update: President Trump now seems to have fixed the blame for the low US testing rate on the Obama administration. So that’s all sorted out.

The US numbers for testing, then, are extremely low and now obscure. The US numbers for total people infected are also not anywhere near reality, as became obvious this past weekend, when the sequence of the virus from the second US fatality was sequenced. It was clearly related to the virus from the first case (reported on January 19 in the same county in Washington state), descended from it in a way that makes it almost certain that the coronavirus has been spreading undetected among that population for weeks. As Trevor Bedford (Fred Hutchison center) of the team doing this work said on Twitter, “I believe we’re facing an already substantial outbreak in Washington State that was not detected until now due to narrow case definition requiring direct travel to China“. There are now at least two separate transmission chains in the Seattle area, and Bedford himself told Stat that “January 1 in Wuhan was March 1 in Seattle”. It’s hard to say he’s wrong. And remember, 11 other states (as of yesterday) are reporting cases.

Meanwhile, as anyone who knows anything about drug or vaccine or antibody development knows, we are many months away from the quickest possible proven intervention (more on this in the promised post). No amount of rah-rah is going to affect that, but unfortunately that’s what we’re getting from a lot of people who should know better. One of those people is HHS Secretary Azar. Yesterday here he was in front of the cameras. I quote his exact words:

“. . .got to hear from actual bench scientists, who within three days – within three days – developed a potential vaccine for the novel coronavirus, and they reported some really important news to the President. That yesterday the Food and Drug Administration authorized the entry of that vaccine into Phase I safety clinical trials. . .”

Azar really leaned on the “within three days” part, but that is of course the least of everything involved. The previous work on coronaviruses (such as SARS) and the use of modern sequencing technology immediately suggests “potential” vaccines in this case, which is great, but it’s not anything like a rate-limiting step. Making a big deal out of that is misdirection and public relations. The director of the FDA’s CBER has already said (correctly) that “The development of a vaccine is not going to prevent a pandemic here“. That is the truth, and we’d better be ready to deal with it and act accordingly. In case anyone thinks I’m just a disgruntled political opponent of the current administration, keep in mind that I have over the lifetime of this blog ripped into previous FDA commissioners, Democratic and Republican officeholders, foreign government officials, and more biopharma spokespeople and press releases than I care to count for just this sort of overpromising. Hype is hype.

But the entire summit meeting with President Trump and other officials with the drug industry on Monday was surreal. No one expects the president – any president – to understand drug and vaccine development. It’s not their job. But here come some politics: Trump hardly understands any subjects whatsoever, while at the same time claiming vast areas of expertise. The entire meeting featured him misunderstanding (again and again) what people were trying to tell him, that it was going to be months and months and months (at best) before a vaccine of any sort could be tentatively said to maybe exist, much less be ready to deploy in a large population. Read that last link; it sums it up better than I can. Every time you think something is getting through to Trump on this subject, it turns out that no, it didn’t take. Anthony Fauci of the National Institutes of Allergy and Infectious Disease is an extremely competent and accomplished immunologist and his expertise in virology (through his work with HIV), epidemiology, and public health issues is very substantial indeed. But we are putting his talents to work by having him attempt, over and over, to drive what should be simple concepts through the president’s skull.

This administration has demonstrated again and again that it just wants this whole epidemic to go away. Fine, so does everyone else. But that’s not going to happen. The odds are very high that we are going to see a substantial increase in coronavirus cases as we come to terms with the fact that it is now and has been spreading through the US population. Wishing that this were not the case is a foolish, dangerous waste of time. We need straight talk on this from the highest levels of the government, and we need the people with expertise to be able to speak their minds as they see fit. I know that Richard Feynman’s quote from his appendix to the Challenger disaster gets trotted out a lot, but when has it applied more than now:

For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.

116 comments on “Get Real”

  1. Vader says:

    It is a characteristic of almost all politicians, from across the political spectrum, to engage in magical thinking. And by magical thinking I mean the believe that, if there is enough political will behind it, miracles can happen.

    1. zero says:

      That’s exactly how change happens. The trick is to suspend disbelief in social change without also abandoning science. It helps to be ruled by something other than greed and hate, too.

      1. NoNotAllPoliticiansDoItTroll says:

        simply. not. true.

        1. Vader says:

          T’aint just politicians who love magical thinking.

    2. James Millar says:

      Magical talking. I’m pretty sure the actual thinking is a lot more pragmatic in most cases.

    3. Anne C says:

      They speak magically because there are many stupid people that want to believe in magic. That doesn’t excuse politicians, but they wouldn’t speak in magic if nobody listened.

    4. Daniel Jones says:

      Not just politicians. I recall the mind-jobbed but still demonstrably intelligent Dr. Wallace Breen of Half-Life 2 infamy trying to advise against magical thinking on the part of citizens. Yes, he was coming at it from an extreme viewpoint in his own right but the character was still correct about people suspending disbelief and critical thinking.

      People do that. It almost never works. Planning for a good result does not require suspension of doubt but openness of mind and scrutiny to ensure any progress seen was actually progress made.

  2. ChairmanMao says:

    Id be curious into a more scientific understanding of the test for coronavirus itself- the what, who, where aspects of this assay and its intra-interday variability- and even more curious-If the virus is so new- why did China have it already to diagnose 100’s of thousands?

    There is something not right and while washing your hands is critical, having a detection method dispersed that works should be the subject of the Twitter world of instantly relayed science.

    1. CS says:

      I’d like to add my support to this request too!

    2. Biochemist says:

      As far as I know, it’s just a RT-PCR assay, so development wouldn’t take that long, I’d imagine. Once the virus was sequenced, work would go quickly on that.

      I don’t have experience in clinical validation, so I can’t say how long that would take, but again I’d imagine not too long, assuming everything worked.

      1. Vaudaux says:

        RT-PCR protocols including primer and probe sequences have been on the WHO website since January

        1. Mick says:

          There are a few, but for the most part, public health agencies at the local level are not in an education or experience position to be conducting PCR assays. Hospitals don’t make money off of it. So the real solution would to coordinate with local academic institutions, particularly State funded ones.

    3. electrochemist says:

      The article linked below (from Reuters, FWIW) indicates that PCR tests were used initially in China, then a switch was made to CT scans/X-rays (which resulted in a surge in false positives). Apparently, CT scans are now used for screening and followed by confirmatory PCR testing.

    4. MTK says:

      The answer lies in the fact that the WHO, with the help of a German company, quickly developed a RT-PCR diagnostic which China, S. Korea, and others adopted. In mid-January, however, the CDC decided not to adopt the WHO test but develop their own. I read that CDC wanted something more specific. The test that CDC eventually developed had 3 nCOV-19 specific primers. It also contained a negative control, a positive control, and a RNAse P specific primer. The last is to ensure that the sample contains RNA, so that negative results from the 3 nCOV-19 primers aren’t a false negative due to a bad sample. Unfortunately the test didn’t work well. There’s conflicting reports on what exactly went wrong, since I’ve read that “one of the 3 components” didn’t work or that the “negative control” didn’t work. One of the three primers not working seems to jibe with the fact that the CDC decided that just two positives from the the other 2 primers was enough to deem the overall a result a positive for nCOV-19.

      Whatever the problem, it seems that the problem was due to contamination at the CDC as they put together the test kits. They say that they’ve fixed the problem and that tests kits are now being delivered. The FDA has also said that LDT (lab developed tests) can also now be used. It shouldn’t be hard for labs to develop their own since the CDC has published the primer sequences. The hard part may be getting the primers, however, since IDT is working overtime evidently to produce the primers.

      The upshot is that the CDC screwed the pooch and there’s been a 6 week delay and rolling out a testing program. In early February, CDC claimed they could run 500 tests/day. They ended up running 472 total between Jan 21 and Feb 29. It’s hard to describe how pathetic this whole effort has been. Words such as abysmal and horrendous aren’t too strong.

      1. Ted says:


        That’s a common problem with DNA amplification-based diagnostic development, and not necessarily unique to the CDC labs. We have separate spaces for assay research and assay development, but it still requires a high degree of training and diligence to keep from contaminating a workspace from a handful of errant molecules.


        1. MTK says:

          Oh, I understand that, but a) they could have just adopted WHO’s test from the outset, b) they should have caught the contaminated tests before sending them out, and c) this ain’t their first rodeo.

          They screwed this one up.

      2. paperclip says:

        Thanks, very informative post. Was there a good reason for the CDC not to adopt the kit from Germany until theirs was up and running?

        1. MTK says:

          Don’t think that’s ever been made public.

        2. Anonymous says:

          Another historical note (link in handle): Back in the 1980s, Gallo (NIH – NCI) and Montagnier (Pasteur Institute) at first thought they had different HIV isolates. Both were developing tests for HIV. It turns out that the NIH virus was the Pasteur virus (Pasteur had sent their samples to NIH) so they were developing tests for the same thing. … It got pretty ugly with accusations about Gallo’s handling of the matter (he and a colleague started a company to make and sell essential HIV research reagents to research labs, including his own NIH lab); did the lab know they were working with the French virus?; etc.). … But there was the potential to be making a lot of money from test kits.

          There were lawsuits and, eventually, a settlement, announced by Pres Reagan and Prime Minister Chirac, and a sharing of royalties and credit for the discoveries and test kits. See pubmed: 2699159

          So, maybe some people are thinking about making money from a patented test kit or not having to pay another company royalties if using their test kit.

          1. dearieme says:

            The people I knew who knew something about the matter universally disparaged Gallo. The Nobel committee perhaps agreed – Montagnier and a colleague were rewarded, Gallo was not.

            In the words of the New Scientist ‘in June 1991, Gallo finally admitted that the AIDS virus he had “discovered” in 1984 really came from the Pasteur Institute’.

      3. eub says:

        “I read that CDC wanted something more specific.”

        I believe (but cannot now find) that I read an account from a research test developer that CDC wanted specificity to exclude SARS(-1) and MERS CoVs. Is this accurate?

        (If so, the public-health importance of that specificity strikes me as rather low.)

  3. Wavefunction says:

    Hopefully the public will rake Trump and his minions on coals and vote them out once they realize the false hopes that these men tangled in front of them, hopes that cost lives.

    1. Cuban B says:

      Trump told his people that in April the warm weather will kill the virus.

    2. chemist says:

      You’re getting 4 more years of Trump. Enjoy it!

      1. Mark W. Noonan says:

        That’s what you think.

  4. MAGGAVIRUS says:

    There is no virus, its a HOX created by the low energy DEMS to propel sleepy joe to the nomination!! #SAD

    1. Engine54 says:

      What is a “HOX?” Is that an acronym for something?

      1. viral lode says:

        a humorous or malicious deception.

        1. Ogamol says:

          Hoax = false information portrayed as real.
          HOX = a genetic trigger of gene expression, often activated during the differentiation of cells in zygotes and embryos. Hindering HOX genes, in fruit flies, has resulted in legs forming where other body parts should. But that’s just 1 example.

  5. Dr. Manhattan says:

    “Gilead Sciences has commenced two Phase III clinical trials of its investigational antiviral drug, remdesivir, for the treatment of Covid-19 in adults. This announcement comes after the US Food and Drug Administration (FDA) accepted and reviewed the company’s investigational new drug (IND) application for remdesivir in this indication. The randomised, open-label, multi-centre studies will assess the safety and efficacy of the drug in nearly 1,000 patients. A five-day and ten-day dosing regimen of an intravenous formulation of remdesivir will be tested.”

    Any comments on Gilead’s remdesivir and it’s potential for at least being a compound that could be administered to individuals at high risk due to pre-existing conditions? Clearly as an IV compound it is not capable of general distribution such as Tamiflu. Also, even at the fastest pace, it will be a few months before it would become approved.

    Also, was the “three day vaccine” the mRNA based version from Moderna? They have quite a few early stage programs and a couple in Ph.II, but as of yet, their technology has not been proven to work (as has been discussed here before),

    1. Calvin says:

      So this compound has a very interesting story. It was originally part of a RSV program Gilead had (presumably to compete with the now doomed Alios RSV nuc). During the Ebola outbreak in 2014-2015 they got a bunch of compounds tested and out popped remdesivir. Gilead spoke to a number of the philanthropic players looking for advice (not money!) on how to progress it for Ebola. It looked, in vitro and in vivo absolutely fantastic against Ebola which resulted in it going head to head with a number of other antibodies. Sadly, and somewhat surprisingly, it didn’t show the efficacy that was expected, the antibodies were much better. I suspect that that was a function of the compound being given too late in the infection, although I must confess that for the same reason I’d have anticipate the antibodies would have limited efficacy.

      Gilead, to their great credit (for once) have not walked away and had previously to taken the time to look at it’s activity against other viruses and it’s pretty clear it has fairly respectable efficacy against a range of cornoviruses. And this follows through to decent activity against COVID-19. Given that these are all RNA viruses with RNA dependent polymerases, which these compounds target, this is not unexpected. But the key is likely to be making sure that when it is used clinically it’s done as early as possible. I think it will have less effect on patients further on. But we’ll see.

      So while I agree with Derek that most of the stuff about vaccines not coming anytime soon I think there’d a decent chance remdesivir could have utility in the coming months and given they have run decent sized clinical trials already in Ebola I suspect that they have some ability to manufacture and deploy. All the other compounds that have been bandied around are never going to work. Favipirivir is >50 micro molar so it’s just not at the races. These were all trotted out during the Ebola outbreak; they were crap then and they are crap now, but the Gilead compound has a decent shot.

      I did find Trumps little table gathering hilarious and frightening. So the credible Pharma companies who have developed vaccines and products were there and mostly talked sensibly, but I have no idea why Curevac were there (zero products beyond Phase 2) and Novavax (who specialize in P3 failures whilst trying to claim success) other than, presumably, hoping to get Federal funding. I wonder whose friends got them in there. The same happened with Ebola. A number of shady companies (and academics) came out trying to get funding (a few even got cash) based on the hype/desperation cycle which helps nobody.

      And Trump clearly is not a bright man but thinks he is. I’m sure previous administrations have been rubbish at this type of thing, but at least they kept that behind closed doors and let their experts drive things rather than demonstrating total incompetence and ignorance publicly whilst appearing to think that was fine. Watching Trump fail to understand, repeatedly, that the flu vaccine will do nothing, or the various other gaffs was frightening.

      1. Charles H. says:

        Actually, the flu vaccine is very important. Getting both the flu and COVID-19 at the same time could be expected to be a very bad experience, and would probably severely escalate the fatalities.

  6. InThisForTheLongHaul says:

    I agree with most of your article. But as someone who has sat across the table from some very well known high ranking politicians with the same and similar offices as Trump’s, I would say you are delusional if you think that Trump is any worse than others who appear publicly to be better spoken.

    None of them has the first clue about drug discovery or antivirals or any of it. Some are just better actors, better able to pretend to know something, to play the seasoned advocate on TV.

    Trump may not know how to come across as knowledgable (or maybe he just doesn’t care if everyone sees that he isn’t), but having a clue about this stuff is your signpost for a quality President, then we haven’t had a quality president in many many years (if ever).

    Don’t let political views cloud your typically excellent overviews.

    1. Hap says:

      But you don’t (shouldn’t) expect that of Trump (or any President, or for that matter, legislator or judge). What you should expect is that he might know that he doesn’t know, understand that his wishes can’t become reality because he wishes them to be, and delegate authority to people who might know and are able to actually do useful things. And Trump (enabled by his party) seems demonstrably much worse at this than others, as the problems in the executive branch seem to indicate.

      1. InThisForTheLongHaul says:

        Look. I don’t want to say too much because it would be speaking out of class.

        But I can say this in broad terms: I was in a room with a lot of people and another President who I think many people here would consider better than the current one. Talking about how to deal with a major outbreak issue. And the President was mostly quiet and seemed to be getting what the scientists were saying. The few things he did say were encouraging. Then we got a summary statement from the meeting, and it was clear that the President (or whoever he trusted to sign his name) didn’t have a clue. I mean, it was Trump-in-public level stupidity.

        So, yeah, listening to Trump live is like nails on a blackboard. But I am not sure that he’s any worse. He just isn’t able to PRESENT himself as measured.

        1. Anonymous says:

          So, your claim is basically an anecdote that some meeting notes were taken by someone who didn’t understand, and you are eager to ignore all the differences in policy decisions (like Trump appointing people for the express purpose of destroying the agency they manage), so you can pretend both sides are equally bad? And you similarly pretend the only problem with Trump’s constant lying and saying science is false is that it is irritating to listen to, eagerly ignoring the fact that a large percentage of americans believe his lies?

          You are helping Russia’s disinformation campaign, whether you know it or not.

    2. Joshua says:

      Long… Sigh….

    3. Jim Davis says:

      I do not expect politicians to understand science, but I do expect them to know that they do not understand science, and delegate to those that do know. Trump’s crime is not that he is ignorant (all of us are, outside our narrow specialty) but that he boasts of expertise he lacks.

      1. Joe says:

        Ignorant confidence… the worst quality indeed.

      2. Lynn says:

        This is a man that never takes ‘no’ well. His ignorant confidence has paid off before – people say it can’t be done but then someone does it. Science isn’t just a business deal that money can fix. People who talk to him should know this. So when he heard someone from pharma say ‘2 months’ that’s all he hears “joe there said 2 months” and then Fauci has to be the sane one.

      3. MagickChicken says:

        Not only that he boasts, but that he seems to believe his boasts.

    4. Wavefunction says:

      The difference is that those other people will defer to subordinates who are experts and change their minds whenever necessary, whereas Trump has surrounded himself with subordinates who are supposed to simply reaffirm his own views.

  7. Brett says:

    Trump’s people are just lucky that a lot of the response is being done at the state level. I agree that to the extent that there is any plan, it seems to consist of haphazard measures and a lot of hope that maybe it will just resolve itself without getting too bad.

    Meanwhile, I just read that the WHO upped their estimate of the mortality rate to 3.4% – heavily concentrated among the elderly.

    1. MedChemist says:

      The 3.4% mortality rate is probably largely based on numbers from China having a relatively young population. Given that the elderly are more vulnerable, will that number increase for Western countries with older populations? But then again, Japan with a rather old population seems to be quite successful at preventing too many deaths. I guess there are plenty of factors at work and it may be crucial to slow down the epidemic as much as possible in order to not overload health care systems. Intensive care units are not abundant in most places.

      1. Harrison says:

        In addition to age, I think a history of respiratory problems is going to be a large factor in the mortality rate. Countries with rampant air pollution are probably to have a higher mortality rates than those with little air pollution. Check out some of the cities with the most air pollution.
        The top of the list is dominated by China, Iran and India (Makes one wonder what if, anything, India is doing differently). What is the first western European country to make the list? Italy.

        1. An Old Chemist says:

          A Google search for weather tells me that:: in Beijing 27 *F, in Tehran 50*F, and in India 59*F. I guess that a simplistic explanation of this could be that higher temperatures may well indeed be (hope so) detrimental to the virus survival same, same as in the case of the influenza virus.

        2. Kaleberg says:

          Let’s not forget smoking. Apparently there are a lot of serious smokers in China, and smoking can make any respiratory problem worse.

      2. Chris says:

        There’s some evidence from the cruise ship events that the death rate may be rather lower than originally thought, based on around 50% of people with the virus being asymptomatic – which is a hopeful sign, with a mortality rate of just under 1%.

        Still bad obviously, but not as bad as some estimates.

  8. mallam says:

    Politicians don’t have to understand the underlying science or related information, but should have to be able to accept comments from the top scientists in the country and overall let them take the lead particularly with an imminent threat. When the politicians try to dismiss the scientists as if they know better, make comments that conflict with the scientific information in an attempt to lesson the risk, and appoint a pandering, fawning political subordinate to lead the national effort and have all comments cleared through the same groveler, clearly then we have a major issue. Enter Trump stage right.

  9. luysii says:

    Having dealt with patients for decades getting unpleasant news, usually of a neurologic variety, I can tell you that Trump’s reaction as reported by the Washington Post is fairly typical. People under stress hear what they want to hear. They try their best to hear good news. Many times I’ve been reported to have said the exact opposite of what I’ve actually said.

    I do not trust the Washington Post. They performed a 590 word elision of Trump’s phone call to the Ukraine, which completely distorted the sense of the conversation, once he released the full transcript. We’ve just finished 3 years of ‘bombshells’ about Russian collusion all of which had to be walked back (if they were walked back at all). So is a verbatim transcript of the meeting available? If so, I’d like to see it.

    1. Earl Boebert says:

      Collusion is only required if the agent of influence is witting. Collusion is not required if the agent of influence is a fellow traveler or useful idiot. Absence of collusion is not evidence of absence of influence.

      1. chemist says:

        You can’t prove a negative, dip shit.

    2. C says:

      Would love to see more analysis on Hillary’s kill list from you Luysii! Really cutting edge stuff

      1. Mark W. Noonan says:

        Oh For god’s sake give it a rest. Conspiracy Theory galore.

    3. Wallace Grommet says:

      Is the full unredacted phone transcript released?

    4. Anonymous says:

      The memorandum of transcript Trump released included him saying “I want you to do us a favor, though”, which is hard to read as anything other than thinly-veiled extortion, which is exactly what was claimed from the beginning. Several republican senators admitted Trump did basically everything he was accused of, and voted “not guilty” anyway, so basically they didn’t think anyone would believe they were being honest and following their oath. The “party of personal responsibility” strikes again…

      As for walking back on Russia, remember when Trump and Fox said there were no meetings? And then there were no meetings during the campaign? And then the meetings during the campaign were only about adoption? And then that they were about info on Hillary, but Trump didn’t know about them in advance? Then finally, testimony that Trump did know exactly what they were about, in advance, and they repeat “collusion is not a crime” forever, ignoring the fact that conspiracy is a crime, and a type of collusion. And, they ignore the repeated obstruction of justice that is the entire second half of the Mueller report.

      It is a shame that even smart people are falling for the lies and misdirection from Trump and Fox…

      1. fightingillini says:

        The complete sentence was “I would like you to do us a favor though because our country has been through a lot and Ukraine knows a lot about it”. The sentence didn’t just stopped after “though”.

  10. An Old Chemist says:

    Everything We Know About the Coronavirus (from C&E News):

  11. jak says:

    As far as I know Remdesivir has been demonstrated to be reasonably safe and effective against other similar viruses (SARS). It may be worthwhile to fast-track this for emergency use in most-at-risk classes of patients now. Now isn’t really the time for the usual safety checks (that I generally am in favor of)

  12. common SENSE says:


  13. dearieme says:

    It must be said that in terms of action by the federal government the big decision made at Trump level – the ban on flights from China – was probably wise.

    The decision made at State Department bureaucrat level – to fly in infected people from the cruise ship against the direct command of the Prez – was reckless.

    The decisions made at science bureaucrat level – in both the CDC and (I understand) the FDA – have been abysmally incompetent.

    In light of which perhaps we sciencey types should pipe down a bit about the Twerp-in-Chief: so far His Absurdity has done better than we have.

    As for Presidents having much of a brain – come on, the last brainy President was Hoover and everyone scorns his time in office. The only one for whom an IQ measurement is publicly available is JFK, who would have been borderline for admission to the second highest stream in my secondary school.

    If you want clever politicians move to Singapore: the present Prime Minister was Senior Wrangler in his day.

    1. Hap says:

      I thought the major problem though was that there wasn’t a backup plan – that testing only recent travelers was insufficient (otherwise you wouldn’t know if there was community transmission and be able to contain outbreaks). Since no one had the chutzpah/lack of survival instincts to tell the President that that was likely not to be sufficient, nothing else happened. When not wanting to hear contrary advice is career-lethal, you’re not going to get good advice.

    2. Will Cody says: had an interesting article o this issue:

      The CDC and FDA initial response to testing violates key design principles: good enough is best; don’t let best be enemy of the good. Rather than take the role of validating the most basic test as a first step, the CDC decided they knew better to design and arrange manufacture of a super controlled test. As a result of this NIH syndrome, they were the developer, manufacturer, and QA/QC of their own complicated test design. They might have taken a more direct approach to use the vibrant corporate assets of the USA to get there fast.
      -Set out the absolute minimum specifications to get a screening test: able to detect the specific virus with a chance that some overlap with SARS and MERS is not a disaster.
      -Made sure they had the right material for validating the tests;
      -Ask a subset of the many US based companies to provide tests based on these simple specifications for a quick validation by the CDC or other, quality independent testing labs.
      -Let the companies use their own primer and probe and reaction design to meet the criteria and pass validation studies with provided testing material.
      -Work with the FDA to get rapid approval of these minimal tests.
      -In parallel, work with companies to follow up with more elaborate tests to eventually supplant the first round.

      The capitalist economy has the potential to deal with this sort of problem, as did the capitalist sector of the Chinese economy. The failure to use those assets is an issue that should be corrected.

      1. Hap says:

        Well, I’m not sure how wrong I am but I was wrong. A significant part of the problem is the bad test that Trump didn’t do anything to cause (I don’t think?). I

      2. Pallas_Athena_2 says:

        How about using one of the existing tests used by the Europeans – or anyone else – to get started treating people while we come up with our own, then go back & retest people who were tested with the other to verify?

        Better to start to correctly treat & quarantine people – check health care workers to be sure they are safe & not infecting others – even if there are some false negatives and/or false positives.

    3. Was-a-nuc says:

      Carter was Navy Nuc, selected by Rickover. Engineer more than scientist, but went through technical programs to some success.

    4. hope isn't eternal says:

      IMO it was important for our government to assist citizens on the ship off the coast of Japan. The problem was that State did not listen to CDC’s recommendations as to how to protect those coming in contact with the people, and then idiotically putting them on a plane with other passengers. Likely to contain cost at expense of safety and national security.

    5. loupgarous says:

      “As for Presidents having much of a brain – come on, the last brainy President was Hoover and everyone scorns his time in office. The only one for whom an IQ measurement is publicly available is JFK, who would have been borderline for admission to the second highest stream in my secondary school.

      Before Hoover, there was Woodrow Wilson, who earned a PhD from Johns Hopkins and was President of Princeton University before he was President of the USA. Wilson made it among his first tasks to eliminate what progress Teddy Roosevelt, Grover Cleveland and other Presidents had made toward racially integrating the Federal Civil Service. Brains aren’t necessarily a character reference.

    6. Pallas_Athena_2 says:

      “Though Brown wouldn’t say if other presidents or Cabinet leaders are members of the elite group, he did say several have reached career milestones that would have qualified them for Mensa admission. For example, President Bill Clinton was a Rhodes Scholar, Jimmy Carter worked as a nuclear engineer and George H.W. Bush was a military pilot.

      ‘Each could have encountered standardized academic tests (LSAT, GMAT, Miller Analogies) where qualifying scores would have propelled them into Mensa,’ Brown told The Hill, noting that admissions tests aren’t the only avenue for geniuses to become members of Mensa.”

  14. Robert Micheals says:

    Gilead’s remdesivir is IV only, not oral. 10 Chinese scientists already published in Nature recently that an older, inexpensive drug chloroquine used to treat malaria was effective in vitro at very small levels, and chloroquine is well known to permeate all body tissues, 70+ years of use, side effects not substantial:

    In vitro is not the same as in vivo, but it’s a really small risk IMHO to try it out, we don’t risk much at all trying it but it it really works a lot of seniors lives may be saved.

    1. Dan says:
      Chloroquine works in vivo I am a believer as it blocks the endosomal uptake of virus

    2. Chris says:

      So… Gin and Tonics are a preventative? Bring on the self Isolation!

      (And I always have my G&Ts in vitro, so no problems there…)

  15. Lynn says:

    All the posts in the world about how many people you’ve tested don’t mean squat if you aren’t doing follow up on contacts and quarantine. South Korea appears to be. China did, sometime using its authoritarian abilities. Outcomes are all that matters, not millions of negative tests – ie the 2 people reclassified as coronavirus deaths who died in February. They were hospitalizes getting the supportive care they would have had received whether tested or not. But we would have had weeks head start on contacts and understanding the spread. I do not believe they haven’t traced the source of the first infection strain yet. It’s a visitor or employee. But does the fear of lawsuits get in the way – company won’t tell you employee x grandma who lives with them just got back from China (or now Iran, Italy) because they fear getting sued. Does the US have the willingness to force people into quarantine like China? If not, testing is a false sense of security.

  16. covtester says:

    One thing I have been trying to figure out is why South Korea’s testing rate is so high? Is it only because there is a higher incidence there?

    I’ve reads plaudits from epidemiologists to South Korea for the efficient testing that they brought up quickly, but no clear condemnation of the US for testing at such a low rate. What does public health say about how much testing should be done?

    1. colivid-2019 says:

      The South Korean data shows how valuable extensive testing can be. If one looks only at their numbers, there are 5,600 cases with 35 deaths and just 27 serious cases at the moment. This puts the mortality rate at considerably less than 1% so far. Still scary and worthy of caution, but a much more reassuring number that the 7.5% mortality rate that the US figures currently show.

      With extensive testing with properly functioning test, I expect things to get less frightening, not more.

      1. covtester says:

        Obviously there are benefits to (accurate and sensitive) testing; but there are also costs and the effects in terms of overall outcomes. It isn’t a given that more testing results in better overall outcomes.

        I’ve heard many public complaints about the testing efficiency in the US, but it isn’t clear to me if the low number of tests isn in line with sensible public health policy or not, or simply a result of the average number of contacts per patient (e..g the church at the center of the outbreak in South Korea may have facilitated many more contacts than the patients in the US).

  17. Christophe Verlinde says:

    SCIENCE published an article on the bungling of the CDC when they released their test:

    In addition, the CDC ukaze to forbid anyone else to do independent testing was a direct contradiction of the FDA regulations that specify that any clinical pathologist is allowed to devise their own tests – after all they had years of education and training in qPCR testing.

  18. loupgarous says:

    CDC’s numbers on coronavirus cases versus (say) Johns Hopkins’ global, GIS-driven “dashboard” map of COVID-19 coronavirus cases shows a difference in the tally of total US cases of 48 between the two (CDC says 80 cases, Johns Hopkins says 128).

    Interestingly, the number of deaths reported in the two Web sites is the same, 9 deaths. Johns Hopkins narrows the location of those cases to Washington state (8 in King county, 1 in Snohomish county).

    Why, across the breadth of the continental US, does just Washington state report fatalities from COVID-19? (Johns Hopkins’ “dashboard”, a day or so ago, listed the case in Madison, Wisconsin as a fatality for a few hours, then walked that back and now lists the Madison case as “confirmed recovered”.) There are larger foci for infection up and down the Pacific coast, but only King and Snohomish counties in Washington state have fatalities. Why?

    If we saw an isolated pattern like that in Big Pharma clinical data, first we’d suspect the data themselves – and we might send people down to the center reporting data that varied from the norm to go over the charts which the site statistican drew on for their Clinical Research Forms (the basic documentation on which reports of new drug safety and efficacy are based).

    First, we should look at the possibility either COVID-19 deaths are being missed and not reported elsewhere than Washington state, or that the assessment of what caused the Washington state deaths needs to be re-confirmed. The patient charts for those deaths ought to be checked for things like co-morbid conditions or other confounding factors, anyway.

    So far from having a single, interrogatable database to go to for information on COVID-19 coronavirus cases in the United States, that the Centers for Disease Control’s assessment of confirmed COVID-19 cases and a major medical school’s global database on COVID-19 cases differ in their assessment of how many confirmed cases of COVID-19 exist in the US by 37% (the 48-patient difference divided by Johns Hopkins’ assessment of total confirmed COVID-19 cases).

    It’s nice having two different databases as a validation check on their data, but why do their differ so widely?
    “One big database” with a common dataset architecture might be tempting, but as a rare disease sufferer, I’ve seen a medical school professor familiar with my case struggle with which ICD code to assign it to (the rarer neuroendocrine cancers are still not as well-characterized as we’d hope they were). So, why do CDC and Johns Hopkins differ so widely on the total number of COVID-19 cases in the US? ICD coding errors? Incomplete reporting by state health agencies (which CDC states as a potential problem)?

    I’d hope that CDC and Johns Hopkins are at least corresponding with each other about a discrepancy in the total number of cases of COVID-19 coronavirus this large.

    1. Vaudaux says:

      “There are larger foci for infection up and down the Pacific coast, but only King and Snohomish counties in Washington state have fatalities. Why?” The deaths in Washington State are nearly all connected to a single nursing home. It is not surprising that when coronavirus enters a nursing home, it causes a large number of cases, with a higher proportion of deaths than in a less vulnerable population. It is very likely that similar clusters exist elsewhere and are being missed, because so few people have been tested. Testing now is very non-random, being conducted only around cases that are already known or suspected.

      1. loupgarous says:

        Thanks for the information. I’d heard about the King county, WA cases being in a single nursing home, but couldn’t find an open source for that information. That still raises questions about confounding factors that ought to be looked at. CDC themselves state that nationwide reporting of COVID-19 cases in the US is sporadic.

        We see that COVID-19 has a known higher death rate among the elderly, but need to get more specific answers to “Why?”. Which concomitant diseases and conditions are seen most often in COVID-19 deaths? Are we missing COVID-19 deaths in other parts of the US?

    2. loupgarous says:

      Update as of 12:03 am Eastern:
      159 total US cases of COVID-19
      11 total US deaths from COVID-19.
      9 deaths in King county, WA, 1 in Snohomish county, WA, 1 in Placer county, CA.
      figures courtesy of Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE

  19. The Iron Chemist says:

    I’ll re-interpret/re-phrase the Feynman quote: “Nature doesn’t give a s___ what you believe.”

  20. Eleven fingerrrrrrsssss says:

    1 we need a healthcare system not a healthcare denial/profit system.

    2 interesting data on lethality from cruise ship here. Looks maybe less than 1 percent

    1. loupgarous says:

      that article in Slate, “COVID-19 Isn’t As Deadly As We Think” by Jeremy Samuel Faust intended to allay fears about how many people will die of COVID-19 is inadvertently alarming. Quoting from the article:

      “This is where the Diamond Princess data provides important insight. Of the 3,711 people on board, at least 705 have tested positive for the virus (which, considering the confines, conditions, and how contagious this virus appears to be, is surprisingly low). Of those, more than half are asymptomatic, while very few asymptomatic people were detected in China. This alone suggests a halving of the virus’s true fatality rate.

      On the Diamond Princess, six deaths have occurred among the passengers, constituting a case fatality rate of 0.85 percent. Unlike the data from China and elsewhere, where sorting out why a patient died is extremely difficult, we can assume that these are excess fatalities—they wouldn’t have occurred but for SARS-CoV-2. The most important insight is that all six fatalities occurred in patients who are more than 70 years old. Not a single Diamond Princess patient under age 70 has died. If the numbers from reports out of China had held, the expected number of deaths in those under 70 should have been around four.

      Fair enough.

      Using this analysis of the Diamond Princess cruise ship, with a heterogenous crew and passengers in reasonably good health, let’s apply the same numbers to the United States:
      Of the US’s 330,000,00 residents, 19%, or 62,700,000 would contract COVID-19.
      Of those patients, 0.85%, or 532,950 would die nationwide.

      But we don’t all live in the close quarters of a cruise ship. My point is that if you use numbers to make a point about communicability of a disease and its case fatality rate in Country X, the numbers we find among the passengers and crew of a cruise ship don’t necessarily tell you how that fast or far that disease spreads or how many it kills people in Country X.

      The unintended point in the Slate article is that even seemingly rosy statistics such its author’s estimate of 0.85% case fatalities over expected deaths from other causes, when applied to entire countries lead to pretty dismal estimates compared to the CDC’s recent tally of 80,000,00 deaths from influenza in the winter of 2017.

      I don’t think the author of the Slate article intended to mislead anyone, but neither does his Diamond Princess cruise ship analogy stand up to further analysis.

      1. loupgarous says:

        erratum. The US population is now estimated to be just under 330,000,000. I used this number in my calculations.

      2. loupgarous says:

        Likewise, the STAT News article I linked to reported a CDC estimate of 80,000 deaths in the winter iof 2017-8

  21. Dave says:

    I’d like to respectfully disagree. Having worked for a number of years in disaster management, I feel that I have a bit of insight here.

    Yes, President Trump certainly doesn’t understand biomedical issues. But, that’s not his job. His job is to enable the various researchers to best do their jobs, while preventing the public from panicking. Yes, he has told some little white lies. But, telling the population that there’s little hope will cause people to panic, and, when they panic, they do stupid things, which very well may make the situation even worse, and result in lower levels of survival for everyone. We don’t need riots at the stores, due to people buying all of the hand sanitizer, face masks, soap, toilet paper, and ice cream. We’ve already seen where a shopper in Sydney, Australia had a knife pulled on him as he attempted to buy toilet paper. We do not want that to occur here.

    So, yeah, mother nature can’t be fooled, no matter how blatant the lies from politicians. On the other hand, the general population can often be calmed by such a little white lie. And, are President Trump’s statements that different from Winston Churchill’s “We shall fight on the beaches” speech?

    1. MagickChicken says:

      From Trump’s coronavirus summit yesterday:

      “A year to a year and a half,” Fauci again clarified.
      “Well, but, Lenny is talking about two months, right?” Trump said, incorrectly referring to Schleifer’s August estimate.
      “A little — a little longer,” Schleifer again clarified. “A little longer.”
      “A couple of months, right?” Trump pressed. “I mean, I like the sound of a couple of months better, I must be honest with you.”

      In other words, this would be more like Churchill saying, “We will fight them on the fjords!”
      Montgomery: “Sir, we don’t have any fjords.”
      Churchill: “We have beaches. And cliffs. That’s a fjord, right?”
      Montgomery: “Sir, a fjord is an inlet carved by a glacier. Great Britain is a peninsula cut off by ocean rise at the end of the last ice age.”
      Churchill: “So now you’re bringing fake climate change into it, too? I like what that Rommel guy says better!”

      1. MeAgain says:

        I have been in many meetings with high level managers where the discussion goes like this:

        Manager: “How long do you estimate this will take?”
        Reportee: “I’d say 6-8 months, assuming 3FTEs on the project.”
        Manager: “I want this in 3 months. I’ll give you the resources you need.”
        Reportee: “I am not sure that more resources will allow us to finish any more quickly.”
        Manager::”Well, we need it in 3 months. So find a way to try to make that happen.”
        Reportee: :”OK”

        It’s the eternal push and take between upper management, who wants it yesterday, and those in the trenches, who find those demands unrealistic. It never changes, and upper management always wants it yesterday, and those who report to them always, in some way, capitulate to “I like the sound 2 months better” in some way during these meetings. And then they go back and do what they can do. Which may be 8 months.

        Nothing different than Trump (a manager) and everyone else. He sounds like every single upper-level manager I’ve ever dealt with, and some of those people were hugely successful and very smart.

        1. loupgarous says:

          Which is fine until the rate-limiting steps – animal and human testing for tox and efficacy – get in the way of clearing a COVID-19 vaccine in two months. CDER has already been making questionable calls to get Sarepta’s exon-skipping drug on the market in the name of “doing something” about Duchenne’s.

        2. Vader says:

          The analogy goes clear back to _The Mythical Man-Month_ in 1975, but no one’s ever topped it: You cannot get a baby in a month by getting nine women pregnant.

  22. DD says:

    A large number of Trump’s behaviors would not be acceptable – not even close – from anyone with an minimal sense of decency and morals.
    Why should we accept them from our leader?
    If we did, we would deserve him.

    Now, perhaps those behaviors have become part of the standard accepted behaviors for the majority of Americans voting?
    If so, I guess evolution is happening and we are getting our dues.

    1. chemist says:

      The Democratic party is the party of criminals and the insane. They should never be allowed back into power in this country.

  23. gippgig says:

    Humanity is actually very lucky that what got loose wasn’t so mild that it will be ignored (remember the 2009 flu outbreak?) or so severe that it will cripple civilization (SARS, with a fatality rate of ~20% as I recall) but apparently just right to get people to finally take the threat of epidemics seriously.
    A couple other suggestions:
    Get the pneumonia vaccine (altho it may be too late since it takes time for vaccines to work). It’s often a secondary infection that kills people.
    If you have an allergy stock up on medicine. Pollen season is about here & nasal congestion will almost certainly make any respiratory infection worse.

  24. oldworldbiologist says:

    I could not imagine a starker contrast. The other day, I was watching the German health minister and a panel of experts informing the public about the unfolding Coronavirus- situation in Germany and planned measures to slow down its spreading. While watching, I kept thinking: this is democracy at its best. Elected representatives and knowledgeable experts answering questions and putting things into perspective. No fearmongering or downplaying.
    Compare this to a head of state saying warm April weather is going to take care of the virus.

    1. OldFart says:

      It’s like the movies:

      Some like Adam Sandler, some like Antonioni.

      At the end of the day, it’s all theater. Same with what you see on TV as the heads of state address the Coronavirus.

      I guarantee you that how this plays out will have nothing to do with the different ways that the leaders in free nations present themselves. It will come down to science and how it’s applied at the boots-on-the-ground level.

  25. COV19FEFE says:

    Relax, the virus hoax will go away in April when the warm weather comes

  26. Barry says:

    The latest data I’ve seen show a mortality rate in the U.S. of 6.9% (more than twice the value reported elsewhere. We’re (probably) diagnosing all the deaths. But we’re diagnosing FEWER THAN HALF of the infections. Americans who aren’t yet deathly ill aren’t rushing to incur the expense of testing.

  27. Sulphonamide says:

    Is there a one-liner anyone can supply to explain why flu tends to strike primarily in winter (avoiding anything like “coz it’s seasonal flu, dummy”) and thus why we hope/confidently assert that this will go away by spring if only we can hold out that long? The argument that people spend more time outdoors indulging in healthy activities only seems to hold water for those of us in cold damp countries (after all, doesn’t much of the developed world spend much of the summer cooped up indoors with the aircon cranked up?)…and if it were just about indoors/outdoors then does that mean that countries with little seasonal variation don’t get flu or colds. Or is it just a subtle combination of factors that tweaks the R0 below 1?

    1. Hap says:

      Maybe that people stay inside and air flow is limited? If the same air flows around with the same germs then lots more people could get infected from the same does of virus (though that depends how good the virus is at surviving outside the host). Having lots of people together inside rather than outside might mean more people can easily be exposed to a single case. Lack of sunshine could help, too, since viruses/virii probably aren’t very good at repairing lots of DNA damage at once.

      Hope is still not a plan, though.

    2. Darby says:

      I believe that flu viruses are more stable in warm dry conditions, such as indoor winter conditions. The swine flu that arose in summertime Mexico was an exception – I never understood why the CDC expected it to re-emerge when that year’s flu season hit…

  28. N says:

    Stunned and shocked at the response from the American leadership and science and health community from the top down.

    Read the WHO mission report released two days ago.

    This is not a question of developing a vaccine or a treatment that will take months. The situation in Wuhan exploded in a matter of weeks. We have a massive science bureaucracy that is geared towards research, NOT pandemic response. A HUGE hole in the CDC/NIH has been exposed. We don’t need our top science minds telling us to wash our hands and cover our mouths and not be xenophobic. What we need:

    1) hospital beds
    2) quarantine spaces
    3) local, regional, and national travel BANS not suggestions
    4) respirators
    5) oxygen and sterile tubing
    6) gloves and masks
    7) full body protection suits for healthcare workers

    We needed these _yesterday_, when the first case of community transmission was reported in the US.

    We have NONE of these being coordinated and NO one on a national or even state level seems to be coordinating this. I cannot believe how utterly inept and headless this response has been. Of course Trump has responded poorly, but he’s the only one we EXPECTED to do so. I am shocked at the soft language from supposed public health experts with decades of experience. This is going to be our nation’s worst national catastrophe since 1918. Undoubtedly.

    1. Ogamol says:

      N: We also needed an intelligent response (i.e. geared toward outliers), not a knee-jerk one (which was geared solely for average illness time, as far as I can tell). The news, in mid-January, had already reported symptom onset taking up to 20 days. And our gov’t stuck to 14 day quarantines…

  29. An Old Chemist says:

    Why Coronavirus Testing Should be Free for All Americans:

  30. exGlaxoid says:

    My understanding is that the human nasel lining dries and cracks much more in dry interior conditions (from furnaces drying the air as it is warmed) which allows more bugs to get into the live cells. That seems pretty consisent with my experience of getting colds when the air inside is extremely dry. Humidifiers help some with that, but can only do so much.

    1. HVAC-COV-2 says:

      furnaces don’t dry air FYI. At a given dew point the relative humidity goes down as temperature goes up but the absolute amount of moisture in the air doesn’t change. If indoor humidity is low then your house has air leaks, nothing to do with the type of heat. The more you know

      1. Some Dude says:

        Not sure what is up with your tone, but isn’t vapor pressure and therefore the equilibrium between liquid and gaseous water dependent on temperature? So even though the absolute amount of gaseous water stays the same when heating up air, doesn’t therefore the “drying capacity” of the warmer air increase? This is most likely what the OP means, and which is also reflected in other comments.

      2. Annonned says:

        HVAC-COV-2, how do you believe a hair dryer works?

        1. Maybe you're born with it says:

          Hope you’re kidding, is it too late to delete this? Open vs closed systems? Where do you think the water from your hair goes… away?

      3. Wallace Grommet says:

        You got it half right. Lower relative humidity in the household air means nasal passages experience drying. Your nose doesn’t care about the amount of water dissolved in a given volume. The lower the rh, the greater drying process. Which is bad. The more you know.

      4. albegadeep says:

        HVAC-COV-2 says: “At a given dew point the relative humidity goes down as temperature goes up but the absolute amount of moisture in the air doesn’t change.”

        While technically true – a change in temperature does not change ABSOLUTE humidity – most of the time it’s RELATIVE humidity that matters. Skin drying out is one of these – you’ll notice it happens a lot more in the winter than the summer. Doesn’t matter if it’s snowing outside (100 %RH at 20 °F), take that air and warm it to room temperature (70 °F) and it’ll be quite dry (15 %RH).

        (Note: measurement is literally my job.)

  31. Kaleberg says:

    A discussion:

    “The real reason germs spread in the winter”

  32. x says:

    Contrary to Derek’s claim, there is one proven intervention which is highly effective at reducing the spread of disease which could, in theory, be implemented immediately: isolation.

    In practical terms, isolation means guaranteeing workers paid sick leave so they can afford to stay home when sick. The fact that the people least likely to have this benefit are also the ones least able to voluntarily skip work and also, in many cases, likely to interact with a large number of strangers (and possibly serve them food and drink, to boot) may not be intentional, per se, but it is not exactly coincidental, either.

    More funding for scientific agencies and healthcare free at the point of service would probably help too, but of course, those are harder to implement in a hurry (though it’s noteworthy that that Trump’s pondering having the government pay for COVID-19 testing, even though I’m pretty sure that means we’ll all end up in gulags or bread lines or whatever).

    As for the Trump administration’s response to COVID-19, I feel compelled to point out (no doubt to many people’s annoyance – I know, unpleasant truths are unpleasant!) that Trump’s losing opponent in the last election was overwhelmingly supported by the Democratic establishment despite being deeply unfavorable to much of the electorate. Now that same establishment is pushing hard to nominate a man with obvious progressive mental decline (not to mention his wagonload of political baggage, but you can decide if that bothers you or not). His opponent in the primary has, at least, said that scientists should be planning the response to this disease outbreak, and generally favors paid sick leave.

    If you are an eligible voter who is dissatisfied with the president’s handling of this issue, you ought to consider whether you’d rather take your chances in the upcoming general election with someone leaning on the left edge of Overton’s window who’s professed a belief in science, or someone who’s losing his mind… and vote in the Democratic primary accordingly, if you still have time.

    Jusssst sayin’.

  33. drsnowboard says:

    Surprising that US leaders of all persuasions aren’t taking a higher interest in controlling the spread, given that they are all exclusively in the ‘elderly white guy with underlying health conditions’ population where mortality is highest.

    BTW Italy was one of the first countries to ban direct flights from China. Travellers took indirect flights, government had no way of tracing incoming subjects who may have been exposed. Careful what you mandate.

  34. An Engineer says:

    drsnowboard said

    “Surprising that US leaders of all persuasions aren’t taking a higher interest in controlling the spread, given that they are all exclusively in the ‘elderly white guy with underlying health conditions’ population where mortality is highest. ”

    This exact thought crossed my mind this morning. I am both ashamed that I’m wishing death on others and not because well… have you seen congresses taxpayer funded lifetime healthcare package?

    If they had to operate in what is hilariously called a “marketplace”… things would be… different.

    I am a bad person /sigh

    1. x says:

      Innocent people are going to die needlessly because of bad policy deliberately made and implemented by crooked politicians and amoral executives. I don’t think there’s anything bad about wishing that some of them would suffer the dire consequences of a health crisis they exacerbated. Seems more like cosmic justice, hoped for in the spirit of self-defense.

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