A new nightmare — extracts from a long thread:
COVID Update September 19: SCOTUS edition.
A massive impact on our ability to fight the pandemic and on those effected by it depends on the Court. 1/
— Andy Slavitt @ ? (@ASlavitt) September 19, 2020
Because that damage can be immediate, chronic, recurring, or hidden in the body only to show up years later, COVID-19 is the ULTIMATE pre-existing condition. 3/
— Andy Slavitt @ ? (@ASlavitt) September 19, 2020
If you are one of the 20-40 million who has a case that hasn't been diagnosed, if you get a condition in the future, and you can be checked for anti-bodies, the insurance company could cancel your policy & refuse to pay your claims. 6/
— Andy Slavitt @ ? (@ASlavitt) September 19, 2020
Mandatory disclaimer: Slavitt is very much an interested party here, but while he may overstate, IMO he’s not wrong.
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Cheryl Rofer recommended this info-rich article from UCSF Magazine — “We Thought It Was Just a Respiratory Virus. We were wrong.”
… When UCSF researchers tested people for SARS-CoV-2 in San Francisco’s Mission District, 53% of those infected never had any symptoms. “That’s much higher than expected,” says Monica Gandhi, MD, MPH, a UCSF professor of medicine with expertise in HIV. Surveys of outbreaks in nursing homes and prisons show similar or even higher numbers. “If we did a mass testing campaign on 300 million Americans right now, I think the rate of asymptomatic infection would be somewhere between 50% and 80% of cases,” Gandhi says. Millions of people may be spreading the virus without knowing it, she points out, making asymptomatic transmission the Achilles’ heel of efforts to control the pandemic – and highlighting the importance of universal masking.
“The majority of people who have COVID-19 are out in the community, and they are either asymptomatic or only mildly ill,” says Sulggi Lee, MD, PhD, a UCSF assistant professor of medicine. When the coronavirus pandemic hit San Francisco in early March, Lee conceived a study to investigate why. She scrambled to assemble a team and procure funding and equipment. She borrowed a colleague’s mobile clinic – a van outfitted with an exam table and a phlebotomy chair – so that her team could drive around the city, collecting samples from infected people. Lee hopes data from the study, called CHIRP (COVID-19 Host Immune Response Pathogenesis), will show how people’s immune systems respond as SARS-CoV-2 starts to gain a foothold in their bodies.
“A lot is riding on that initial response,” she says. If Lee and her collaborators can figure out the biological processes that allow some infected people to stay relatively well, they can perhaps use that knowledge to prevent others from falling severely ill…
Since March, Marcus has co-led one of the largest community surveys to better understand the spread of SARS-CoV-2 and its myriad effects. The study, dubbed COVID-19 Citizen Science, has so far enrolled more than 27,000 people; anyone with a smartphone can participate. Marcus plans to also start collecting data from wearable devices, including Fitbits and Zio patches, which wirelessly monitor heart rhythms. “There may be large numbers of people who are suffering from cardiovascular effects of COVID-19 in the absence of other symptoms,” Marcus says. “I’m worried we’re missing those cases.”
It stands to reason that SARS-CoV-2 affects the heart. After all, heart cells are flush with ACE2 receptors, the virus’s vital port of entry. And, indeed, laboratory experiments suggest that the virus can enter and replicate in cultured human heart cells, says Bruce Conklin, MD, a professor of medicine and an expert in heart-disease genetics at UCSF and the Gladstone Institutes.
But Conklin doesn’t think SARS-CoV-2 necessarily kills heart cells outright. Rather, in the process of copying itself, the virus steals pieces of the genetic instructions that tell the heart cells how to do their job. “It’s hauling away and hijacking stuff that’s necessary for the heart to beat,” he says. He is currently testing this hypothesis using human heart cells grown in cup-sized vessels in the lab of Todd McDevitt, PhD, a bioengineer at UCSF and the Gladstone Institutes…
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Another excellent read from the always-interesting Atul Gawande, in the New Yorker — “We Can Solve the Coronavirus-Test Mess Now—If We Want To”:
To get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. From the way people often talk, you might think we need a technological breakthrough to achieve this. In fact, we don’t have a technological problem; we’ve got an implementation problem. We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional…
To fix testing, we have to accelerate two lines of operation: test collection and test processing. The primary challenge of test collection—sticking a fifty-cent swab in someone’s nose—is last-mile logistics, which can be more intricate than most realize. You’ve got to manage people flow; it can be a challenge just to find locations where potentially infectious people can turn up without infecting others. Then there’s the flow of supplies, which involves having adequate quantities of the swabs and tubes that your particular lab requires, plus the personal protective equipment required for the staff. There’s the information flow—gathering and linking a patient’s information, the provider information, and the bar code on the specimen tube in a way that the laboratory can deal with. And there’s the financial flow—figuring out the billing system required to get reimbursed by the correct payer, which, for a particular person, could be Medicare or Medicaid, a private insurer, an employer, the state, the patient herself, or any number of other sources. Running a test-collection operation can be a nightmare for scores of reasons. You have to navigate supply shortages, neighborhoods that object to having lines of cars turn up at a pharmacy or clinic parking lot, business-insurance plans that may not cover you if you provide testing, and building owners with liability concerns. You may be unable to use your label printer and computer system if there’s no Wi-Fi in the parking-lot drive-up location you’ve picked.
Processing tests is a very different enterprise. It is exacting. Most diagnostic tests are performed by putting a sample into a device and getting a result. But large-scale molecular diagnostic testing—in which segments of genetic material are read—isn’t done with off-the-shelf kits; these are laboratory-developed tests, meaning that running them is less like operating an appliance than like doing a procedure, with multiple steps requiring precision and tight controls. The basic coronavirus PCR test starts with a reduction process—a series of steps to wash the specimen from the swab, inactivate any virus present, and separate out the genetic material (both human and viral). What arrives at the lab as a six-inch specimen tube of material is reduced, by means of chemical reagents and various machines, to a few extracted drops of nucleic acids. Then comes the viral-detection phase. Enzymes and probes—special stretches of DNA—are added that, under the right conditions, recognize and bind to SARS-CoV-2 RNA. (The genome of coronaviruses is made of RNA, not DNA.) The binding of a probe triggers a reaction that creates a DNA transcription of the viral RNA template. That enables the final steps: the signalling process.
The mixture is now put into a PCR machine—in essence, a tiny oven that sequentially heats and cools the mixture to precise temperatures, triggering further reactions that generate new copies of the viral genetic material. Each cycle of heating and cooling doubles the number of copies. After thirty cycles, up to a billion copies of viral DNA are produced from each strand. A separate marker in the mix recognizes the DNA and releases a fluorescent dye that can be measured by an optical device in the machine; there’s a threshold above which the test is considered positive. The result is checked by a technician and released electronically back to the test site. Although labs are constantly making improvements to this chain of steps in order to increase efficiency and accuracy, the whole process, from receiving a sample at a lab to sending a result, typically takes between six and twelve hours.
Running a clinical laboratory in the United States requires making the entire collecting and processing operation run smoothly. That’s why testing here is dominated by such a small number of national laboratories. The big four commercial labs are really logistics and distribution companies wrapped around a network of regional laboratories. That’s also what makes them a chokepoint. As Quest and LabCorp have both warned, they do not have the ability to expand their systems quickly enough to meet current needs, let alone meet the demands that will come with flu season.
Yet we have other laboratories with large amounts of untapped processing capacity ready to provide next-day results. In July, for instance, I visited the Broad Institute, a large academic laboratory affiliated with M.I.T. and Harvard, in Cambridge, Massachusetts, which has provided coronavirus testing for area hospitals, clinics, and others. As Sheila Dodge, the senior director of Broad Genomics, explained as she walked me through its molecular-testing operation, they had the capacity to process up to thirty-five thousand tests per day. With a few weeks’ notice, they could expand that to a hundred thousand a day—more than fifteen per cent of the nation’s current capacity. But, when I visited, they were receiving just a few thousand test specimens per day. I saw an entire room of machines standing by, mostly idle…
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The catastrophe on the high seas threatens supply chains, international finance, and the lives of seafarers. https://t.co/KMWZUr7Ifk
— Justin Ling (@Justin_Ling) September 19, 2020
Knock-on effects of the pandemic, per Bloomberg:
On July 25, the Unison Jasper pulled into the Australian port of Newcastle carrying 31,000 tons of alumina bound for one of the country’s largest smelters. The ship had traveled around the world in the seven months since the pandemic began, but in Australia, authorities found a problem serious enough to detain the vessel.
Seven of the 22-person crew had been on the ship for 14 months, beyond the end-date of their contracts and in breach of international maritime law, regulators and union officials said. They were owed $64,000 in back pay, and there wasn’t enough fresh food. There was also no valid plan to get them home to their families in Myanmar. They wanted off…
In conversations with Bloomberg reporters, more than 40 seafarers on nearly as many ships described deteriorating conditions. Most asked for anonymity given the fragility of their situations. About half didn’t have current contracts and some said they hadn’t been paid in more than two months, meeting International Labour Organization’s definition of forced labor. Overtime pay, they said, was inconsistent, if their extra hours were logged at all. Most haven’t left their ships in months after coronavirus outbreaks tied to cruise liners and merchant ships put an end to shore leave. Seafarers with abscessed teeth haven’t been able to get dental care, and others say they’ve received stitches from crewmates in lieu of off-shore medical attention. On one ship, the captain died of a heart attack, and the crew stored his corpse in the freezer for nearly two weeks before it found a port that would repatriate the body…
Many companies have rerouted ships and chartered flights to facilitate crew changes, and still some 300,000 seafarers are overdue for relief—a number that grows as the pandemic drags on. The crisis has begun to reach shipping investors including global asset manager Fidelity International Ltd., American insurance giant Massachusetts Mutual Life Insurance Co., asset manager Oaktree Capital Group LLC and finance titan JPMorgan Chase & Co. If it isn’t resolved soon, analysts say, it threatens to ripple up the supply chain, affecting commodities companies like Cargill Inc. and Glencore Plc. and retailers like Dick’s Sporting Goods Inc., just in time for the holiday shopping season…
Most efforts haven’t risen to the magnitude of the crisis, says Kinsey, the risk consultant at Allianz. More drastic action is in order, he says: Ships should stop calling at ports that refuse to repatriate seafarers, and ship owners should declare their vessels unfit to make deliveries because the crew is overworked.
“Nothing’s going to get resolved until you start disrupting trade,” Kinsey said. “If everything gets delivered and ships continue to come and go, the crew gets forgotten. That’s what’s happening now.”…
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Those of us who’ve been reading about this since March or April won’t find much novelty here, but for those who haven’t, it’s a comprehensive roundup from a ‘trusted sourse’…
I am just saying: if you have not been following the coronavirus news closely, and you read this piece, you would have a solid broad-stroke understanding of what's up. https://t.co/u20zqzAxvw
— Jeneen Interlandi (@JInterlandi) September 18, 2020
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One more thread:
We're about to pass the deeply tragic milestone of 200,000 deaths from COVID in the US. What have we learned about COVID and our response to it over the last 7 months? So much. Here is a start: 1/x
— Tom Inglesby (@T_Inglesby) September 19, 2020
Government needs diagnostic manufacturers to be ready to prepare to develop & mass manufacture diagnostic tests (PCR and rapid Ag) – to Dx the sick and their contacts, to screen asymp in higher risk environments, and for surveillance. We need a national testing strategy. 3/x
— Tom Inglesby (@T_Inglesby) September 19, 2020
No more reliance on international supply chains. No more laissez faire approach to ‘letting market handle it” because it won't 5/x
— Tom Inglesby (@T_Inglesby) September 19, 2020
rikyrah
Andy Slavitt is a go to Twitter feed for me. He is terrific. He is informative.
Baud
Someone I know had family member just die of COVID. She was in her twenties.
WaterGirl
@Baud: Holy shit.
Roger Moore
The thing that’s so maddening about the Inglesby thread is how little of the stuff we’re supposed to have learned is really new. We knew a long time ago that you need to be ready for a pandemic before one shows up with stockpiles of supplies. We knew that you have to start preparing tests and testing strategies on the assumption it will show up sooner rather than later. Back when we had a competent government, we were doing those things. The only thing that wasn’t built into our plans was the need to avoid international supply chains. We just decided to throw that knowledge out the window out of spite and stupidity.
Tony Jay
And in Britain the over-promoted poshboy slacker 14+ million Britons prefered as Prime Minister over the fictionalised monster our non-partisan Press offered as his only challenger has had the nerve to tell the nation a 2nd Wave of mass infection was always inevitable, and has nothing to do with the fact his z-list Government treated the pandemic as a Poor Person Problem they could exploit to funnel billions out of the public purse into donor’s pockets.
The winter and spring riots here are likely to be epic. They’ve quite simply skinned the country’s patience down to wet muscle – before – the real pain kicks in.
Who’s to blame, Flobalob? Could it be you? Enquiring minds, etc.
Another Scott
@Baud: :-(
We still don’t know enough about COVID-19, but we know that age is no guaranteed protection.
(The story says the person’s age was between 10 and 19, but are giving no other details.)
:-(
Condolences,
Scott.
Omnes Omnibus
No, very specific people did that.
Keith P.
Contrast how fast Mitch McConnell moves to make a vote on SCOTUS vs making a vote on a COVID relief package.
Tony Jay
@Baud:
Jesus Christ. That’s bloody horrible.
WaterGirl
@Roger Moore: I found the ad very comforting last night – the one where RBG talks about the pendulum swinging, and hopeful that it would soon be swinging back because it has gone too far in one direction.
But we’ll have to build US supply chains from scratch, and that’s gonna take time. And that’s just one piece of it.
opiejeanne
@Baud: Terrible. It’s so awful that whenever I hear anyone has died, including Belichick’s 98 year old mother, that my first thought is Covid-19.
My niece’s cousin goes to USC, baseball scholarship. His roommate was just diagnosed with Covid. He came home for the weekend and casually mentioned it to his parents. They had everyone in the house tested, and he’s got it, but they tested negative.
His comment was, “I’m not sick. I don’t feel sick.” He’s 19.
Jay
So, we have carpet cleaners, have been the only Chain renting carpet cleaners because we have in store ability to clean and sterilize them between use during Covid.
We, ( the entire Chain) ran out of carpet cleaning soap in August.
We have no Clue when we are going to get some in.
Covid 19 is breaking supply chains.
So, we are sending people to Walmart, Cave On, Stupid Store, Crappy Tire for soap, because they have soap, but can’t rent their machines.
(* yes, I know that formite transmission of SARS-Covid-19 via a carpet cleaner full of soap is probably 0% possible, but apparently the Corporate Lawyers don’t.)
Jay
@opiejeanne:
So far, 7 – 21 days to go.
Redshift
I found out from my parents that the father of a family we’d been on swim team with back in the day had died of covid. (I haven’t seen them in a few years, but my parents still cross paths with them and mutual friends at the community pool.) The father was in home health care, so they didn’t find out until afterward that it was covid. The whole family went to be with him when he was dying, and they have all had it since then, though thankfully no one else died.
Another Scott
We don’t have to do it all, but we should do what we can as long as we can.
(via NotLarrySabato)
Cheers,
Scott.
Jay
@Redshift:
I don’t fear dying of Covid, I fear being crippled.
trollhattan
So the spouse has a river paddleboard class today, up in them thar hills. Small group with a lone instructor, congregate at the put-in spot, masked and distanced, getting the day’s rundown. Then a group of about 150 fundys show up for a gottdang mass baptism in the American River, packed together, unmasked.
Her group skedaddled across the river and went on with their day. I hope fundy Jezus held back the virus today, because a thousand unsuspecting people will interact with that group over the next week.
Jay
@Another Scott:
Ruckus
@Baud:
Just read a tweet that a young doctor 28 just died of Covid. All that work to get to be a surgeon and she’s gone.
trollhattan
@Jay:
Can I not have either? That’s what I signed up for.
Amir Khalid
@opiejeanne:
His chances of serious illness and life-long consequences are relatively low but not zero. The denial is strong in this one
TS (the original)
Lockdown seems to work. Melbourne (Australia) had just 11 cases today (2 deaths). I can’t remember when this new lockdown started but I think late July was the full stage 4 with curfew. So 2 months & down from 700 to 11. Shall have to see if it lasts.
And the economists are saying – fix the virus & the economy will fix itself – which all the sane people said at the beginning.
Jay
@trollhattan:
yurp, I too would prefer neither, and have “free healthcare”, but spending the rest of my life with diabetes, or erectile dysfunction, or heart and lung damage, or brain damage, un able to walk,
I’ll take death over that.
Redshift
@Jay: Another friend in Texas has “long covid” along with her son. She had it several months ago and still is exhausted all the time. I may have mentioned her a while back because when one of the hurricanes was headed in that direction, she was hoping it wouldn’t hit, because she didn’t have enough energy to drive to evacuate.
Jay
@TS (the original):
masks, wash hands, lockdown, GAI,
we knew that in Feb.
the Powers that Be and many of our neighbours, failed us.
Amir Khalid
@TS (the original):
Of course lockdown works, if you’re strict about it. The only problem is that people get tired of it. and want out NOW NOW NOW.
Amir Khalid
@Jay:
You will, eventually.
?BillinGlendaleCA
@Amir Khalid:
opiejeanne did say he’s going to U$C.
Jay
@Redshift:
we lost an Associate back in March, young Syrian Refugee just starting to rebuild his life, have one young, one older Long Haulers struggling to come back, months later. The young one, ( former ultramarathoner) get’s MRI’s every month, still has micro clots in her lungs, heart, pancreas and brain.
Can barely read a paragraph with out exhaustion. Forgets names, can’t hold a conversation.
Jay
@Amir Khalid:
diabetes on my Mom’s side, strokes on my Dads side.
Dad lived 24 years in extended care, unable to get out of bed.
Grandma, 38 years, unable to even recognize her children.
There is a real limbo.
JMG
My son and his fiancee, who rescheduled their wedding to the end of next March, are moving towards a decision that they can’t have the one they want in Brooklyn and will find a JP and just get married by themselves. My rage is such that if somebody like Lindsay Graham or Mike Pence was in front of me, I could and would easily kill them with my bare hands. I’m 70. I could live a long time yet and I still don’t think this virus will get beat. America is too fucking stupid and much of it too evil to do what’s needed.
opiejeanne
@Jay: I know. I really hope they don’t get it. Her aunt Debbie is one of the nicest people I know, and her uncle is the only one of the three brothers (including her dad) who seems to be sane.
Cheryl Rofer
Good to see Gawande and Inglesby pushing testing.
We will not have a vaccine generally available until mid to late next year AT THE EARLIEST. Testing can make things more bearable for us meanwhile.
I had a short Twitter chat on the subject that got me wondering if the Ignoramus in Chief isn’t messing things up again so we can’t have testing. “I really think we do too much testing.”
opiejeanne
@Amir Khalid: He’s an athlete and not as bright as I thought. If he continues to exercise and train he risks damage to his heart, possibly permanent. I hope he stays in quarantine and behaves himself. I’m not sure where he’s quarantined, but I don’t think he’s at home.
opiejeanne
@Jay: Watching Bill Belichick wearing a mask incorrectly. He started with his mouth uncovered, and by halftime his nose was hanging out. I want the Seahawks to beat him so badly! Their coach is wearing his mask correctly, except for a brief moment when they were leaving the field at the half, and he wasn’t near anyone so we could see his smile.
opiejeanne
@?BillinGlendaleCA: Oh shush you. We all know you went to UCLA.
The operative part of this is probably not the particular college, but any college plus the age.
Ohio Mom
JMG @31: My cousin’s daughter and her intended finally went with a Zoom wedding over Labor Day weekend.
It was short and sweet and small — just the couple, the officiant and the videographer. All their family members live many states away; the young couple are in Nevada because that is where they were both able to find jobs in their fields.
I could see my cousin in a box on the screen, wiping away her tears. I know it broke her heart not to be there in person.
For me, it felt funny to stop my Saturday morning chores to sit in front of the laptop to witness the ceremony and then twenty minutes later, go back to housecleaning. I’m thinking it was at least a historic wedding. Everyone will remember the wedding was a Covid one.
Jack Canuck
@TS (the original): Back to Stage 4 was early August (2nd maybe?). It’s working, but holy crap we’re all sick of it. As a teacher (and parent) I have to say that I hope they prioritise getting kids back to school once Term 4 starts, above hospitality or retail etc. In my (completely man-in-the-street) opinion, things are in good enough shape for that, and it would make such a difference for the kids and an awful lot of adults.
Sally
@Cheryl Rofer: Okay, start with the WH, do less testing THERE!
HE does too much testing.
Jay
gwangung
@Jack Canuck: The country is so flummoxed with so many different standards and so many different strategies that NO plan is going to be trustworthy at this date.
Fuck the shitgibbon for refusing to lift a single finger to do anything.
Jack Canuck
@gwangung: Should clarify that I’m talking about the situation specifically here in Melbourne regarding reopening. We’ve been doing this whole thing through the middle of the school year instead of over summer break as in the northern hemisphere, and it’s been exhausting for teachers, kids, and parents.
Jay
@opiejeanne:
in June, the Corp made a digital “learning” module on mask wearing mandatory, ( and gloves),
my DS told Kim and I to basically “blow it off” because she has been watching our mask and gloves protocols since Feb.
We both also constantly wear eye protection.
Rain-X, Fog-Off or even just a 3% soap solution, applied, dried and then gently polished clear, ( along with a proper nose bridge, properly fitted), will keep eyewear from fogging for at least 4 hours.
gwangung
@Jack Canuck: Oh. Well, that’s different.
I’m so pissed off at this disaster in the US that any Trump administration figure is gonna be in danger of their lives if they get within striking distance
opiejeanne
@gwangung:
YS
@NYinLA2121
·
3h
Watching our kids surfing from the beach, my wife lifts up her head from her book, turns to me… “I hate Mitch McConnell so much I would unplug his ventilator to charge my phone.” Then went back to her book.
LongHairedWeirdo
Apropos of nothing in particular, I’d also like to point out that there are too many stupid fact checkers out there, insisting that Trump’s declaration that “this is their new hoax” isn’t damning, because…
Let me pause here. I’m going to lay this out in a way that makes those fact checkers look moronic, so I’d be glad to hear a different explanation that, nevertheless, explains why they’d say using “he said hoax” isn’t quite true.
Where was I? Right, fact checkers saying that it’s not truthful to point out that Trump said “this is their new hoax” because he wasn’t saying that the *VIRUS* was a hoax, but that the Democratic *reaction* was a hoax. They weren’t actually *concerned* about the virus killing tens of thousands, they were just trying to damage him politically!
Well, whether he was saying the virus was a hoax, or that the Democratic concerns about it were a hoax, he was 100% wrong, 100% stupid, and 100% worthy of having his epic failure being remembered.
Poe Larity
Brainiac on 60 Minutes bemoans both-sides-do-it:
If only Nancy wasn’t such a meanie.
Ohio Mom
Cheryl Rofer @33: Thank you for reminding me that increased testing can be a bridge to some level of normalcy until the world is vaccinated. It’s something to hope for.
I’m having a bout of cabin fever and feeling very deprived. Not anything special, I know everyone else feels the same way. So I’ll start whispering “testing” to myself and see if that helps.
Matt McIrvin
@Poe Larity: What the fuck? Does this person ever talk to Republicans? No, they do not agree with any of those things, that’s the problem.
I was just telling off one of these numbskulls waving an obviously deceptive climate graph on Facebook the day before yesterday (which revealed global warming to be nonexistent through the magic of stupidly scaling the y-axis), right after Lindsey Beyerstein and I wasted a bunch of time arguing with a COVID denialist on Twitter. Just a moment, I’m going to bang my head against the wall some more.
Brachiator
Playing with numbers…
Trump and conservatives who think like him keep trying to minimize the need to try to contain the coronavirus. They point to the “relatively” small number of fatalities or the groups they think are most at risk and declare that it’s more important to get back to normal and get the economy working again.
But here is a very simple way of looking at why we are fighting this thing. We are trying to minimize the spread of the virus and protect the lives and health of the 40 percent of Americans who are most at risk. I am using Kaiser Foundation numbers for this little exercise.
Again to simplify, let’s assume that kids are not at risk. But 92.6 million adults over age 18 are at risk because they have underlying health conditions or are over age 65. This includes 41.4 million adults age 18 to 64, and 51.1 million adults age 65 or older.
And even here, not all of these people would get seriously ill if they caught the virus, but here is a rough and dirty calculation. Based on what we have seen to date, we can predict that about 92 percent of the hospitalizations and fatalities will come from this group.
Are their lives worth it? I would say hell yes. But then again I am a member of this group, so I have a vested interest in being protected.
And the evidence suggests that younger people who do not get ill or who do not get seriously ill are infecting older people.
In Italy, the median age of cases went down from nearly 60 in February to 30 at the end of August. Now, it’s back up to 40 — and experts think it’ll rise again as outbreaks move from social settings like nightclubs into households again.
We are beginning to see similar patterns elsewhere in Europe and in the United States.
Just one way of looking at it. In addition, about 5 million folks most at risk do not have health insurance. And oddly enough, a significant number of this group live in red states or in Southern states.
ETA: And obviously, when you look at the wider course of this pandemic, children and younger people are at risk, people who survive hospitalization suffer long-term effects, and there is still much that we do not know about this virus and its effects.
Another Scott
More news from the UK:
(via Brad DeLong’s blog – https://www.bradford-delong.com/2020/09/islam-england-has-lost-control-againnoted.html )
If you’re watching Kevin Drum’s daily graphs of fatalities, they’re clearly a lagging indicator. https://www.motherjones.com/kevin-drum/2020/09/coronavirus-growth-in-western-countries-september-19-update/
Cheers,
Scott.
Benw
@opiejeanne: tuning in late now that the LAL/DEN game is done (holy hell Lakers!!) and I’m happy to root for the Patriots to get crushed (although I do like Cam)
Fair Economist
@Jay:
Wow, that’s brutal. We will see such a catastrophe if the Republicans manage to trash Obamacare.
Xenos
As a US expat in the EU I am really divided from my family now, can’t visit, can’t host anyone. My daughter had a mild case of Covid over the summer, is doing fine now, but she wanted to go to college in the US, and how can she get insurance now she has a broad preexisting condition?
We can still vote and pay taxes, but there is no going back, indefinitely. This really changes how you view the world and your place in it.
Jay
Another Scott
@Xenos: The ACA is still the law of the land in the USA and most (except for Donnie’s super cheap plans, I think?) health insurance cannot discriminate about pre-existing conditions. She should not have any trouble at all signing up for a decent policy.
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
Check with David Anderson here if you need more details.
Good luck!
Cheers,
Scott.
Dan B
@Matt McIrvin: I was shouting at McMaster when he spelled out what we “all” agree on. He hasn’t heard what my in laws say, or sometimes bellow.
JaySinWA
@Poe Larity: Good god, he believes that a majority of R politicians would agree to all of those climate change statements? What cave has he been living in. Some have 1, a few have 2 but virtually no-one will commit to 3.
Brachiator
@opiejeanne:
I would hope that schools would counsel students who test positive to notify family and relatives before they just pop up at home
Kay
@Xenos:
My son and daughter in law are in the same boat. I just miss them. I spoke with them today and they said Danes resisted wearing masks initially but now they’re seeing a lot of them:
They’re both voting for Biden but it won’t help much- Illinois voters.
Jay
@Fair Economist:
you will see massive tragedy, if you don’t fix the ACA. SAR’s Covid 19 is here to stay, for at least half a decade, if we all do everything right, ( which we are not),
medical care should be a human right, not a market commodity.
Kay
@Jay:
I love that. The bluntness is very Chicago :)
Cheryl Rofer
@Matt McIrvin: Blocking is your friend on Twitter. My patience is short right now, and blocking people helps to save it for the important things.
Lacuna Synechdoche
WaPo:
I love how the Trump administration is now making lifetime appointments on the basis of short-term (less than 45 days) political expediency.
It just gives me so much confidence in our long-term prospects …
Brachiator
@Amir Khalid:
His comment was, “I’m not sick. I don’t feel sick.” He’s 19.
It’s not denial. His statement is eminently reasonable for now. Right now, no one has developed follow-up protocols to document and track post virus health issues. No one knows what his health may be like 5 or 10 years from now.
BTW: A couple of British comedians on a panel show noted that they had the virus. Both are in their 30s and reported getting winded much more easily while running or exercising.
Jay
Brachiator
@opiejeanne:
That is cold.
And it made me laugh. Thanks.
TS (the original)
@Amir Khalid:
Firstly they whinged about it. Then they attacked the Premier because it was all his fault in the first place.
Now that it is proven to work – they are complaining because some people are not being fined for breaking the rules!
My mother survived 5 years seeing my father only 3 times. He didn’t see his first child until 2 years old. We have had it so easy.
Jay
@Brachiator:
it isn’t. “I don’t feel sick” simply means that he’s asymptotic right now, could be a much bigger issue up to 21 days later, or lifelong.
Because SARS-Covid 19 amongst other things, suppresses lung function, but not through CO2 excession, which the body feels as suffocation,
lots of cases have been recorded as “feeling fine”, and a couple hours, days later, dying before they could get to the elevator, when they finally “felt sick”. And it’s most common amongst young adult males.
I do a pulse oximeter reading in the morning, and before bed. So does SWIMBO. If it drops below 80 on the oximeter, we will go to the ER and let them know.
TS (the original)
@Jack Canuck:
I can understand that. I’m not in Melbourne, but being older with breathing issues, I haven’t been to a social event since February. We get 90% of our shopping delivered & one of us (couple) goes out once a week for anything else. our exercise is online classes plus a 30 minute walk most days. I haven’t seen my child/grandchild since February. See them online only.
I’m sick of it too – but if it helps kill off this virus, I’ll do it. At least everyone is now much more appreciative of teachers/schools having tried the home schooling option.
?BillinGlendaleCA
OT: I just read of news that the Nature Center at Devil’s Punchbowl(my May 27th OTR submission) burned down in the Bobcat Fire.
ETA: All the animals at the center were evacuated prior to the fire getting there.
Mai Naem mobile
I’m just feeling down about all this. I just feel like we’re entering a very dark period. I know people don’t like Debbie Downers on these threads but all I can imagine is bad scenarios, each being worse than the other. They get the a USSC Justice and Orange Pig wins the election because of the USSC. I want to see it but I don’t see the Dems having the balls to pack the court and add PR and DC. Anyhow, I know the Dems are going to talk about Roe but frankly I think talking about the ACA would net more votes. I sincerely believe with Plan B,chemical abortions,change in attitude towards illegitimate births,OTC pregnancy tests etc. etc I don’t think Roe makes as much impact on voters as healthcare. Don’t get me wrong, Roe is important but politically IMHO healthcare is more potent.
Brachiator
@Jay:
Right now, no one can say anything meaningful about lifelong issues and it makes no sense to judge his statements from that perspective. Covd-19 is new. You cannot point to anyone who has survived it and say anything about lifelong issues.
And yeah, as he goes through quarantine, things might change, but still there is no way to judge whether or not his statement will be reasonable a week or two weeks from now.
And depending on when he was diagnosed, that he does not feel sick now could be a good sign.
And the odds are hugely in his favor if he does not have any of the documented underlying health issues.
Xenos
@Kay: masks in Belgium, France, and Luxembourg are universally enforced in any sort of enclosed space. Kids are back in school, but the first reports of kids getting positive test results are already coming in. It will be a long year.
Brachiator
@Mai Naem mobile:
It is reasonable and understandable that a lot of people feel uneasy. BTW, I think it is sometimes easier to feel down about the possible outcome of events simply because we can look at the current bad and project. It is harder to imagine a brighter future that has not happened yet.
However, we simply do not know how things might change for the better when (not if) the Democrats win in November, especially if they win big.
Also, I don’t think that there is much point in trying to weigh Obamacare v Roe. Both are under attack. And it is not as though we can offer one as a sacrifice to appease Republicans.
BTW have you ever seen Julie Nolke, Explaining the Pandemic to My Past Self
The future always takes us by surprise.
Julie, Part 2 is even wilder. Can’t imagine what Part 3 might be like
Jay
@Brachiator:
Safir had the “flu” back in Feb. 24 years old, no “underlying health issues”. Called 9/11 when he “couldn’t breathe”. Died before the Ambulance got there. 24 minutes from “having a mild fever” and nausea, to being dead.
Now, we all, ( minimum wage employees) support his wife and kids, and are trying (sponsoring) to get his parents and younger brother out of a camp in Lebanon,
but, Covid.
I understand the “immortality of youth”, but for christs sake, the kid may have killed off his whole family by not letting them know in advance.
frosty
@Brachiator: It made my wife laugh too. It’s the casualness of charging the phone.
Jay
@Mai Naem mobile:
has there been conversations here on how, by hard House and Senate rules, ( not “norms”), impeachments take precedence in the schedules over confirming judges?
Jay
Roger Moore
@TS (the original):
It’s fun to complain about people being inconsistent, but I’d rather they change and get it right than be consistently wrong.
Another Scott
@Jay: Google tells me:
FWIW.
Cheers,
Scott.
Jay
James E Powell
@Poe Larity:
Has HR McMaster not watched FOX news? Is he not familiar with the statements of the president he worked for as NSA? Americans do not agree on these things at all.
Roger Moore
@?BillinGlendaleCA:
It’s terrible. I thought they had the Bobcat fire more or less under control, and then it suddenly blew up. I feel terrible for the people in the Antelope Valley. It feels like all the effort spent protecting Monrovia and Arcadia was at the expense of preventing the fire from spreading elsewhere.
Amir Khalid
@Brachiator:
opiejeanne’s young relative is quite clearly in denial; he’s positive and has been ignoring the precautions he must know he’s supposed to take to protect himself and others around him. Medical science has yet to document all the long-term issues for survivors of this very new disease, true. But it does know that those issues exist, even for those who have had only a mild case of the disease itself.
RaflW
It feels like this country is becoming more and more of a powder keg. Will we manage to act like the good people of Minsk and other Belarusian towns and cities? I doubt they have an NRA-fueled paranoia culture. But I really don’t know how much they’re armed v. here.
RBG’s death magnifies a lot of factors. And I think a SCOTUS operating with at least two stolen seats, propping up a mad and moronic president, while stripping health care from millions of sick people, well, that’s not going to work out how Republicans think it will. And that chaos, anger and violence that seems too likely will cause untold suffering and loss.
It’s rough. Damnably so. I’m not giving up. I’m trying to get my head around how things might go so I can gird myself for the challenge.
Mary G
Allie Brosch of Hyperbole and a Half has put up a chapter of her new book on her blog, and it is hilarious.
?BillinGlendaleCA
@Roger Moore: They were trying to keep it south of Angeles Crest while doing structure protection on the south side, it didn’t work and the winds picked up in the Antelope Valley. It’s very sad.
patrick II
@LongHairedWeirdo:
The only way that the Democratic alarm at COVID could be called a hoax is if the underlying premise — that the virus wasn’t worthy of alarm — was false. It wasn’t. And saying the Democratic response was just a hoax is just as wrong.
Not to mention Trump didn’t specifically say the Democrat’s response is a hoax, he said
joel hanes
Azar moved to take all control over approval of vaccines and treatments, not just for COVID but for all conditions, out of the FDA — and asserts that now, only he has the power to approve.
https://twitter.com/dandrezner/status/1307894891163324417
I’ll be god-damned if I’ll let myself be injected with anything subsequently approved by Trump’s FDA.
Jay
Roger Moore
@?BillinGlendaleCA:
I know intellectually it’s not a fair criticism, but it feels like one of those cases where the rich people get the elevator and the poor people get the shaft.
RaflW
@Roger Moore: This is rather minor, but I have a fondness for the scrappiest and most obscure ski areas in America.
Mt Waterman is one of them. It appears to be well inside the Bobcat burn zone on Inciweb. I drove up there a few years ago to check it out. Three aging lifts run on a few weekends in some lucky winters that have snow, and for summer hike/bike/frisbee golf.
Compared to homes, neighborhoods and lives lost, it’s small. But it all just sucks.
Chetan Murthy
I live in a really liberal, science-based city, where we don’t leave people behind, esp. people whose lives and work are so heavily intertwined with all our lives.
https://missionlocal.org/2020/09/mantra-follow-the-data-and-science-to-crush-covid-19-falls-short-for-latinx-and-southeast-san-francisco/
NOT. Sigh. So even while SF’s infection rate is dropping, the rate in working-class Latinx communities is high, and SF isn’t even doing adequate testing there. And these are poor people, who have to work to survive. The city isn’t providing income replacement for people who get sick, so they can quarantine.
I guess I shouldn’t be surprised. But it means that even if the city as a whole seems to be licking the virus, in critical communities there’ll still be community spread. B/c even in SF, we’re unwilling to do what it takes to lick this virus.
And meanwhile, people wanna reopen restaurants for indoor dining.
Emma from FL
So… I have worked in Universities since 1983. One of my first supervisors explained it to me this way:
The common name for a college student between the ages of 18 and 24 is some variation of “fuckup.” Even the most thoughtful, intelligent, informed one will screw up at some point, kayn ahora, not badly, but that cannot be guaranteed. They are nor perverse or stupid. They are young, and their judgment skills are still underdeveloped. They also think of themselves as immortal. The combination can be terrible.
In the age of COVID, well, it can be deadly.
Jay
Brachiator
@Jay:
Yep. I noted that. But it is also clear that schools and other institutions should counsel students and probably staff on things they should do if they test positive for the virus. They should be encouraged, if not outright required, to inform family before they return home.
And there may be some legal or medical confidentiality issues as well.
But it is not only an issue of the student doing the wrong thing.
And of course, we don’t know whether any procedures were in place to deal with this.
?BillinGlendaleCA
@Roger Moore: I think they really thought they could keep it south of the 2, but the winds shifted. Good for Monrovia and Arcadia, bad for Juniper Hills.
Jay
@Emma from FL:
in some regards, it really depends.
injury, sure, I was immortal and healed fast,
stupid stunts, well, I would bet beers in the student lounge, that I could break bricks in the decorative wall, with my head.
Transmissible diseases, nfw. Had too many as a kid, before vaccines, lost friends.
as I tell the younger associates at work, this is my 4th pandemic, and we still don’t have vaccines for 2 of them, and they are still out there, and it’s been over 40 years.
Ruckus
@Roger Moore:
Possibly true but the entire area is/was primed for a fire. Most of it hadn’t burned in 60 yrs and you know what the vegetation is, very drought resistant, the terrain is very inaccessible so the only way to fight it is water drops. There aren’t a lot of places for a plane to reload water so that leaves most water drops to helicopters, which can’t carry as much water. They seemed to be hoping to use route 2 to stop the fire but if it crossed they really had almost nothing to stop it till route 138. Which is where they are now.
Brachiator
@Amir Khalid:
Nope, but you raise some interesting points.
We don’t know whether he ignored precautions in the past. And as I noted elsewhere here, we also don’t know if his college just sent him home or counseled him about telling his family before he went home. It seems obvious, but wouldn’t it make sense for schools to have some formal procedures in place for students, teachers and staff who test positive?
Even a kid who was otherwise smart and kind might not know how to react to the news.
The majority of younger people who test positive for the disease do not display any issues later. HOWEVER, I have not seen anything anywhere that suggests when anyone who has tested positive for the virus but who does not contract the disease should have any follow-up medical checkups.
Also, right now, there appears to be some differences in the health outcomes of people who have been hospitalized for the virus and who have recovered, and people who test positive but who never have to be hospitalized. And obviously, very little data has been accumulated on people who never go to their doctor or to the hospital.
Jay
@Brachiator:
about a month ago, I woke up running a temp and nausea. Pulse oxy was normal, but I was 103.
called work, scheduled a Covid test.
didn’t go into work and they told me to stay away.
Covid test was negative.
Later that day, abdominal swelling and pain.
MRSA infection in my upper intestine.
it’s a condemnation of the entire US “systems” that a 19 year old, old enough to no better, comes home and casually announces that the ly have Covid. A whole generation of Typhoid Marys,
Mai Naem mobile
@Brachiator: I am definitely not sacrificing Roe. I just think putting the ACA front and center is more important because of COVID and that it’s become more popular and in the past it’s been shown to be a winning issue for the Dems.
@Jay: i am all for whatever tools Nancy can use. We are talking about eating up about 15-20 business days. I am guessing the Dems on the Judiciary committee can eat up at least 3 days. Also the vulnerable GOP Senators are going to want to be campaigning. Also there’s always COVID19 around to mess with stuff.
Ruckus
@RaflW: The “ski” area is within the fire area. However the only skiing done in the last few years has been on man made snow, otherwise it would be rock skiing.
Emma from FL
@Jay: I didn’t say they all acted on it or that all acts are of similar severity. But the potential is always there. Every librarian of long standing has at least one interaction that usually ends with “shit, he was here last week looking for Prof. Robson’s reserve readings, what the hell happened?” I would say, with a degree of certainty that I am under-counting, that 70% of all students that passed through my door in my years in public services were primed for disasters ranging from “oops” to “AAAARRRRGH”. 98% of them went on with their lives, more or less bruised by the experience. The other 2%, well…
Jay
@Brachiator:
https://www.webmd.com/lung/news/20200811/asymptomatic-covid-silent-but-maybe-not-harmless
https://www.webmd.com/lung/news/20200811/asymptomatic-covid-silent-but-maybe-not-harmless
Asymtomatic people still have microclotting issues in all their tissues.
We don’t know the long term issues on a disease we have only started to know about.
Ruckus
@?BillinGlendaleCA:
With so much of the west coast region on fire or burnt out the resources are spread very thin. I think the system can handle something about half the fires that have burned over the last couple of months, after that they have to do exactly what you said, protect structures first and uninhabited land second. It’s not good, it’s what there is. I think that in CA alone there has been probably 3/4 of a million acres or more burnt (and my estimation may be rather low) with only so many planes, helicopters, people, bulldozers, there is just only so much to be done
Here is the statewide CalFire report page. I’m off by just a bit of acreage.
jl
I am cranky, so apologies in advance, but the idea that a new serious virus might cause chronic damage is kind of ‘well… duh….’. That is why the messaging to younger people has always seemed very irresponsible to me. For some reason, serious supposedly expert people in the US, decided early on to implicitly tell younger people they didn’t have much to worry about, and their adherence to precautions was to save others. Well… OK, what now? It caused serious harm to the control effort, and now more and more evidence it is causing serious harm a substantial portion of younger people who get sick, except not immediately apparent.
There were serious chronic effects of the 1918 pandemic flu. Many infectious diseases have cause serious long term damage that is not immediately apparent.. chagas disease, dengue fever are two. Polio used to cause long term, very slowly emerging nerve damage to those who seemed to escape unscathed during the acute illness. I think the extent of the heart damage is still emerging and we are not sure how serious it really is, and how many of those with asymptomatic or mild infections will be effected. But why take the risk? The precautionary principle doesn’t seem so silly or over cautious when it comes to our own health, which may be a clue why we should take it more seriously in other areas.
I think there is more evidence that asymptomatic and mild cases cause lung scarring, which when a person gets older can kill them. There are several endemic fungal infections in the US that do that. Killed one of the oldsters in my family. He had to mild fracture in a leg, and had to stay in bed for a while. He was in such good shape otherwise the docs weren’t that worried. but his lungs began to fail, and lung imaging showed large areas of scarring. Doc said ‘Looks like he had coccy when he was young… so now things are serious’. Coccidioidomycosis. So, he declined and died, because of the lung scarring and having to lie down, not the minor fracture.
The longer this tragedy continues, the more I think ‘everything old is new again’. The countries that have done best at beating covid-19 didn’t sit around ooohing and aww-ng, and panicking and gaping at this ‘every thing is unknown!’ and ‘so much we don’t know’ crap. They got to work, applied infecious disease epidemic control practices that have worked for 100 years. Look at Taiwan and New Zealand.
BTW, just we can all know how decayed and degraded the US is, a number of very poor African countries are now showing they can do better than us. Even accounting for differences in age structure of the population (which for some of them is substantial), they are doing much better.
Jay
@Emma from FL:
while old age and treachery will beat youth, innocence and feelings of invulnerability,
aids, fuck,
Hep C
hpv
Did nobody pay attention to the PHSA’s?
Jay
@Ruckus:
At last count, roughly 1/2 of Cali’s firefighter pool, is out with Covid or Quarantine,….
Brachiator
@Jay:
From one of your links.
Some people here are making an assumption that everyone who tests positive for the virus all display the same level of serious after-effects. This is not the case.
That’s what I said a few times here and there.
Some anti-mask nut mentioned to me that we don’t know a lot about the virus. I replied that we are still learning about the 1918 Flu pandemic. That’s how science works.
Brachiator
@Mai Naem mobile:
I’m not sure what putting ACA “front and center” means as a practical issue.
What happens and what priorities are set depends on what happens in the November election.
Also, I don’t know what relevant cases will be put before the Supreme Court when it meets for its fall session.
A lot of variables at play here.
Ruckus
@jl:
Conservative principles are money, money, money. How easily can we get it, keep the most of it, and what’s the least we have to spend to do both. Science really isn’t all that old and much of what we consider science is actually quite young. It’s been less than 70 yrs since a polio vaccine was created and I know people today who still suffer because they got it before then. But conservative policy doesn’t give a damn about science, unless they can profit from it. They think that survival of the fittest is a natural law that can not be changed. They think global warming is a hoax. They think that everything can be fixed with a strong military, which they never have to belong to unless they are poor. They don’t give a damn that people are dying, that’s more room and profit for them. Their policies are antiquated and were shit when formulated long ago. But the big thing is they want to live in a world that would feel at home to the parents of today’s geezers, like me, if those parents had been wealthy. Of course they want all the latest doodads but other than that they want the politics of at least 100 yrs ago. And the world is so different than even when I was born that it’s impossible to have that world back. And the majority of people would be chopping off heads if they had to live like that. Because it sucked then and it sucks now.
Ruckus
@Ruckus:
This year in CA it looks like a rough count of the CalFire report page is easily over 3 million acres burnt.
jl
An interesting issue on PCR tests. If the processing is set to make them extremely sensitive, they will pick up infections that have resolved weeks or several months ago. Most PCR tests in the US and Europe are set to be extremely sensitive. So, upsurge in cases in Europe might be more a matter of appropriate test calibration, rather than true increase in cases. The hospitalizations and deaths are not following the upswing in cases, except for Spain, which does seem to have a serious problem. But, as I’ve noted before, the real problem with a resurgence is in the Balkans, there you can see deaths increase with cases within a month.
If you have repeat testing with rapid results, it’s not a big problem. If you don’t, then it’s a big problem because you want a very sensitive test when someone is just coming down with the disease. And for outbreak control, when you can’t do repeat testing, then you have a huge proportion of false positives (from people who had the disease a few weeks or months ago) that swamps the contact tracing system, because you can’t separate the people who are just coming down with the disease from those who are still shedding virus RNA a long time after they recover.
US testing system is too effed up to do repeat testing with rapid results (actually, unless you are rich, can’t do much testing at all with rapid results), so like everything else we are shit out of luck and doing a crappy job.
@michaelmina_lab
So much focus on sensitivity of the test. As though all tests must match up to PCR
But could focusing so much on achieving the greatest molecular sensitivity for asymptomatic testing *when testing is infrequent* be doing more harm than good?
I’ll explain
https://twitter.com/michaelmina_lab/status/1296690611685404672
frosty
@Emma from FL:
Yep, I was one of the 70%/98%. Although I know one of the 2% and I sometimes wonder how and where he ended up. TBI from a fall in the foothills, checking on dope plants.
phdesmond
@Emma from FL:
emma, there’s a classical joke here in cambridge, mass., more popular with the residents than the students, which goes:
a student wheels his loaded supermarket cart into a checkout line. a local says, “hey, kid,” and points to a sign at the register, which reads “Twelve items or less.”
he then asks, “do you go to Harvard and can’t count, or M.I.T. and can’t read?”
Jay
@Brachiator:
that’s “the thing”.
we don’t know.
some people nada,
some people, crippled for life,
some people, like post polio, long healthy live, followed by crippling disease,
In Canada, there ain’t a “preexisting conditions” get out of jail free card for insurers, and there is the Universal Coverage fall back.
?BillinGlendaleCA
@phdesmond: I’ve heard that one, oddly enough from a student at HLS.
egorelick
@Mary G: Thank you for letting us know. I thought she had disappeared forever, overwhelmed by her popularity. Maybe we really will get the end to the Kingkiller Chronicles if we Allie can put new work out there in this pandemic.
Brachiator
@Jay:
Yep. We don’t know. And in some cases, there is nothing that we can know. Nobody can tell you about the health of someone who had the virus 5 years ago because the virus didn’t exist 5 years ago.
I hope that researchers are thinking about what they want to track and methodologies for getting that information.
mrmoshpotato
@Mary G: Thank you!
bluefoot
@Brachiator: A doctor I know said that the recommendation being handed down is for athletes (of any age) who have had COVID is to get a cardiac MRI before restarting training. Not just professional level athletes, but kids who play for their high school teams, or in junior leagues too.
They said there’s also some worry that young people who have recovered may be fine now, but may end up with congestive heart failure or other health issues at a much earlier age than expected e.g. heart attack in their 40s, early strokes, etc. We just don’t know enough yet.
bluefoot
@Jay:
This happened to a friend of mine. She went from feeling fine to dying during the 15 minute ambulance ride to the hospital within a day.
People need to take this shit seriously.