[NatureNS] Covid lock down

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Hello Richard,

     I was hoping you would join the discussion because you, as an MD, 
are able to see this from a different perspective which, for the rest of 
us, as potential medical patients, is a closed book.

     In agricultural research, where there are potentially many 
conditions which might affect outcome, I found it desirable to first 
identify the Coarse Controls; those factors which have a dominating 
influence on outcome. And I think a similar approach might be of use 
with Covid-19.

     From my corner, the top question (Coarse Control) with respect to 
Covid-19 is as follows; How can I best prepare myself so, If exposed to 
Covid-19, I have minimum risk of getting the disease and maxim chance of 
it not being fatal if I do get it ?

     This may be hokum but, based on various articles about people who 
live well beyond 100 and personal experience, I think fresh air, 
physical activity and a positive outlook (good mental health) improve 
the chance of not being overwhelmed by a disease.  So when I see Miners 
Marsh and hiking trails closed but the liquor store open my first and 
last reaction is "How can out glorious masters be so stupid ?"

     I personally am not affected much by such controls because I have 
two woodlots for exercise and fresh air. But the vast majority are not 
so fortunate and when the lock down is lifted one may expect many out of 
shape couch potatoes in circulation and I wonder if they, on average, 
will tend to become carriers if exposed to Covid-19.

     And to balance this I certainly favor an early end to lock down.

     I was just at this point when news of the end of lock down arrived. 
Thank heavens for that. Exposure to fresh air, exercise and personal 
freedom will work wonders.

     This may be pushing the envelope but on medical matters who better 
to ask than an MD ? My sinuses tend to get plugged and a sauce made 
mostly of Jalapenos clears them like magic. I notice that this sauce 
also increases pulse strength.

     It does not affect rate; just strength sensed by fingers on wrist. 
Is this a positive indication (improved circulation) or negative (Heart 
overstimulated) ?

       The internet is not a good source of medical information. My 
lungs are in bad shape so I searched for ways to improve Oxygen uptake. 
Answer: drink lots of water which is almost entirely Oxygen.

Dave Webster




On 5/1/2020 2:35 PM, Richard Stern wrote:
> My 2c. worth, just because I enjoy discussing all manner of stuff  
> ------- There are lies, damn lies and statistics (I can't remember 
> where that phrase came from originally).
>
> When talking about risk in this situation, I feel there are 2 rather 
> separate questions - 1). What is the risk of an individual person 
> contracting Covid-19 or any other infectious disease for that matter, 
> and 2). Having contracted the disease, what is the risk of that person 
> dying of it?
>
> There are several potentially statistically valid ways to determine 
> the true risk to an individual of Covid-19 in a given population, all 
> of them fraught with difficulties and flaws. Probably the best would 
> be to take a very large random selection of a total population, which 
> would have to include pre-symptomatic, asymptomatic, and symptomatic 
> people, test the entire sample for active infection ( e.g. with nasal 
> swabs, although they apparently have a significant false negative 
> rate) , and for evidence of cleared infection (e.g. by looking for 
> antibodies in the blood, which is not yet proven to be accurate). And 
> all the groups would have to be re-tested until the answers become 
> clear-cut. At the present time, it seems there are not enough 
> resources to carry this out.
>
> A second potential method is to compare current death rates in a total 
> population with those of, e.g. 1 year ago, when weather, flu rates ec. 
> were comparable, and assume that any significant difference is 
> probably due to Covid-19. That is also fraught with the difficulty of 
> making the huge and untested assumptions that the null hypothesis is 
> true, and that retrospective death rates are accurate.  There are 
> probably other statistically valid methods, but I can't think of them.
>
> In terms of calculating the risk of dying if you have already 
> contracted the disease, it seems at least reasonably well-established 
> that there is increased risk of dying from Covid-19 in older people 
> (but no definition of older), people with underlying immune 
> deficiencies, underlying other chronic medical conditions, and some or 
> all of the above. Other factors, e.g. genetic predisposition to viral 
> infections, are unknown. Otherwise healthy "young" people can also die 
> of this disease, and it is unknown how many people in the "high risk" 
> groups are pre- or a-symptomatic,. At least in Canada at the present 
> time, transmission statistics seem highly biased towards whether or 
> not one is in a long-term care facility. So estimates of death rates 
> are almost useless in determining population statistics regarding 
> transmission, unless all the sub-groups can be teased out.
>
> Whether it is safe to decrease the current isolation, lockdown , 
> re-opening etc., is a societal decision without  having the above 
> valid statistics. Which is the higher risk to society - 1).. staying 
> isolated and locked down for an unknown period, with all the mental 
> health and financial problems etc. that will bring?  Or 2). opening 
> things up without any valid statistics on transmission of a 
> potentially (but we don't know how potentially) fatal disease, is 
> something for society to decide. Some countries, e.g. New Zealand, 
> have already tried option 1, evidently with some success so far, but 
> others, notably USA, are in the process of trying option 2, and it 
> will be interesting to see if that produces an outcome acceptable to 
> their society.
>
> And for individual people, which is the better/ worse choice - 
> enjoying your pre-lockdown activities but being a- or pre-symptomatic 
> and risk infecting others or yourself; or giving up that enjoyment and 
> feeling good about protecting others and yourself? Or a bit of each? 
> That is something for the individu