Footnotes E1 U0 - The Covid Survival Guide

This page has the footnotes for the first edition with no updates version of the book.

You can click the section link here to go to the chapter your footnote is in, or simply scroll down to it.

Introductory Material

[1] Here’s the very first footnote. I try to provide sources and proof for everything I say and felt it easiest to put these in footnotes rather than to have the main narrative interrupted by such things.

[2] See https://thecovidsurvivalguide.com/footnotes/ or https://cov.cx/fn

[3] See the form on the top right of the website home page, https://thecovidsurvivalguide.com/ or https://cov.cx/covid

[4] Remember how there were hopes to “re-open” the country in time for Easter (12 April)? Then in time for May Day, Memorial Day (25 May), and 4 July? Alas, the virus is unpersuaded by three-day weekends.

Mere weeks before the election, President Trump was still maintaining there’d be a vaccine announced before the election. That never happened, but subsequently, it turned out that Trump may have finally been correct – Pfizer had very positive news about its vaccine candidate, which it chose to delay announcing until five days after the election. See https://blog.thetravelinsider.info/2020/11/why-did-pfizer-delay-their-vaccine-announcement-so-long.html or https://cov.cx/tia1 A week after Pfizer’s announcement, Moderna made a similar announcement.

[5] We discuss the difficulties in counting deaths later on. Surprisingly, something as seemingly obvious as the number of deaths is vague and unclear, but there are reasons why this is so. This article is a helpful explainer and suggests that the true count, in early December, might be almost 400,000 – about a third more than the official count of 274,000. See https://www.mediaite.com/news/staggering-new-cdc-data-suggests-true-coronavirus-death-toll-is-now-near-400000/ or https://cov.cx/a1f59

[6] The problems, while definitely reflecting very poorly on the Trump Administration, date back to the previous Administration, and to several previous ones too. The problem further has to be shared between the Administration – wrong priorities – and the Congress – lack of budget funding. No-one, of any political persuasion, can feel proud of their record. And we, the voters, need to share in that complicity too.

[7] Assuming a rate of about 2500 deaths/day, as is the December seven-day average rate of US deaths – see https://www.msn.com/en-gb/news/us/1-american-is-dying-of-covid-19-every-30-seconds/ar-BB1bBckt or https://cov.cx/a1f60 and https://www.worldometers.info/coronavirus/country/us/ or https://cov.cx/a1a11 for whatever the rate is when you are reading this.

[8] You don’t need to understand how a car engine operates to drive a car well and we can all participate in public debates about what speed limits and other traffic rules should be. Similarly, you don’t need to understand “virus spikes” and “receptor cells” to see the good sense in taking medications that help speed recovery, you don’t need to understand the properties of aerosols to know that wearing a mask and keeping your distance is sensible, and so on.

Chapter 1 An Unfortunate and Unnecessary Controversy

[9] In my case, even if I am not to be allowed to provide original findings, that shouldn’t be a problem. Very little in this book is original “out of nowhere” material. Instead, I collate and present to you the best of the findings and expert opinions, and provide sources to substantiate every point I make. Critics should not “shoot the messenger”. They shouldn’t attack me for presenting such information – they should attack the underlying sources of anything they disagree with.

[10] See https://www.cnn.com/2020/10/18/us/anika-chebrolu-covid-treatment-award-scn-trnd/index.html or https://cov.cx/a1a12

[11] See https://pubs.acs.org/pb-assets/documents/infocentral/2018%20Institutional%20Print%20Subscription%20Rates.pdf or https://cov.cx/a1a13

[12] This is of course an enormous simplification of how trial results are presented, but the ultimate point of any trial write-up should be one of three things –

(1) The trial persuasively shows a positive result
(2) The trial persuasively shows a negative result
(3) The trial is unpersuasive by itself and more research/trialing is required

[13] The most extreme example of extraordinarily wrong data has been just about every early projection about the extent of the spread of the disease and the number of people who would die.

Even more amusing are the studies that initially showed what seemed like enormously high numbers of infections and deaths that were then hastily changed by their authors (the highest-profile example being the Imperial College London projection in mid-March, projecting 2.2 million people would die in the US over the next few months – see https://www.theatlantic.com/health/archive/2020/03/how-many-americans-are-sick-lost-february/608521/ or https://cov.cx/a1a14 ), sometimes reducing by 20-fold their projections, with lots of excuse/explanation about how they were right to start with, but are now more right with their 20x lower numbers.

The tragically amusing part is that now we are getting closer to the original numbers which they rushed to disown, but in a very different scenario to the one that they earlier based their projections on.

It is true and fair to say that the early models and their projections were wrong due to a lack of hard data on which to base the models, but those weaknesses were only minimally featured in the model results and findings.

One last thing about models. There’s a truism – “all models are wrong, but some are useful”.

[14] This issue is one of the most important ones of all. The CDC says newly infected Covid-19 patients should do nothing except stay at home and hope for the best. Most doctors are adopting that advice without question. Only a minority are pointing out the ludicrous concept of doing nothing when it is easiest and least costly to defeat the virus, and waiting until an infection has become severe before responding. Imagine if the same approach was adopted for cancer treatments!

Here’s a great article that supports early intervention and treatment, by a physician who is also the Executive Director of the Association of American Physicians and Surgeons. https://aapsonline.org/lessons-from-the-9-month-covid-emergency/ or https://cov.cx/a1f79

[15] For every opinion/theory that the Democrats are deliberately shaping the crisis to their advantage, there is a similar theory that the Republicans are doing the same for their advantage. I guess I’m either too naïve or too cynical and tend to ascribe the political mismanagement as much to incompetence as to venality, failings shared equally on each side.

[16] Which in itself is an appalling situation that both public health officials and politicians should never have allowed to happen.

[17] At the risk of stating the obvious, it was always easy for adroit public health officials and government regulation to corner the market in officially approved highest quality “medical grade” N95 and similar masks. There was never a reason to lie to us.

Furthermore, the current encouragement for people to make their own masks of any style or shape/size, and from any material at all, could have been promulgated right from the start. A decision to lie to us back then has terribly diminished the trust and confidence we have now in what public health authorities are telling us.

[18] Even the venerated Dr Fauci tried to “square the circle” in the early days (March 8), when he said that mask-wearing was important for infected people, but not as a preventative measure for normal people. Here’s a short video clip in which he waffles a bit but says “….in the United States people should not be walking around with masks”. The interviewer asked him if he was sure about that, and Dr Fauci repeated the same statement. But later in the short clip, he then referred to other countries where up to 85% of the population are wearing masks and said, seemingly dismissively, “I’m not against it” and then revealed the big issue – “it could lead to a shortage of masks for the people who really need it”. See https://www.youtube.com/watch?v=PRa6t_e7dgI or https://cov.cx/a1f87

Now flash forward to September, where the truth couldn’t have changed more. The director of the CDC, Dr Robert Redfield, says in a Senate hearing “Facemasks are the most important powerful public health tool we have, and I will continue to appeal for all Americans to embrace these face coverings”. He went on to say “we have clear scientific evidence they [disposable cheap face masks] work and they are our best defense”. If that wasn’t strong enough, he then said a face mask was better protection against the virus than a vaccine. Here’s a short video clip : https://www.youtube.com/watch?v=NYRAZxcp_hU or https://cov.cx/a1f88

[19] The slowness to appreciate the risk presented by the aerosolized spread of virus particles is very puzzling. Was it related to the decision to downplay the value of masks, or was it a separate failing?

[20] See https://www.fda.gov/news-events/press-announcements/fda-issues-emergency-use-authorization-convalescent-plasma-potential-promising-covid-19-treatment or https://cov.cx/a1a15

[21] A relevant page on the NIH site now seems to have disappeared. Discussed from about the 18-minute point in this podcast : https://www.youtube.com/watch?v=fdbwTNNsF1E or https://cov.cx/a1a16 The NIH now seems more neutral about convalescent plasma use https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/blood-derived-products/convalescent-plasma/ or https://cov.cx/a1a17

[22] See https://www.msn.com/en-us/news/politics/in-stunning-reversal-cdc-abruptly-changes-position-on-when-to-get-tested/ar-BB18oiTf or https://cov.cx/a1a18 and https://www.msn.com/en-us/news/us/trump-administration-defends-inexplicable-changes-to-coronavirus-testing-guidelines/ar-BB18p6yr or https://cov.cx/a1a19

[23 Here’s an article headed “Health agencies’ credibility at risk after week of blunders” – see : https://apnews.com/b9b6dc204d780fac7e6a79c1dbf21b8d or https://cov.cx/a1a20 . Maybe this is due to political meddling, but that is almost irrelevant. The point is that, for whatever reason, sometimes the public health leaders who we necessarily must place the highest degree of trust in are telling us things that don’t survive scrutiny and which end up being reversed. We need to preserve and encourage such scrutiny, not seek to forbid it.

[24] Some apologists say that public health officials have been pressured into making incorrect policy statements by their political masters. That may or may not be true, but it is not an excuse. The excuse of “just following orders” didn’t help many Germans at the Nuremberg trials after WW2, and is not allowed as a defense in our Armed Forces now. It shouldn’t be a defense for public health officials either.

[25] See https://www.propublica.org/article/inside-the-fall-of-the-cdc or https://cov.cx/a1a21

[26] It is almost irrelevant whether this decision was made out of utter ignorance or because of trying to protect scarce hospital beds for people who were “more deserving” of treatment (ie would live longer). It was medically wrong and morally suspect and is another example where public policy is not necessarily reflective of the best practices, and another reason why we all deserve both to be given full information and to be allowed to participate in such policy discussion and formation.

[27] There’s also a cogent case to be made that as a result of re-opening the country too early and being too permissive in terms of social distancing restrictions, tens of thousands of Americans have died who would not otherwise have been infected. The brutal reality is that the US is the third-worst country in the world (ignoring small countries) in terms of overall infection rate, and the 6^th worst in terms of death rate. Canada to the north and Mexico to the south have had only one fifth and one quarter as many cases as us. Canada has one third the death rate, Mexico has slightly less than our death rate.

There are probably many factors giving rise to that, but our public health policies and virus response actions have to be considered a major influencer.

[28] For example, see https://www.npr.org/2020/10/01/914433778/web-of-wellness-doctors-promote-injections-of-unproven-coronavirus-treatment or https://cov.cx/a1a22 and https://www.nbcnews.com/news/us-news/oregon-doctor-s-license-revoked-over-refusal-wear-mask-during-n1250092 or https://cov.cx/a1f84

[29] I don’t know if this lady – the Associate Chief Medical Officer of Health for Ontario, Canada, and her boss, the Chief Medical Officer, are joking or serious when, as you can see and hear in this video, she says “I don’t know why I bring all these papers, I never look at them. I just say whatever they write down for me” and he appears to say, after some interaction, “Yeah, same”. See https://twitter.com/OnCall4ON/status/1338933683592556544 or https://cov.cx/a1g11

[30] I’ve viewed the video of his conference where he first mentioned HCQ. He merely said that some people were reporting good results, that it seemed promising, and that it should be looked into. He never stated as a fact “HCQ is a for sure guaranteed way of curing Covid-19”.

[31] More recently there has been a suggestion that President Trump only decided to promote HCQ because he has shares in a mutual fund that in turn has shares in a French company, Sanofi, that makes HCQ tablets, and so he decided to recommend it to make money for himself.

Ignoring the fact that any of us with mutual fund holdings probably indirectly have shares in half the companies listed on the stock market, there is very little likelihood that any company would get rich from making and selling HCQ, because it is made by so many different companies, already, all around the world, and at extremely low costs – I just checked and the Sanofi Plaquenil brand is selling at a price of 10c/tablet in US discount drugstores such as Kroger. If a drug is being sold, at retail, for 10c each, and you only need a dozen or so tablets for a course of treatment, how will anyone, anywhere, get ridiculously rich on that transaction?

[32] Is it a coincidence that the only “Emergency Use Authorization” treatments for Covid are very expensive drugs made by large pharmaceutical companies; while low-cost expired-patent medicines are now being used successfully in many other countries to treat their Covid sufferers but remain unacknowledged and unapproved in the US?

Rather than having deep-pocketed supporters and lobbyists pushing for HCQ use, it almost appears that the companies who do have the deep pockets and supporters may have been keen to argue against HCQ for fear that it would harm their efforts to promote their alternate and very much more expensive drugs.

[33] The highest-profile example is an article that was published to great acclaim by the once highly regarded British journal, The Lancet. Within a few days, the data used was exposed as being fraudulent. The Lancet has no explanation for how its peer-review process failed to notice the obvious data inconsistencies that even I saw, and has now retracted the article. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext or https://cov.cx/a1a23 A similar reliance on unreliably sourced data caused the NEJM to somewhat ungraciously retract an article too – see https://www.sciencemag.org/news/2020/06/two-elite-medical-journals-retract-coronavirus-papers-over-data-integrity-questions or https://cov.cx/a1g09

[34] See https://c19study.com/ or https://cov.cx/a1a24

[35] See this excellent testimony to a December Senate Committee https://www.hsgac.senate.gov/imo/media/doc/Testimony-Orient-2020-12-08.pdf or https://cov.cx/a1g06

[36] See https://c19study.com/ or https://cov.cx/a1a24

[37] While the “Who Benefits and How?” question/test shouldn’t be the sole element of evaluating findings, we are touched by the obvious altruism and open honesty present in some of the quietly shared findings by individual doctors and their practices.

[38] This is often termed, sometimes derisively, as “Real World” results. A new act, passed in 2016, the “Cures” Act, encourages the FDA to give more credence to real world data, rather than only considering “gold standard” double-blind random clinical trials.

[39] We acknowledge that not all studies are equal, and trying to evaluate the evidence for/against HCQ (or anything else) based simply on counting the studies for and against is terribly over-simplistic and potentially misleading.

But when the imbalance between the “pro” and the “con” articles is so strongly in favor of the “pro” articles, it is perhaps an acceptable short-cut, prior to further examination of all articles, as a way of establishing there is probably something important and positive to be evaluated. This is especially true when so many of the “pro” articles are published in refereed journals and so can be considered, prima facie, as being of high quality and persuasive.

Limitations notwithstanding, we suggest a simple count is no worse and probably better than simply picking and choosing one or two articles to support the “con” view and not even looking at any of the many refereed articles that support the “pro” view.

[40] One of my pre-publication physician readers, who strongly disagrees with me about HCQ, challenged me that the better question is why I am so keen to prove that HCQ is good. I’m happy to answer that. I have no dog in this fight whatsoever and don’t stand to profit. Amazingly, some physicians have even suggested that bad doctors are wanting to profit by promoting HCQ to their patients. That is impossible. Doctors don’t sell medicines, pharmacies do, and the cost of HCQ is very low in any event.

My only interest is in protecting myself and my loved ones. By helping you too, I’m in turn reducing the risk of you becoming infected, passing the infection on to someone else, who then passes it on to me or a member of my family. I see in HCQ a classic case of all upside, no downside. That is what I’m keen about – that we don’t reject it “just because”, but rather we give it a balanced and fair appraisal.

I’m writing this book to try and help us all, and in HCQ I see a drug that might help us. Many credible studies are suggesting it does help, and few studies to the contrary. I also note that everyone who says to me “HCQ is no good” – with a look of absolute certainty on their face – refuses to look at the huge number of positive studies. I don’t know why, which brings me back to the “why are they so desperate to prove HCQ is bad” puzzle.

[41] See https://www.sciencedirect.com/science/article/pii/S2052297520300998 or https://cov.cx/a1d94

[42] See https://www.citizen.org/news/the-public-already-has-paid-for-remdesivir/ or https://cov.cx/a1a25

[43] See https://www.webmd.com/drugs/2/drug-179015/remdesivir-intravenous/details/list-sideeffects or https://cov.cx/a1g10

[44] This article, and the linked article in Science Magazine, set out the puzzling nature of the remdesivir approval and would give most reasonable readers cause for concern. https://www.trialsitenews.com/remdesivirs-sordid-regulatory-history-calls-efficacy-into-question/ or https://cov.cx/a1a26 and https://www.sciencemag.org/news/2020/10/very-very-bad-look-remdesivir-first-fda-approved-covid-19-drug or https://cov.cx/a1a27

[45] See https://c19rmd.com/ or https://cov.cx/a1a28

[46] See https://apnews.com/a7f0e8aac34a860ad502912564681b7c or https://cov.cx/a1a29 . Some of my pre-publication readers have suggested this is all political rather than medical. That may be true, but it is not a positive explanation. If we can’t trust the FDA to tell us the medical truth rather than the political spin, and if this is an example of that, what shred of credibility do they have on any topic?

[47] Well, maybe I do have an agenda item. My travel business was zeroed out entirely by the virus. The sooner the world beats it, the sooner I can return to my “day job”. So I’ve a vested interest in helping everyone beat the virus, allowing my own life to return to normal.

[48] Actually, I’m not just guessing. Here’s an interesting open letter from initially 37, now 42 American, British, and Brazilian professors, statisticians, mathematicians, and doctors pointing out basic errors in statistical analysis in some of the published studies about Covid-19 treatments. They refer also to similar errors being found present in 51% of all similar papers. See https://veja.abril.com.br/saude/especialistas-contestam-estudos-que-nao-viram-beneficios-na-cloroquina/amp/ or https://cov.cx/a1a30 and https://drive.google.com/file/d/1NZOJ57fM0RTaHD1t_9w2iua7lUJhOgWT/view or https://cov.cx/a1a31

[49] It can easily take an hour to fully read and analyze a single study and to understand how it was conducted and why, and then to consider its conclusions and seek to identify any unstated weaknesses or omissions.

We can’t guess how many studies there are being published every week, but we’ll guess more than 10, possibly even more than 100, some weeks.

[50] So if I were to go on and ridiculously say “I’ve forgotten more about statistics than you’ve ever learned” that would be a confession of my latter-day inadequacy rather than a boast!

[51] Yes, they know very many other things, too! This is not a complete list.

[52] It isn’t just medicine in which the “funnel effect” occurs – specialists and experts become more and more knowledgeable, but about less and less, eventually ending up with people proudly knowing almost everything, but about almost nothing! A similar concept is “when the only tool you have is a hammer, every problem looks like a nail” – there is definitely validity in experts and their contributions, but they then need to be carefully interfaced into the general world in which they have to be applied. We need “Renaissance men” generalists as well as experts.

[53] In any event, just about every shade of opinion and approach to anything to do with Covid-19 is supported by some doctors and opposed by others. Should we put these issues to a vote? No, because science isn’t a popularity contest, and most of science’s currently accepted fundamental tenets were once unpopular and denigrated.

It is only by allowing and considering ideas that are first lambasted as being unpopular, unlikely, and unusual that ultimately sees science advancing.

[54] This concept is used as guidance by the government when deciding what new safety measures to mandate. Does the cost of the measure outweigh the benefit in terms of lives saved? Currently, it seems the value of a life is thought to be about $10 million. See https://www.npr.org/transcripts/835571843 or https://cov.cx/a1a32 and https://www.wired.com/story/how-much-is-human-life-worth-in-dollars/ or https://cov.cx/a1a33

[55] Generally, I try and support everything I say either with detailed reasoning or links to articles. But, even with this book now exceeding 400 pages, sometimes I edit out things that perhaps should be left in. So if there’s something you don’t understand and want to understand, please let me know. That will help me to know what is important and helpful to you, and I’ll update the book to include additional explanation for the benefit of all readers.

[56] So too might your pharmacist.

[57] A sad emphasis needs to be placed on the “could”. I know Covid-19 sufferers who were forced to “doctor-shop” in trying to find a doctor who would agree to at least have an open discussion with them about the pluses and minuses of HCQ and other drug use. Regrettably, most doctors recoiled in horror at the thought and refused to discuss the matter at all.

[58] The doctors were debatably wrong on the first point, and totally wrong on the second point. Yes, to be clear and blunt, I am saying the doctors lied directly to this person when they said they were not allowed to prescribe medicines for off-label use (discussed subsequently in this book). Doctors that lie to you? …..

[59] You might think you’re a careful person and you might feel you’re doing sufficient “due diligence” by researching the companies, the websites, and the products they promote – maybe you even do a Google search for “(company name) fraud”, and all you find are positive articles, so you feel reassured that the company or product is trustworthy.

But did you know there are companies – they call themselves “reputation management” companies – that charge sizeable sums of money to ensure that when people search for one of their clients, they only see good positive articles online. They’ll even create a network of seemingly independent sites, all with some generic articles and also positive articles about their client. Needless to say, some of the people spending tens of thousands of dollars every month for reputation management services have deservedly bad reputations to start with. So it is very hard to really truly know who and what to trust.

Yes, I know, I’m saying, by obvious implication, “don’t trust me”. And I’m happy with that statement. That is why I’m never asking you to trust me “just because”, and am supporting everything I say with what I hope to be links to credible sources.

Back to my point. Because doctors have seen so much that is untrue and false, they’ve developed an immediate rejection type response to most new information that doesn’t appear in “trustworthy sources”. But the conservativism of those trustworthy sources, while working in everyone’s favor in normal times, is a problem in fast-moving fast-changing situations such as we are in at present with the virus. We all need to open our filters a crack and at least consider some of this stuff with a slightly open mind. Just because most alternate type medicine is nonsense doesn’t mean it is all nonsense.

[60] While a patient might make any number of promises upfront to not sue, no matter what the outcome, and while the doctor might make extremely full disclosures of any risks involved, try telling that to the ambulance-chasing attorneys if things subsequently turn out negatively.

This is even more certain if the patient dies, and an action is brought by the patient’s grieving family (who never promised not to sue), demanding compensation for their loved one’s “wrongful” death due to “medical malpractice”.

There are so many ways a non-standard course of treatment can be twisted and turned and made into seemingly medical malpractice.

[61] Usually, the problem arose when the charter airline had to cancel a flight. Best case scenario, it might refund a small portion of the original fare, but it would never offer to re-book you, for free, on another airline to keep you more or less close to your original travel dates and times.

[62] And sadly also, things I was unable to resolve – travel agents don’t set airline policy and only rarely can prevail upon airlines to vary their policies.

[63] We see this in every election campaign, don’t we. The incumbent quotes numbers to show wonderful the economy is, the aspiring other candidate uses the same data to “prove” how the economy has been woefully mismanaged. The numbers are the same, it is how they are interpreted that varies. This ability to selectively interpret data in many different ways is a theme running through much of the rest of this section.

[64] But if we were to answer that question, we’d probably say that rather than a blanket ban on the new drug, or a blanket approval, it should be left up to each patient and their physician to evaluate and decide. We know that some doctors are unscrupulous, and of course, most patients are not well-informed about medical issues, but when it comes to you and your health, who do you most trust? The doctor you’re dealing with face-to-face, and yourself; or nameless faceless bureaucrats in Washington, DC, who have made “one size fits all” rules and regulations that don’t have the flexibility to consider you and your specific case and situation?

We’d also point out that this question/dilemma is not a medical issue. It is a public health policy issue, and we all (should) have an equal voice in the formulation of such matters. And, most of all, it is both a public health policy issue in general, but also a very personal life and death decision for each patient individually.

At the risk of touching on a very contentious issue, we (and most other societies around the world) allow women to decide if they have an abortion or not. So why can’t we also allow patients to make other major issues about their healthcare? Don’t we have a similar “right to choose”? Isn’t it a similar protected privacy issue?

And, for the many good people who are uncomfortable about abortion and opposed to it, hopefully they’ll agree there’s a huge difference between decisions involving the life of an unborn child and decisions involving only one’s own life.

[65] HCQ has become the most vivid example of a drug getting an undeserved bad reputation, but many other drugs are also being totally ignored. They’re not being criticized, they’re just being ignored, even though other countries are using them with positive results – for example, ivermectin.

[66] You might say “But, David, if HCQ doesn’t help seriously ill patients, surely it also doesn’t help people with milder infections?”. That’s a fair question to have, but most anti-viral drugs work best in the early stages of a virus attack.

Think of the virus infection like a leaky old boat. The more that water leaks into the boat, the more it continues to leak and the faster the water floods in (more water pressure as the boat settles into the water, and more holes get below the waterline as the boat gets deeper and deeper into the water). Eventually, the water breaks over the sides of the boat and then it rapidly completes its sinking.

Now think of HCQ (or any other anti-viral drug) as a bailer. When the first leak starts, the bailer can easily handle all the water coming in, and there’s no problem. But if you don’t start bailing right away, the leak slowly gets bigger, and the rate of water coming in increases. Now, if you start using the bailer, you can barely keep up with the water. If you wait a bit longer still before responding, more leaks start letting in more water, and the bailer can no longer keep up with the rate of water flowing in. Eventually – if you don’t get to shore in time – the boat then has the water flooding over the sides and nothing will save it.

The analogy with the virus is to think of the virus growth like the growing rate of water coming into the boat, and HCQ like a moderate-sized bailer. In the early stages, HCQ may be able to defeat the virus, before it gets established and reaches a critical/sustainable level of infection. In the middle stages, HCQ might slow the deterioration of symptoms to a noticeable degree (or might not). And in a late-stage, almost nothing will make a difference.

[67] By all means, write to me and explain otherwise. I’ve no vested interest other than optimizing my own chances of surviving a Covid-19 infection. I’m seeking the truth, wherever and whatever it is.

[68] For example, Covid-19 testing on people in Laos, where only 3 people per million have contracted the virus, would probably give very different results to people selected in Luxembourg, where 11,861 people per million have contracted the virus. No-one knows why, but there’s an X factor that is causing something.

There are ways to reduce unknown additional factors, but it is hard to know there isn’t some subtle obscured bias that has managed to sneak into the trial.

[69] What you do is to have two halves to your trial, with as similar as possible groups of people in each. One half is taking the drug that is being tested, and the other half is not (and no-one knows which is which). Then you can say “we had 50 women in their forties, all of European background, all vegetarians, all slim, all with two children, in happy marriages and working in similar jobs, living in the same town, going to the same church, none lactose intolerant, none with high blood pressure, (and so on and so on in as much detail as possible to eliminate other factors that might impact on the outcome…..) in each group, and 30 of the women in one group experienced a positive outcome and only 20 of the women in the other group did – therefore this drug seems to improve the chance of a positive income by 50%”.

[70] That points to another possible error – “confirmation bias”. This is an insidious and subtle effect that can flow into and taint every element of a test/trial, starting with the way the trial is designed in the first place, and running through to the analysis of the results in the end.

Our “confirmation bias” from the coin tosses would depend on if we’d randomly pulled a coin out of our pocket, or had been playing a gambling game based on coin tosses in some shady gaming room. Our bias also extends to “knowing” intuitively that a coin will only land heads or tails, and “never” on its side. These are obvious examples of confirmation bias, and because they are obvious, they are less dangerous. It is the more subtle ones that we don’t pick up on that can come back to haunt us, later.

[71] Test design and validation is an exceedingly complicated field. But here’s a fascinating article, easily readable, about how one person “proved” the existence of ESP while simultaneously following what appeared to be all the best test design practices. https://getpocket.com/explore/item/daryl-bem-proved-esp-is-real or https://cov.cx/a1a34

At another level, it is possible to surround an apparently robust theory or test analysis with such an impenetrable wall of babble and jargon as to cause all readers to “give up” on their analysis and simply accept the result, as ridiculous as it may be. This is most famously exemplified in the Sokal Hoax. Seehttps://physics.nyu.edu/sokal/Chronicle_Jan_1_17.pdf or https://cov.cx/a1a35

We are NOT saying that all (or even any) of the many drug studies to do with Covid-19 treatments have been deliberately distorted, but we are saying that whether deliberate or accidental, it is possible that test weaknesses may have slipped into an analysis, undetected. There are already examples of some such studies that have even been “refereed” before publication in very esteemed journals (namely, The Lancet in Britain and NEJM in the US) which have subsequently been exposed as failing to meet even the most basic and rudimentary standards of test/analysis protocol.

[72] You might say “those other causes of death can easily be distinguished on the death certificates, so there’s no danger of confusion”. I’ll disagree with that. Our authorities, in the US, are finding it an enormous struggle to accurately count true Covid-19 deaths at present, due to how death certificates are completed and the varying requirements for what is needed to qualify a death as being counted as a Covid-related death.

The most strident example of this was in Washington state, where gun-shot victims were being counted as Covid deaths for a while. See https://www.freedomfoundation.com/washington/washington-health-officials-gunshot-victims-counted-as-covid-19-deaths/ or https://cov.cx/a1a36

[73] See https://c19study.com/ or https://cov.cx/a1a24 and the (as of 17 Dec 2020) 205 studies about HCQ they review.

[74] There are other unproven treatments. The thing that strikes us is how the “medical establishment” reacts so extraordinarily negatively to all such possibilities. Rather than saying “Wow, those preliminary results are really promising, let’s rush to research it further to see if it checks out” there’s an overwhelming rejection, saying “You haven’t proven this already to the n^th degree with multiple trials involving thousands of people over many years, so we’re not interested in hearing what you’ve got to say”.

That is sometimes accompanied by an ad hominem attack – “You can’t be trusted, because you have a vested interest in the outcome and success of this”. But if having a vested interest is to be a disqualifier, what about all the Big Pharma companies? Why are we investing billions of dollars to rush through the production of untested vaccines, while refusing to listen to “Small Pharma” and their under-funded early results of promising new drugs?

[75] See https://www.axios.com/trump-covid-oleandrin-9896f570-6cd8-4919-af3a-65ebad113d41.html or https://cov.cx/a1a37

[76] The actual 18-page research paper (not peer-reviewed) showing the promise of oleandrin is here : https://www.biorxiv.org/content/10.1101/2020.07.15.203489v1.full.pdf or https://cov.cx/a1a38

[77] My, how times have changed. We in the US alone, although with four times fewer people than China, are now reporting more cases in a single day than China has acknowledged, in total, right from the very start of the virus onset.

[78] It is interesting to remember the horror and amazement which those of us monitoring China’s official numbers in February felt – up to a maximum of about 3,500 new cases a day – numbers which seemed apocalyptical and impossible to countenance. But now, India is reporting over 90,000 cases in a single day – India is having more new cases every day than China has reported in total – and the 90,000 cases a day barely rates a mention in the (non-Indian!) press. And we in the US are leaving every other country in the world behind us, with up to 250,000 new cases every day.

[79] For example, looking at this site https://www.worldometers.info/coronavirus/ or https://cov.cx/w-c on 17 December, we see there are 20 countries with total infection rates greater than 40,000 per million people, and 62 countries with total infection rates less than 1,000 per million people. Similarly, the case fatality rate (the percent of total cases who die) ranges enormously, and some countries with what you might think are primitive healthcare systems have much lower CFRs than countries with sophisticated healthcare systems (such as, ahem, the US and UK).

I’ll concede that different countries have different ways of counting cases and deaths, different approaches to testing, and all sorts of other differences too. That might explain the difference between the US and Cameroon, but is less likely to explain the huge difference between the US and Canada, or between different countries in the EU such as Germany and France. There are some mysterious unknown factors also present. We should be moving heaven and earth to identify these and then use them to our advantage.

[80] Even the 2 + 2 = 4 assumption is a simplification, but that’s not something we’ll dive into here! It can also be subject to computer errors (if not represented as integer type values – also not something to go into here).

Water can also be a solid, a super-cooled (solid) liquid, or a gas. Some flames burn very coolly because they require almost as much heat to evaporate the liquid they’re burning as they generate in heat.

[81] We’d also point to the fascinating story of how our understanding of what causes stomach ulcers has evolved. For the longest time, they were thought to be caused by stress. An obscure doctor in western Australia dared to think otherwise, and was ridiculed for doing so by “the experts”. But he persisted in his research and even infected himself to prove his theory, and eventually came up with conclusive proof that stomach ulcers are caused by bacteria. He and his partner-researcher ended up winning the Nobel Prize for medicine.

So much for “all experts agree that …..”. Most advancements in medical science start with a need to rebut the implacable deadening of open-minded inquiry and experimentation caused by the “all experts agree that ….” statement.

See, for example, https://www.discovermagazine.com/health/the-doctor-who-drank-infectious-broth-gave-himself-an-ulcer-and-solved-a-medical-mystery or https://cov.cx/a1a39

[82] Yes, there are point scales to measure degrees of severity of illness and degrees of recovery as well. But they are very subjective – just think when a doctor last asked you “On a scale of 1 – 10, how would you rate the pain you are feeling at present?”. When I’m asked that question, I have no idea where in the scale any pain should be placed, and I also suspect that whatever my rating might be will be several points higher or lower than the next person with the same pain.

[83] An example of this happened to me, almost 40 years ago. I was doing a major research project for a retailer in a small New Zealand city, and part of that involved surveying both their shoppers and the shoppers of competing stores in the town. We had interviewers outside the exits to all relevant stores, asking questions of people as they left. One of the other stores objected, claiming that the people leaving their store were “their” customers and that their customers’ opinions were a trade secret that we were trying to steal. A nonsense claim, of course, but the last thing we and our client wanted was a major argument and possibly a court case in a small town where you needed to cooperate positively in the community.

I asked my senior partner what we should do? We needed the data. He said, “Offer to give the other store a complete copy of all the survey data we get, both from their store and other stores”. I marveled “Doesn’t that mean we’re giving them a free copy of what we are charging our client many thousands of dollars for? That doesn’t seem fair. What will our client think?” The older wiser partner replied “The raw data is meaningless and has no value. Anyone can collect data. What we are charging for is how we analyze the data, and the recommendations we derive from its interpretation. The other retailer won’t know what to do with the data.”

He was correct. We uncovered interesting differences in perceptions and attitudes between the different stores, and the client retailer made successful changes as a result. The other complaining store made no changes at all, even though we saw issues and opportunities for them too in the data we gave them.

The moral of the story is that raw data, by itself, is useless. The magic of its meaning lies in how you interpret it. The data might be absolute (but usually isn’t). Its interpretation is almost always subjective.

[84] In case you wondered, there is then another large drop in death numbers to India, with 145,000 deaths, and then Mexico with 116,000, Italy with 67,000, and so on.

[85] Remember also our point above that the truth changes. Countries often swap places on these lists and can shift from way below average numbers to way above average, or vice versa. Between 14 Aug and 17 December, India went from fourth place to second place, and then back to third place. Many other countries have changed their rankings, too. This will of course continue into the future, just as it has in the past.

[86] Taken from this page, you can visit it for the current updated data and additional data from other countries https://ourworldindata.org/mortality-risk-covid#the-case-fatality-rate or https://cov.cx/a1a40

[87] That’s a totally wrong statement, and obviously made by someone who never heard the aphorism “There are lies, damn lies, and then there are statistics”!

[88] An example of an appropriate use of a log scale would be measuring different sound levels, because we hear sounds logarithmically, and indeed the typical measure of sound – Bels and decibels – is a logarithmic measure.

[89] See https://rt.live/us/HI or https://cov.cx/a1a41

[90] Well, we now know the answer to that question, don’t we! President Trump got VIP treatment and a barrage of experimental, expensive, and scarce drugs such as the rest of us could never hope to get.

[91] Well, even that might sometimes work. The placebo effect is very real. And how to explain the loyal following and supporters of homeopathy, which involves taking substances that have been so diluted that there is no longer any active ingredient at all remaining in the medicine – not even a single molecule. Homeopathy supporters even acknowledge this but claim that the past presence of the chemical in less dilute portions of the medicine has somehow changed the state of the now completely diluted water.

That sounds like a ridiculous and laughable unscientific piece of nonsense. But so too have any number of “folk medicines” where unlikely mixtures of plant and animal life are claimed to cure all manner of evils. The interesting thing is that many of medicine’s most exciting breakthroughs have been by examining and understanding what the active ingredients are in such folk remedies. So – who knows – let’s not yet dismiss homeopathy entirely (but yes, feel free to be very cautious about it, too!). We discuss homeopathy further in the chapter on medicines, supplements, etc.

The homeopathic example points to another mystery of life and medicine – no matter how much we surround ourselves with science, there is still an enormous amount we don’t know about life, diseases, and treatments, and many modern treatments and medicines have evolved out of folk-remedies that were at one time popular, then ridiculed by people preferring “science” over folklore, only to be subsequently shown to actually contain some ingredient that truly does influence a specific disease.

Chapter 2 Have the Sacrifices We’ve Made So Far Been Worth It?

[92] This interesting article in the Wall St Journal includes the observation that ten years of consumer adoption of e-commerce was compressed into three months. Many of the social changes forced upon us are likely to be lasting. See https://www.wsj.com/articles/four-reasons-the-stay-at-home-economy-is-here-to-stay-11605934806 or https://cov.cx/a1a42

[93] Taken from https://www.census.gov/retail/mrts/www/data/pdf/ec_current.pdf or https://cov.cx/a1a43

[94] See https://www.foxbusiness.com/markets/future-malls-coronavirus-25000-stores-close or https://cov.cx/a1a44

[95] See https://www.cnbc.com/2020/08/27/25percent-of-us-malls-are-set-to-shut-within-5-years-what-comes-next.html or https://cov.cx/a1a45

[96] To give two examples of unexpected offshoring, the first is that when you next go to your local fast-food drive-through, there’s a chance that the voice coming out of the speaker wanting to take your order isn’t coming from a person inside the restaurant, but from someone in a call center, possibly in a totally different country.

The other example – you go to a hospital and need an X-ray. The radiographer who “reads” that X-ray might not be in the room next to the X-ray machine. He might be in India – the X-ray is digitally sent through the internet to an off-shore radiographer, and their analysis is sent back the same way.

[97] Most infamously, I tried to call Google Fi support on their 800 number, and was told “Due to the virus, we are not offering phone support at present”. That’s appalling. The virus doesn’t travel down phone lines, and surely Google of all companies would be able to allow their support reps to work from home, the same way so many other companies do (and have been doing for years).

[98] I’ll not make this a lengthy treatise on the economics of restaurants and bars, but the short answer is that particularly in restaurants, the highest cost is labor. You know yourself from cooking at home how much time goes into buying food, preparing it and cooking a meal, serving it, and then cleaning up and doing the dishes afterward. Food and labor costs alone represent 60% – 70% of your meal price, and then rent is another 8% – 10%. Other overheads – utilities, repairs and maintenance, depreciation and capital equipment purchases, advertising, and so on, take up most of the rest, leaving maybe 5% for profit – sometimes (rarely) more, often less.

[99] Here’s an interesting albeit slightly confusing report on a survey done by Yelp for the six months through the end of August, showing the proportions of various types of businesses it lists that have closed, either temporarily or permanently. Food businesses and other general retailers were hit the most, professional service providers the least. https://www.cnbc.com/2020/09/16/yelp-data-shows-60percent-of-business-closures-due-to-the-coronavirus-pandemic-are-now-permanent.html or https://cov.cx/a1a46

[100] See https://www.cnn.com/2020/06/10/business/starbucks-closing-400-stores/index.html or https://cov.cx/a1a47 It will be sad to see them close. I’m sure I’m not the only one with memories of internet-driven “blind dates” at Starbucks stores in the past.

[101] Perhaps the least commented on aspect of working from home is that in many cases, not only did the parents start working from home, but their children were home too due to school closures. The initial chaos of developing new “office” work routines at home was made much more complex by having one’s children present, with no school work being given to them, and impacting on everything too.

It may well be that in the future, with the children either busy doing school work remotely rather than being unoccupied, or the children back in school, working from home will become even more popular for parents.

[102] See https://news.gallup.com/poll/311375/reviewing-remote-work-covid.aspx or https://cov.cx/a1a48 A subsequent Gallup poll in September/October showed that people have been returning to their offices. Of the remote workers, two-thirds want to continue working remotely and one-third would like to be back in their former office environment. See https://news.gallup.com/poll/321800/covid-remote-work-update.aspx or https://cov.cx/a1a49

[103] Here’s a vague and pompous declaration to that effect https://www.ey.com/en_be/covid-19/why-remote-working-will-be-the-new-normal-even-after-covid-19 or https://cov.cx/a1a50

[104] See https://www.weforum.org/agenda/2020/06/coronavirus-covid19-remote-working-office-employees-employers or https://cov.cx/a1a51

[105] See https://www.kastle.com/city-by-city-views-of-americas-office-use/ or https://cov.cx/a1c21 for the most recent data.

[106] This will be a long-term trend rather than a sudden sharp shift, because companies with multi-year leases may not be easily able to immediately reduce the space they lease, and even when renewing, some companies will prefer “too much” space but keeping their present location and layout and everything rather than the hassle and costs of moving.

[107] See https://ny.curbed.com/2020/3/24/21192454/coronavirus-nyc-transportation-subway-citi-bike-covid-19 or https://cov.cx/a1a52

[108] The Proms have been held every year since 1895, without interruption, until 2020. https://en.wikipedia.org/wiki/The_Proms or https://cov.cx/a1a53

[109] See https://www.vulture.com/2020/07/phantom-of-the-opera-closes-on-west-end-amid-coivd-19.html or https://cov.cx/a1a54

[110] See https://www.cbr.com/sony-covid-19-no-major-movies-in-theaters/ or https://cov.cx/a1a55

[111] See https://en.wikipedia.org/wiki/List_of_films_impacted_by_the_COVID-19_pandemic or https://cov.cx/a1a56 There were rumors in October that possibly Apple might buy the rights to the James Bond movie and take it direct to streaming, but MGM and Apple were unable to agree upon a price – with MGM allegedly wanting $600 million and Apple offering perhaps $400 million. https://variety.com/2020/film/news/james-bond-no-time-to-die-netflix-apple-1234814809/ or https://cov.cx/a1a57 The movie, which was due to be released initially in April 2020, has now been twice delayed and currently is set to be released, in theaters, in April 2021.

[112] This article says Major League Baseball typically gets only 25% of its income from stadium ticket sales. https://www.startribune.com/schafer-how-major-league-teams-can-still-make-money-in-front-of-empty-stands/571676282/ or https://cov.cx/a1a58

[113] She and all her peers were then given “A” passes for the year in all their subjects, no matter how well or poorly they were doing prior to the collapse in education in March.

[114] A humanities/liberal arts graduate can probably proceed into the workplace with a bit less of a thorough grounding in their chosen subjects, but what about an accountant. “Oh, sorry, I missed that section on tax law in my training”. Or a doctor. “I think you might have a tropical disease, but unfortunately they didn’t teach us that subject because of the virus.” Or an architect. “Here are the plans for your new home, except for the bedrooms. We didn’t cover how to design bedrooms.”

[115] There’s another aspect of schooling that is currently being lost – the social element. While, as an anxious father, at one level I’m sort of glad that my high-school daughter is not being surrounded by teenage boys all the time, realistically I feel it is not a good thing that she is missing out on the traditional evolution and maturing of developing relationships with the opposite sex, and fear that when these restrictions are lifted, things might happen more quickly and more impactfully than otherwise might have been the case.

[116] See https://www.tsa.gov/coronavirus/passenger-throughput or https://cov.cx/tsa-c – a very useful counting of people going through TSA checkpoints every day

[117] Even a relatively short 2 – 3 hour flight takes up 5 or more hours from start to finish – driving to an airport, checking in and waiting for the flight, the flight itself, deplaning, collecting bags, getting a rental car, or somehow then going to one’s meeting, then the same in reverse at the end of a trip.

Plus the cost. Assume $400 for a roundtrip airfare, then $100 for other transport and parking, maybe meals, and who knows what else.

Add it all up and you’re looking at the high side of $500 in above-the-line costs, and a full day out of the office, in return for which you get one or possibly two meetings – perhaps two productive hours out of a 10 – 12 hour grueling day. All of that could be done, for free, from your desk, with a normal day’s schedule and six hours left over for everything else.

Don’t forget – that’s a close to best-case scenario assuming a short two-hour flight. If you’re going coast to coast, you have entire days of travel and nothing else, and you need to add hotel costs (and greater personal life disruption at home) to the equation as well.

[118] Amazon reported that it has saved $1 billion in travel costs during the six months of its second and third quarters of 2020, see https://skift.com/2020/10/30/amazons-1-billion-corporate-travel-shutdown-reinforces-a-bleak-2020/ or https://cov.cx/a1a59

[119] The travel industry is desperate to obscure these truths. See, for example, this article that hails the wonder and magic of corporate travel. https://www.bbc.com/worklife/article/20200731-how-coronavirus-will-change-business-travel or https://cov.cx/a1a60 As a former corporate traveler and travel agent, I disagree with its claims of the irreplaceable value of corporate travel.

[120] See, if you can, https://www.wsj.com/articles/what-travel-will-look-like-after-coronavirus-11596026858 or https://cov.cx/a1a61

[121] A lot of businesses might have a profit model like, for example, “We need to average $100 per customer. We will charge business travelers $150 because they are happy paying that, and we will then charge leisure passengers $50 because that is all they are prepared to pay, but on average we still get the $100 we need.” If they then lose most of their $150 paying customers, they need to start charging their leisure customers closer to the $100 average, and with leisure customers being price sensitive, they stop buying the product, meaning that if the company charges the necessary rate, it won’t get enough customers, and if it charges the rate the market will stand, it won’t get enough revenue. That’s a terrible lose-lose with no obvious solution.

[122] The risk of becoming infected during a port call is a huge concern. Cruise lines can do some things to improve the bio-safety on board the ship, but most of us go on cruises as much to enjoy port visits as we do to enjoy the ship itself. The current thinking is that passengers will only be allowed to go on official cruise arranged port tours, and will be required to stay with the group, and not break away to see or do their own thing at all. That will greatly reduce an essential part of most cruise experiences.

[123] See https://www.wsj.com/articles/car-sales-fell-in-the-second-quarter-despite-deals-and-covid-19-stimulus-11593621053 or https://cov.cx/a1a62

[124] We can understand how there can be a (hopefully orderly) line of people waiting on the ground floor to take the elevator up to their apartment, but what happens when you want to go down from your apartment to the ground floor, and every time an elevator stops at your floor, it is already full of the reduced quota number of people allowed in it at one time? That seems like an uncontrollable wait unless the building owner reprograms the elevator controls to a totally different logic for answering button press calls for service.

[125] See https://www.bea.gov/data/gdp/gross-domestic-product or https://cov.cx/a1f96

[126] See https://www.bls.gov/news.release/pdf/empsit.pdf or https://cov.cx/a1a63

[127] I’m not linking to its source because I don’t want to unfairly cite one of the hundreds of examples of this.

[128] It is also true that there were sensible hopes that as a positive outcome of flattening the curve and buying us time, new treatments would be developed, a vaccine created, and so on. But the simple equivalency of these simple charts remains misleading.

[129] Taken from this generally very sensible article https://www.drjohnm.org/2020/05/can-we-discuss-flatten-the-curve-in-covid19-my-eight-assertions/ or https://cov.cx/a1a64

[130] See https://www.worldometers.info/coronavirus/country/us/ or https://cov.cx/w-us

[131] See, for example, https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections or https://cov.cx/a1a65

[132] See https://www.nbcnews.com/politics/donald-trump/fauci-predicts-americans-will-likely-need-stay-home-least-several-n1164701 or https://cov.cx/a1f90

[133] See https://www.worldometers.info/coronavirus/country/canada/ or https://cov.cx/w-ca

[134] And, in almost all cases, for the same reason. After implementing controls to limit the spread of the virus, these countries then relaxed their controls, with the entirely predictable outcome that the virus numbers started to grow again.

Strangely, the controls that such countries had in place back in March and April, and which obviously worked back then, have seldom been brought back again – are we becoming hardened to the impact of the virus?

[135] I’ve arbitrarily decided that these stats should not include minor countries. Tiny countries with less than a few million people can have a single outbreak of a few dozen cases and shoot up the tables due to something that might be a one-off “anomaly”. That is easily explained. The more subjective part is at what size does a country become “major”. For no particular reason, I chose the number 10 million.

But if I’d chosen 5 million instead, the US ranking would stay unchanged for both cases and deaths. The largest of the small countries with more cases is Luxembourg, with a mere 631,000 people. The largest of the small countries with more deaths is Bosnia and Herzegovina, with 3.3 million people.

The data for these two tables is taken from https://www.worldometers.info/coronavirus/ or https://cov.cx/w-c

[136] All these numbers are as of 8 December.

[137] A physician wondered if this might be due to higher rates of mask-wearing in Asia and less travel in Africa. We’re not sure about either of those explanations. Many of the highly infected European countries report reasonably high compliance rates for mask-wearing. This site gives some data on mask-wearing by country, for example, this page on Belgium (the worst country for deaths and second-worst for cases) : https://covid19.healthdata.org/belgium?view=infections-testing&tab=trend&test=infections or https://cov.cx/a1f97 . Belgium has a higher mask-wearing rate than Vietnam (among the very best countries) – see https://covid19.healthdata.org/viet-nam?view=mask-use&tab=trend or https://cov.cx/a1f98 .

As for Africa and travel, it only takes one person and one case to “seed” a new viral outbreak, and most African countries have cross-border travel, local travel, and at least until March/April, international flights too. Plus, a hallmark of many African countries is dense urban centers – what one would assume to be rich breeding grounds for respiratory viral infections. A third of low scoring Mozambique residents live in urban areas, and even if we ignore all the rural inhabitants and therefore triple Mozambique’s infection rates, at 1,554/12 they are still stunningly low and less than 1/30^th of the US numbers.

[138] There is a theory that is becoming increasingly possible that one of the mystery factors might be the varying policy, country by country, to vaccinating people with the BCG anti-tuberculosis vaccine. Some correlations suggest the BCG shot also gives some level of protection against Covid-19 as well. But even if this is indeed a factor, there are probably other factors, too.

Another possible factor may be hydroxychloroquine use. A rather confusing website, https://hcqtrial.com or https://cov.cx/a1a66 contrasts mortality rates in countries where HCQ use is widespread or little used and suggests the clear difference might be due to HCQ use.

Still another factor that is now being given more credence is ivermectin and its potential value as a prophylactic/protective medicine. Ivermectin is often broadly prescribed as protection against various water parasites, particularly in Africa – countries with some of the very lowest virus rates.

[139] One more issue needs to be kept in mind. It is dangerous to draw too many conclusions from these types of statistics currently, because the virus is still active in all countries. Countries are going up and down the “most affected” lists daily, and some of the initially worst countries are now way down the list, while some of the countries now at the top were nowhere prominent at all a month or two ago.

In the case of the US, it fairly quickly rose to near the top of both the case rate and death rate lists, and has stayed near the top consistently, but maybe in the future, more countries will pass it and push it down the list.

[140] Even this question is more complex than it might seem. It appears that it is not uncommon for some virus-caused illnesses to be asymptomatic. Perhaps the best known of these would be HSV-2. So maybe it is correct to fairly count asymptomatic cases, but we would like asymptomatic cases to at least be double-tested to validate the diagnosis.

[141] It is available on this Facebook page, assuming it hasn’t been taken down. https://www.facebook.com/fiona.hine.7/videos/10164697404790441 or https://cov.cx/a1f94 . I urge you also to read the fact-checking rebuttal to the claims being made and to view all the claims being made in the video through the lens of the claims which are clearly wrong.

[142] See, for example, https://www.inc.com/gabrielle-bienasz-mariyam-khaja/covid-rules-regulations.html or https://cov.cx/a1a67 and https://www.bloomberg.com/opinion/articles/2020-04-16/coronavirus-protests-dumb-lockdown-rules-erode-public-trust or https://cov.cx/a1a68 – can we particularly point to how in MI you can buy drywall at Home Depot, but not paint (at the same Home Depot). Why is it safe to buy drywall but not paint?

There’s something very wrong with our public health officials and leadership when they create beyond-stupid policies like that. How can we trust or respect anything they say when they tell us “drywall good; paint bad”?

[143] A great example of problems with such rules is in my own state of Washington. My county announced it would close all its public parks – lovely sprawling open outdoor spaces with few people and lots of space between them – an unnecessary and unfortunate decision. Of all the things to leave open, surely low-density open-air parks would feature highly. Happily – but confusingly – the city I live in said it would keep its parks open. So now we have parks, sometimes within a mile or two of each other, that are variously open or shut. I’d never even known, in my 35 years in WA, which were county or local parks. But now I need to.

[144] See https://www.tmj4.com/news/coronavirus/these-wisconsin-sheriffs-say-they-wont-enforce-gov-tony-evers-statewide-mask-order or https://cov.cx/a1a69 (and many more examples in many other states too). There have been other cases of sheriffs and their departments “looking the other way” in other situations, of course, and even of publicly and totally refusing to enforce laws (for example, some firearms laws). I’m reminded of what the police officer tells me when handing me a speeding ticket – “We don’t make the laws, we just enforce them, if you want to contest this citation, take it up with the judge and your elected representatives”.

It makes me wonder if the opposite can apply too – if sheriffs are free to choose which laws they enforce, are they therefore also free to invent new laws, too? Isn’t that the same sort of thing? Is “frontier justice” still appropriate in the 21^st century?

[145] See https://www.npr.org/sections/coronavirus-live-updates/2020/08/12/901756223/florida-sheriff-orders-deputies-and-staff-not-to-wear-face-masks or https://cov.cx/a1a70

[146] The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

[147] The “equal protection” part at the end of Section 1, which in its entirety reads :

All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

[148] Article 1, Section 8, Clause 3 :

The Congress shall have power to regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes

[149] Partially as a result of that, partially because of allowing the Sturgis motorbike rally to proceed, and perhaps partially “just because”, ND and SD are now the two states with the highest infection rates – 71,261 and 62,625 cases per million respectively. The national average is 31,078 cases per million.

[150] For what it is worth, there are problems in other countries comprising multiple semi-independent regions. Britain has to accept different policies in Scotland, England, Wales, and Northern Ireland. Canada’s provinces have responded differently and with enormously different rates of success.

[151] The federal government, with the support of the courts, has succeeded in eroding many of the state privileges under the guise of interstate commerce, or by linking “voluntary” compliance with federal requirements to eligibility for federal funding. Why has the federal govt been able to do this for all manner of things but shown no interest or willingness to do the same now for virus response measures?

[152] Like many statistics to do with China, this is a strange number, in the sense that it has not changed in the last ten weeks. Is China no longer testing anyone? We’re sure they are.

[153] Some places use numbers per million, some use numbers per hundred thousand, or per some other quantity. It doesn’t particularly matter what the “per quantity” is, as long as it is consistently used, and of course, it is easy to convert as between per million and (eg) per hundred thousand (just divide or multiply by 10).

[154] Don’t misunderstand, please! We still need to do those things, but in terms of getting better control of the virus, tracing is something we can do that is easier than tightening up on mask-wearing and social distancing.

[155] Almost no-one is thought to have caught the disease after touching an infected surface and then transferring some virus particles to the mouth, nose, or eyes. This was “health theater” (a bit like many of the meaningless “security theater” controls at airports these days) and perhaps intended to “give us something to do” and make us feel more in control of things.

[156] Taken from https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections or https://cov.cx/a1a65

[157] See https://www.worldometers.info/coronavirus/country/us/ or https://cov.cx/w-us

[158] See https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=tests or https://cov.cx/a1a65 – although we took this chart in mid-September, it strangely doesn’t have data subsequent to late July.

[159] Generally, virus symptoms appear four or five days after infection, and probably people get tested a day or two after that, so whatever you see in the chart more or less reflects changes in external factors 5 and more days previously.

[160] Taken from https://rt.live/us/WA or https://cov.cx/a1a71

[161] See https://covid19.healthdata.org/united-states-of-america/washington?view=mask-use&tab=trend or https://cov.cx/a1a72

[162] See https://covid19.healthdata.org/united-states-of-america?view=mask-use&tab=trend or https://cov.cx/a1a73

[163] See https://covid19.healthdata.org/united-states-of-america/new-york?view=infections-testing&tab=compare&test=infections or https://cov.cx/a1a74

[164] The purpose of the book is to help you decide what you should do. But we talk about these general issues so that you understand the broader concepts and can better than pick and choose what you do and how you do it, personally.

[165] Heart disease runs about 655,381 deaths a year or 1,796 a day. Cancer runs about 599,274 deaths a year or 1,642 a day. These numbers vary from year to year and from source to source, but are around these sorts of levels. We have now had some days with over 2,500 deaths in a single day from Covid – almost 50% higher than either of these two other causes, and the seven-day moving average has been higher than the heart disease 1,796 number consistently since 3 December through 8 December.

[166] This word is not meant in any pejorative or offensive manner at all. A lot of good and sincere people, and a lot of well-credentialed people, sincerely believe the country has made grave mistakes with the controls that have been imposed on us.

[167] I don’t expect you to believe me when I tell you this, but at this point, as I start to write this section, I really don’t know what the answer will be. I truly have no preconceived notion. I’ll simply look at the facts as best we can determine them and let the conclusions emerge as may become apparent. I hope you’re similarly open-minded.

[168] Someone will validly point out that surely, at some point, people would wise up and start reacting and responding to the virus without the need for a legislative mandate. As I observed a page or two back, this actually appears to be a phenomenon – maybe it truly is “the wisdom of crowds”. The biggest influence of all on infection numbers, at least in the US, doesn’t seem to be external government controls, but rather some sort of hard-to-measure group sense of concern and response.

Should we rely on the “wisdom of crowds”, such as has largely been done in Sweden? I’ll answer with a definite “maybe”. To support my “maybe” I point to the Sturgis motorcycle rally, August 7-16, when 462,182 motorbikers all descended upon the small town of Sturgis SD for a week of partying, most of it with no social distancing. Where was the sense in that? Some studies are suggesting that one event has been responsible for over 260,000 new Covid cases, and a healthcare cost in excess of $12 billion. And ND & SD, in their entirety, with no mandated mask-wearing, have the highest infection rates in the entire country.

The other point is that the whole thought exercise we’re talking about is “if no-one does anything”. Social distancing is social distancing, whether it is voluntary or government-mandated.

[169] Again, data from this site https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections or https://cov.cx/a1a65

[170] I guess I’m showing my age. I remember, as a young lad in intermediate school, having the headmaster come into the classroom and, apropos of nothing, regale us for ten minutes on the subject of how unthinkably vast the number one million was. Being a millionaire meant someone with unimaginable wealth. It wasn’t until 1987 that Forbes started publishing its list of billionaires. That list grew to feature 2,200 people in 2018 but has dropped to 2,095 in 2020. The wealthiest billionaire is Jeff Bezos, now worth a reduced $113 billion. But that is still 113,000 times more money than what a millionaire has.

[171] See https://www.msn.com/en-us/money/companies/you-can-now-rent-a-private-amc-theater-for-just-99/ar-BB1a8aXw or https://cov.cx/a1a75

[172] This site shows $5 trillion spent, and a total of $11.6 trillion authorized to be spent, at the federal level alone. So going from $5 trillion spent federally to a total of $10 trillion doesn’t seem an impossible reach. But pick a number, any number, and do your own sums. https://www.covidmoneytracker.org/ or https://cov.cx/a1a76

[173] See https://www.businessinsider.com/coronavirus-uk-report-projects-2-million-deaths-without-action-2020-3 or https://cov.cx/a1a77

[174] I’d actually put the total potential extra deaths as way higher than 2 million. But we can run with that as a conservative “low number” for the sake of this thought experiment.

[175] My numbers have been wild and wooly – both lives saved and the costs for saving them. Here’s a totally different set of calculations for both lives saved and costs (and over a very different time period); but amazingly, it comes up with a very similar cost per life saved. They estimate $6 million, compared to my $5 million estimate. See https://news.yahoo.com/169-bn-29-000-lives-013740202.html or https://cov.cx/a1a78

Chapter 3 When Will the Virus Finally Go Away?

[176] This is a great site that updates regularly and lists details of all the research and trials it can uncover. See : https://racetoacure.stanford.edu/ or https://cov.cx/a1a79

[177] See, for example, this article : https://www.independent.co.uk/news/uk/politics/coronavirus-uk-pandemic-end-vaccine-flu-ongoing-mark-walport-a9683246.html or https://cov.cx/a1a80 . WHO are, in my opinion, way too optimistic when they say the pandemic might last another two years, based on, of all ridiculous reasons, the Spanish ‘flu two-year outbreak after World War 1. The two outbreaks have nothing in common, and the two viruses also have nothing in common. It is ridiculous to try and draw lessons from Spanish ‘flu and apply them to Covid-19. See https://www.the-sun.com/news/1350542/coronavirus-pandemic-another-two-years-who/ or https://cov.cx/a1a81 Making it more ridiculous is the article even includes contradictory statements by WHO’s emergencies chief.

[178] You’ve probably not heard of rinderpest. There’s a reason why – it is a disease that primarily affects cattle, and doesn’t affect people at all.

[179] See https://asm.org/Articles/2020/March/Disease-Eradication-What-Does-It-Take-to-Wipe-out or https://cov.cx/a1a82

[180] It isn’t just New Zealand. There are other examples of countries and regions having ostensibly become free (we’re not sure we agree they were ever truly free) from the virus, but then after relaxing their controls and restrictions, the virus comes back even worse than before.

[181] A classic example of the difference between the two measures is with contraceptives. A condom has almost 100% efficacy, but only 85% effectiveness. https://www.plannedparenthood.org/learn/birth-control/condom/how-effective-are-condoms or https://cov.cx/a1a83

[182] This is an easy to follow explanation if you’d like to see it in some more detail https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html or https://cov.cx/a1a84

[183] The ROR is also easy to understand, but working out the confidence interval gets a bit more “interesting”. See https://allaboutpharmacovigilance.org/43-reporting-odds-ratio-ror/ or https://cov.cx/a1a85 for a great explanation.

[184] For our purposes, a quick guess is good enough, and remember that statistics are always somewhat vague and never as exact as the calculated numbers imply.

[185] See https://thecovidsurvivalguide.com/vaccine-information or https://cov.cx/c-vi

[186] This BBC article about the vaccine development is headed “Coronavirus vaccine : Short cuts and allegations of dirty tricks in race to be first” – see https://www.bbc.com/news/world-53864069 or https://cov.cx/a1a86

[187] Because if everyone is vaccinated, and only half get immunity, that means we have a 50% level of immunity but need 60% for herd immunity to be effective.

On the other hand, that’s a bit of an over-simplification. As well as vaccine-derived immunity, there is also immunity as a result of having had the virus and recovered from it. Different studies come up with different levels of recovered virus sufferers. Maybe recovered sufferers have stronger immunity? We don’t really know for sure.

The reason for different findings from different studies is the added complexity of evaluating symptomless cases. How many are there is a question that needs to be answered but by definition can only be guessed at. The other always present problem is being able to find truly representative random population samples that can be used to estimate the overall spread of recovered and now immune people, either from symptomatic or symptomless infections.

This also implies the assumption that recovering from the virus gives one immunity. On that point, the best one can say is that the immunity from having had the disease might be only short-lived, the same as may be true of vaccines. It also may not be conferred to every person who had the virus.

[188] So if 50% is too low, what percentage would be acceptable? It might seem like this is a totally theoretical question with no scientific answer, but there is a calculable minimum percentage needed.

Assuming our goal is to achieve herd immunity through vaccination – a worthy goal we must have – there are two factors to point us to the necessary vaccine effectiveness. What percentage of the population needs to be immune for herd immunity to kick in, and what percentage of the population will agree to be vaccinated.

Let’s accept the often-stated requirement for herd immunity as being “at least 60% immunity” and call that 65%. The harder question is what percentage of people will agree to be vaccinated? Surveys have shown widely varying numbers. Only about half the population gets a ‘flu shot each year, but we expect more people will take a Covid-19 shot. On the other hand, if they have to have a double shot, three weeks apart, and if due to special ultra-cold refrigeration storage requirements, the shots won’t be offered everywhere, unlike ‘flu shots, the hassle factor rises and that will reduce total numbers. But, for want of a better number, let’s say 75% of people are vaccinated.

That means a vaccine would need to be 87% effective to generate a 65% herd immunity level. You can adjust the numbers and create your own scenario any way you like, but the simple math is unavoidable – you can’t get 60%+ herd immunity, even with everyone being vaccinated, if the vaccine is only 50% effective. The minimum effectiveness goal should never have been set so low.

There’s of course another entirely different perspective as well. If you get vaccinated, you want it to work and protect you, don’t you! So from that perspective, the closer to 100% the better.

[189] Of course, the truth is that “study the issue” means “do nothing and hope the issue goes away”. We pay these people six-figure salaries – surely we should expect something better than doing nothing from them in return.

[190] See https://news.yahoo.com/us-developing-coronavirus-strain-human-220417655.html or https://cov.cx/a1a87

[191] See https://www.theguardian.com/environment/2020/nov/04/denmark-announces-cull-of-15-million-mink-over-covid-mutation-fears or https://cov.cx/a1a88

[192] Slightly amusingly, shortly after Pfizer broke the news of its vaccine candidate initially showing 90% efficacy, Russia then announced its vaccine was showing 92% efficacy.

[193] See https://www.bbc.com/news/world-asia-china-53917315 or https://cov.cx/a1a89

[194] This is an interesting article about some of the issues involved with how the vaccine is likely to be stored, distributed, and then allocated and dispensed : https://www.usatoday.com/story/news/health/2020/09/06/covid-vaccine-complex-distribution-supply-chain-follow-approval/5712053002/ or https://cov.cx/a1a90

[195] See, for example, this survey in June https://www.sciencemag.org/news/2020/06/just-50-americans-plan-get-covid-19-vaccine-here-s-how-win-over-rest or https://cov.cx/a1a91 and this survey about six weeks later https://news.gallup.com/poll/317018/one-three-americans-not-covid-vaccine.aspx or https://cov.cx/a1a92

[196] See https://www.axios.com/covid-vaccine-election-f267a641-a19f-43e0-80a0-87c8e6eb303f.html or https://cov.cx/a1a93 It is slightly amusing to note that Republicans are less trusting of a Republican administration and Democrats!

[197] See https://www.ipsos.com/ipsos-mori/en-uk/three-four-adults-globally-say-they-would-get-vaccine-covid-19 or https://cov.cx/a1a94 , which has other interesting data as well. The survey was taken between 24 July and 7 August.

[198] I’m probably in the undecided category at present (in case you wondered). I’m nothing at all close to being an “anti-vaxxer” in general, but I’m cautious about the rush into totally new approaches to developing vaccines for Covid-19 – things that would be extremely clever if they work, but which might be terrible if they don’t. I want to see more studies and to allow more time for testing to prove there are no unexpected side effects.

I also hope that after the headlong rush to get the first vaccine out there, things will continue to proceed with more careful testing of better vaccines that get released some months – maybe even years – later.

[199] Ibid. 60% were worried, 37% didn’t think it would work. Note people could give multiple reasons, so the total is greater than 100%. 3% even said they didn’t have the time to be vaccinated.

[200] And let’s not even start to think about how long immunity lasts and how quickly it fades…..

[201] The calculation is a bit more complicated, because you also have to consider the respect chances of getting infected, and the respective chances of dying, but at least to start with, you can see how a “scientific” and dispassionate approach might bring about quite the opposite answer to the expected answer on the basis of traditional values and assumptions.

A real cynic might add to this equation “If a politician gets a vaccine first to a younger person, that younger person will vote for them in more elections into the future than an older person”!

[202] See https://www.scientificamerican.com/article/how-to-decide-who-should-get-a-covid-19-vaccine-first/ or https://cov.cx/a1a95 and also https://www.statnews.com/2020/09/01/u-s-advisory-group-lays-out-detailed-recommendations-on-how-to-prioritize-covid-19-vaccine/ or https://cov.cx/a1a96 which has an interesting table of four priority categories of people.

[203] See https://www.bbc.com/news/blogs-the-papers-54882074 or https://cov.cx/a1a97

[204] See https://www.usatoday.com/story/news/health/2020/11/19/covid-19-vaccines-who-gets-coronavirus-immunization-first/3778098001/ or https://cov.cx/a1a98

[205] See https://www.bbc.com/news/world-australia-55048438 or https://cov.cx/a1a99

[206] See https://www.cnbc.com/2020/12/07/covid-vaccine-update-your-boss-can-fire-you-if-you-refuse-the-coronavirus-shot.html or https://cov.cx/a1f86

[207] All the more so because the US Government paid, up-front, $70.5 million of the costs to develop remdesivir, with no requirement for that funding to ever be repaid.

How much money will Gilead make from remdesivir? That’s imponderable, because we don’t know what the future sales of the product will be. Gilead reported $873 million in sales for the drug in the third quarter of 2020, but the carefully curated campaign of optimism about the drug is slowly starting to fade away and to be replaced with the less appealing reality. See https://www.fool.com/investing/2020/11/04/will-gileads-remdesivir-only-be-a-short-lived-succ/ or https://cov.cx/a1ab01

[208] And for obvious reasons. Viruses “adapt” to become better at passing themselves on – the scenario I described would see each infected person passing on the virus to very few other people. The most effective transmission involves the virus passing itself on before the infected host person even realized they are unwell. Guess how Covid-19 works…..

[209] Do you see the nonsense, now, of the CDC saying that only symptomatic people should be tested for the virus?

[210] Actually, tests don’t have to be 100% accurate to be helpful. It is better to have a good test that is fast to administer and give results than to have an excellent test that is more cumbersome to administer and give results, as we explained previously.

[211] Here’s a recent article about a “breathalyzer” style testing device. https://www.studyfinds.org/coronavirus-test-via-breathalyzer/ or https://cov.cx/a1ab02 This is a product still in a pre-production phase, so we’ve no idea what the cost per test might end up as being, or how quickly the result would be obtained, but presumably the cost will be low and the result quickly provided.

[212] See https://www.cnn.com/2020/08/22/us/hamptons-parties-coronavirus-tests-trnd/index.html or https://cov.cx/a1ab03

[213] This raises the possibility that a person might end up being tested two or three times in a single day. That is getting to the point of diminishing returns, and probably not necessary or justified. But what type of system can be adopted so that a person can prove they were tested, just a few hours ago, somewhere else, and that their test result was clear/negative rather than positive?

There are plenty of ways that this testing could be coordinated, possibly in conjunction with the mobile phone that almost everyone from pre-teen years and forward carries with them, everywhere, these days. The argument against such things is there is the risk of loss of privacy associated with such data sharing and phone apps.

This is another issue that is more social policy than health science. We all should be able to offer our opinions and suggestions on this matter.

[214] We don’t understand why the authorities have been so slow to accept this excellent and time-hallowed concept.

[215] See https://www.businessinsider.com/cdc-modified-covid-19-testing-guidelines-to-exclude-asymptomatic-people-2020-8 or https://cov.cx/a1b01 . This is an impossible to understand or justify decision, and all the more astonishing now that the country is starting to move to having more tests available, and with lower costs per test. All the people who claim that only the CDC and similar “experts” should be allowed to set and debate public health policy went briefly silent while trying to work out how to justify this unjustifiable statement.

[216] See https://www.stuff.co.nz/business/122492568/covidcards-work-but-making-them-mandatory-would-be-an-extreme-last-resort-says-minister or https://cov.cx/a1b02

[217] The R rate would be 6/15 or 0.40.

[218] Not only governmental three-letter-agencies. Private companies, too. It is possible to get companies such as Facebook to serve ads to people based on where they are and where they have been. There are multiple databases out there already that store details of where we are (or, more exactly, where our phones are) every minute of every day. I get a report from Google every month telling me where I’ve been, and how long I’ve been in various places, maybe you do too.

This is not really a new loss of privacy at all. You can decide which concerns you more – the government or private companies knowing more about you than your employer, partner, parents, and children do.

But, however you feel, we’ve already lost much of the privacy we think we still have. It is inappropriate to let concern over losing privacy that we’ve already lost stand in the way of an automatic contact tracing system that could be designed to minimize most of any further privacy loss that it might cause.

[219] Some of the concerns could be ameliorated by keeping data on each person’s phone, and only having it downloaded, with their participation and approval, in cases where they’ve been discovered to have a Covid infection. The phone could also automatically delete data that is more than, say five or six days old.

[220] See https://9to5mac.com/2020/09/01/how-to-turn-on-off-covid-19-contact-tracing-iphone-ios/ or https://cov.cx/a1b03

[221] See https://www.bbc.com/news/technology-53146360 or https://cov.cx/a1b04

[222] See https://www.msn.com/en-us/news/politics/one-third-of-bronx-test-subjects-have-coronavirus-antibodies/ar-BB189LfZ or https://cov.cx/a1b05

[223] This is unlikely. New York has had such a high rate of testing that many asymptomatic cases are likely to have been identified and found. But let’s allow the assumption because it makes it easier to do something that seems impossible – reconcile the claim of one-third of all people in the Bronx having virus antibodies.

[224] We could now be macabre and reduce this by the number of people who died, but again, let’s give the numbers the benefit of the doubt.

[225] See https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/ or https://cov.cx/a1b06

[226] See https://baptisthealth.net/baptist-health-news/covid-19-roundup-new-estimate-of-asymptomatic-carriers-use-of-face-coverings-varies-and-update-on-lingering-symptoms/ or https://cov.cx/a1b07

[227] See, for example, https://www.statnews.com/2020/07/21/cdc-study-actual-covid-19-cases/ or https://cov.cx/a1b08

[228] See https://www.nature.com/articles/s41467-020-18272-4 or https://cov.cx/a1b09

[229] See https://www.washingtonpost.com/health/2020/06/25/coronavirus-cases-10-times-larger/ or https://cov.cx/a1b10

Chapter 4 How the Number of Infections Increased So Quickly

[230] Not to boast, but one of the benefits of being a Travel Insider is that you were getting briefed about and updates on the virus from me way back in January 2020.

[231] See https://www.sfgate.com/news/article/Genetic-data-show-how-a-single-superspreading-15512903.php or https://cov.cx/a1b11

[232] We’re going to try and avoid dwelling too much on the colossal and catastrophic failures of any element of this infrastructure to respond adequately and quickly to the Covid-19 outbreak. But it is really hard not to sound off on these appalling betrayals of public trust by “experts” who only had one job to do – prepare for and advise on such things.

[233] From the first case in the US to reaching 1 million cases took 96 days. To go from 1 to 2 million cases took 44 days. To go from 2 to 3 million cases took 27 days. To go from 3 to 4 million cases took 15 days. Now it is taking about five days for each new million cases. See https://twitter.com/JHSPH_CHS/status/1334947286762270720 or https://cov.cx/a1f85

[234] For our purposes, we can consider the two terms, “geometric (growth)” and “exponential (growth)” as identical and interchangeable. There is a difference, but it isn’t relevant to this discussion.

[235] In case you wondered, an epidemic is a disease that affects a large number of people in a region, community, or country. It is localized (although possibly to a large area). A pandemic is declared when a number of different regions, communities, countries, or continents are all suffering epidemics.

[236] See https://wwwnc.cdc.gov/eid/article/26/6/20-0357-f1 or https://cov.cx/a1b12 This is based on Chinese data, which we are reluctant to accept, but there are other studies that also show a similar value, for example https://www.sciencedirect.com/science/article/pii/S1201971220301193 or https://cov.cx/a1b13

[237] This higher value has been vividly confirmed in August in New Zealand, where the country, which had been virus-free for 102 days and had returned to normal life with no need for social distancing at all, discovered that someone one new case of the virus had come into the country undetected. Within a couple of weeks (about four generations), there were over 100 cases discovered, all as a result of that one case, suggesting an R value in the order of 3.

[238] This is an important concept because it also applies to each person and how they are individually treated. To start with, a person is infected with a low number of virus particles. They replicate and double, then they double again and again and again, and so on. When they are growing by some number of thousand particles per doubling, it is so much easier to fight and eliminate the infection than when they are growing by billions of particles per doubling.

This simple truth explains why it is so important to urgently start treating an infection with anti-viral drugs as utterly soon as possible. But this simple truth is being ignored by our healthcare authorities who tell us just to stay at home and hope for the best if we’re infected, and only go to a hospital if our symptoms become severe.

In years to come, when people write books (maybe even me!) analyzing what happened and how we responded to the virus threat; the lack of interest in deploying early-infection treatments will stand out as one of the most colossal of all our many failures.

[239] See https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article or https://cov.cx/a1b14 . Unfortunately, this statement of the serial interval as being 6 – 9 days immediately destroys the credibility of the study. Just like an average is not a range, but a single number, so too is a serial interval a single number, not a range. Giving the serial interval a range means “we really don’t know what it actually is so we’re guessing”. To be kind to the article/study, it too was based on Chinese data, which may be, ahem, “imperfect”.

The same study also suggests an R value of 5.7. This is interesting, because calculating either the serial interval or the R value, based on observing the rate of growth of an outbreak of a disease, has the two numbers inter-related. It is sort of like saying “something times something = 60”. If the first number is six, then the second number has to be 10, and if the first number is 12, the second number has to be five, and so on. So if they are using a range of numbers for the serial interval, they should be using a range of numbers for the reproduction number, too.

Yes, they do show a confidence interval, but that is a slightly different thing.

[240] See https://en.wikipedia.org/wiki/Basic_reproduction_number or https://cov.cx/a1b15

[241] There are two reasons why these high numbers are so terrifying, one obvious and one more subtle. The obvious reason is because of how quickly the diseases can spread. The subtle reason is that the higher the R number, the harder it is to get herd immunity. We discuss this further in the herd immunity section, further on in the document.

Chapter 5 How Serious is the Virus?

[242] For the last nine years, estimated ‘flu deaths have ranged from a low of 12,000 in 2011-12 to a high of 61,000 in 2017-18. See https://www.cdc.gov/flu/about/burden/index.html or https://cov.cx/a1b16

[243] There’s that exponential thing at work again. The total deaths for two months are 5,206, and of those, 1,101 of them all happened in the previous day.

[244] See https://covid19.healthdata.org/united-states-of-america or https://cov.cx/ihme – this site regularly updates its predictions based on the ongoing data collection and changing current situation. As of its 3 September update, it is showing a projection for 325,907 deaths by 1 December, and 410,451 by the end of the year, with over 2500 more deaths every day to bring us into the new year. Who only knows when and at what number the final total will be.

[245] Good news. A revised projection on 18 September is showing a reduced 378,321 possible deaths by 1 Jan.

And, another update – a projection on 9 October has reduced the forecast further to 321,140. And another update – as of the 29 October projection, the total is now looking to be 326,660.

[246] See https://www.statnews.com/2020/09/14/23andme-study-covid-19-genetic-link/ or https://cov.cx/a1b17

[247] See https://www.hematology.org/newsroom/press-releases/2020/possible-link-between-blood-type-and-covid-19 or https://cov.cx/a1f99

[248] Although one wonders why the projections stop at 50%. Why don’t they keep projecting further? A partial answer is they are allowing for herd immunity, but as we increasingly perceive herd immunity to be temporary rather than permanent, there’s sadly less reason why one couldn’t create a seemingly valid model projecting closer to 100% virus spread.

[249] A more extreme example – you are mugged and shot/killed by the mugger. In WA state, there are five cases of this happening, and the deaths were recorded as Covid-19 deaths. Most people would not consider that to have anything to do with Covid-19. See https://www.kxly.com/three-percent-of-washingtons-reported-covid-19-deaths-may-be-inaccurate/ or https://cov.cx/a1g02

[250] See https://cbs12.com/news/local/man-who-died-in-motorcycle-crash-counted-as-covid-19-death-in-florida-report or https://cov.cx/a1g01

[251] The expression “One foot in the grave, the other on a banana skin” comes to mind!

[252] See https://www.cdc.gov/nchs/data/dvs/DEATH11-03final-acc.pdf or https://cov.cx/a1b18 for a detailed explanation of how death certificates are filled out and for more complete examples.

[253] It would not normally appear here. Physicians advise me the typical cause of death is cited as respiratory failure.

[254] This is not only a problem in the US. In the UK, for example, for the longest time, if you didn’t die in a hospital, the public health authorities refused to consider that your cause of death could be Covid-related. This undercounted a lot of elderly/nursing home/hospice type Covid-19 deaths.

[255] See, for example, https://news.yahoo.com/covid-deaths-europe-us-exceed-164917547.html or https://cov.cx/a1b19 and, for the US, https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e2.htm or https://cov.cx/a1b20

Most recently, this 3 December 2020 article suggests the unofficial death toll in the US might be almost 400,000 at a time when the official count is 274,000 – see https://www.mediaite.com/news/staggering-new-cdc-data-suggests-true-coronavirus-death-toll-is-now-near-400000/ or https://cov.cx/a1f59

These types of estimates are very imprecise, however. For example, as a result of less driving, vehicle deaths have dropped during the Covid period. There are probably other dependent increases and decreases too.

[256] This imprecision has inevitably caused some people to believe that there is a deliberate distortion in the official count of Covid-19 deaths. The only problem is, it seems for every person who claims the death count is being deliberately overstated, there’s another person who believes the death count is being deliberately understated.

What do I think? I’m not sure there are deliberate policies to under- or overcount the deaths. If there are such policies, it seems the possible cases of over-counting in some jurisdictions are being matched by under-counting in other jurisdictions. Perhaps the two balance each other out? Regrettably, a more likely explanation is simply one of bureaucratic bungling and incompetence.

I guess I’m a simple soul. I’m happy to accept the basic statement “this disease is dangerous and deadly, and a lot of people are dying from it” without demanding to know the exact count.

[257] There are problems with matching all cases with all deaths, especially in the early stages of an infection, but now that we have many months and large numbers, those problems become less significant and for the purposes of this simplified discussion, it is probably acceptable to use this simple approach, because in any event, we are going on to say it is not a good measure!

[258] If you look closely, you’ll note that the death curve lags some weeks behind the case curve. That is only to be expected – a person registers as a case usually several weeks before they die. The lag between cases and deaths is made worse by delays in then registering the death as a Covid-19 death. For the purpose of our simplistic analysis here, it is not necessary to drill down into more detail on this point, because there are other much more substantial modifiers that need to be applied to this calculation as well. We discuss these in the following sections.

[259] A key consideration here though is to understand that our improvements in care and the reduction in mortality primarily relate to patients who are most severely afflicted. That’s a small percentage of all patients, and a situation we’re of course eager to improve. There has been little or no improvement whatsoever in the standard of care and responses offered to patients when they are initially infected and only mildly affected.

Of course we’re delighted to see any and all reductions in mortality. But we most want to see a reduction in people who become moderately or severely affected by the virus – a reduction in the number of people who ever need to enter the ICU ward in the first place.

While some researchers are diligently evaluating possible cures and drugs to moderate the severity of an infection, we note the massive unwillingness by most medical practitioners to “think outside the box” and consider, let alone recommend, their patients consider some of the treatments that we detail further in this document. Here we are, 50+ million cases into the disease worldwide, and the standard advice to a newly infected patient is nothing more than to take it easy and drink plenty of fluids. That is appalling.

[260] The charts on the IHME site do a great job of showing estimated daily infections, based on the total number of daily tests and known infections, with the assumption being that the more tests that are done, the more unknown cases are detected, as well as actual daily infections, as do the charts on the rt.live site. See https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections or https://cov.cx/a1b21 and the various state charts from this page https://rt.live/ or https://cov.cx/rtl

[261] Now, in November, you could credibly suggest the case fatality rate is even lower still – perhaps 1.5% these days. It is very hard to say, because of the unknown lag between when cases are reported and when deaths related to the new cases on a given day are reported, and because of the rapidly changing numbers of new daily cases.

[262] Or, if you prefer, some people are 100 or more times less at risk than others.

[263] And frustratingly. While it is interesting to know what our chances are of being hospitalized, surely the ultimate issue we all most want to know is what are our chances of living or dying. Our western aversion to anything to do with death, while understandable, needs to be kept out of a discussion that is necessarily all about death (and its happier twin, survival)!

[264] See https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html or https://cov.cx/a1b22

[265] That’s a bit like a table of bungee jumping deaths by age group. That’s not something most of us never need to worry about, because we’re unlikely to voluntarily go bungee jumping!

If you don’t jump, you have no risk at all. The relevant measure is what percentage of people who jump will die, rather than what percentage of everyone will die from a bungee jump (whether they ever actually jump or not).

Oh, in case you’re wondering, bungee jumping, while appearing to be risky and terrifying, is actually quite safe. It has a very low fatality rate – about one in every half-million jumps. And, yes, I have jumped. Once, but for sure, never a second time!

[266] If that phrase and concept “a statistic that may be perfectly correct, but which is also unhelpful to the point of being meaningless” sounds familiar, it is because we used it just a few pages before when talking about total deaths per million people. This is a subtle trap in data analysis – citing numbers that sound exact and important, but which are actually meaningless.

[267] See https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html or https://cov.cx/a1b23

[268] See, for example, https://www.mana.md/can-children-spread-covid-19/ or https://cov.cx/a1f93

[269] See https://www.studyfinds.org/children-with-covid-blood-vessel-damage/ or https://cov.cx/a1f92

[270] See https://www.sciencedirect.com/science/article/pii/S1525861020304412 or https://cov.cx/a1b24 Note also this study was based on data collected on 7 May. There have been major changes in treatment plans and survival rates since that time, and so the data now might be very different from how it was back then.

[271] See https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-underlying-medical-conditions.html or https://cov.cx/a1b25

[272] There is a subtle aspect to these statistics though. A person is more likely to be admitted to a hospital just because they have a comorbidity, so these statistics are not accurately reflecting only the severity of the Covid infection.

[273] See https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html or https://cov.cx/a1b26

[274] These “other factors” might be the things you’d expect such as quality of healthcare, or tendency to various lifestyle-related illnesses and comorbidities, or they might be surprising “confounders” such as different diets or other unstated reactions/responses to becoming unwell.

It is not just being politically correct to be careful when observing a difference in different demographic groups, because there can be all sorts of related/linked factors over and above the obvious visible “color of their skin” type issue.

[275] See https://science.sciencemag.org/content/370/6515/eabd4585 or https://cov.cx/a1g03

[276] See, for example, https://www.brookings.edu/blog/up-front/2020/05/15/covid-19-much-more-fatal-for-men-especially-taking-age-into-account/ or https://cov.cx/a1b27 and https://www.studyfinds.org/men-more-likely-to-die-from-covid/ or https://cov.cx/a1b28 and newly presented research in December, https://www.cnn.com/2020/12/09/health/men-covid-19-icu-admission-wellness/index.html or https://cov.cx/a1f91

[277] Keep in mind also that we don’t know at all, from the data shown in the table, whether the varying factor is in male deaths or female deaths. We are assuming, from the way the data is shown, that female rates are less varying while make rates change widely. But maybe, actually, it is the opposite way around. That would really be interesting to know.

Yes, you guessed it. Here’s some more data that, while interesting, is also incomplete and, as shown here, almost meaningless.

[278] See https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238215 or https://cov.cx/a1b29

[279] See https://covid.joinzoe.com/us-post/covid-clusters or https://cov.cx/a1b30

[280] Cluster analysis is something to always be very cautious with because the clustering is an artificial construct that someone has created to try and get sense from the raw data; and there’s always a massive danger that the logic of the clustering is actually being determined by a desire to get clear results, rather than coming up with independent justifiable clustering logic and then seeing if results follow the clustering.

Clustering can be helpful but is a dangerous technique, and while it is usually adopted to try and make data patterns more obvious, it may also end up creating patterns where none really exist. It can also obscure true patterns – for example, by collecting an assortment of different symptoms and placing them in clusters, it obscures the relative importance of each of the collected symptoms. Are seemingly different symptoms linked to each other and a different virus strain? The clustering might seem to assume that, but it is an assumption that needs to be tested and validated, rather than accepted at face value.

[281] See https://www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/ or https://cov.cx/a1b31

[282] See for example the data on this site https://www.worldometers.info/coronavirus/ or https://cov.cx/w-c and the huge skew in death rates, both as a percentage of the population as a whole, and more helpfully, as a percentage of case rates

[283] Most of the way down this article is interesting data about the percentage of people who, after becoming infected, are hospitalized. It says that about 9.5% of cases needed hospitalization in August and September, reducing in October, but this reduction, the article suggests, is due to lack of hospital resources rather than cases being milder. See https://www.theatlantic.com/health/archive/2020/12/the-worst-case-scenario-is-happening-hospitals-are-overwhelmed/617301/ or https://cov.cx/a1f89

Chapter 6 How to Know if You Have the Virus

[284] See https://www.aarp.org/health/conditions-treatments/info-2020/ventilator-use-older-coronavirus-patients.html or https://cov.cx/a1b32 and also https://www.inquirer.com/health/coronavirus/coronavirus-covid-19-ventilator-patients-survival-rates-increase-20200703.html or https://cov.cx/a1b33

[285] You know yourself, your general health, and your general attitude to ailments. If you truly feel alarmed – “I’ve never felt like this before” or “Last time I felt this way, I ended up really sick for many days” – or any other similar sort of feeling, don’t ignore your feelings.

[286] See https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Symptoms-&-Emergency-Warning-Signs or https://cov.cx/a1b34

[287] A classic example of official “CYA” actions at work!

[288] As you read further into this book, you’ll discover that the “do nothing” advice may not be the best advice and you’ll have the information and data you need to have a more focused discussion on that point.

[289] For example, https://www.healthline.com/health-news/mild-covid-19-symptoms-can-quickly-turn-serious or https://cov.cx/a1b35

[290] Blood-oxygen levels are a bit misleading. You might think “anything over 50% is a pass”, but actually, optimum levels are in the high nineties percent. At about 94% or so, it has already become a cause for serious concern and possibly hospitalization.

[291] Remdesivir is too expensive, not available in sufficient quantities, and too resource-intensive to administer to everyone who tests positively, and may not be helpful in the early stages of an infection in any case. The overall value of this much talked about drug is no longer as clear in any event, with WHO now arguing against its use.

[292] These are indeed typical platitudes but are also valid, appropriate, and important things to do. But maybe there are some other things that actually can be done to help, as well.

[293] Covid can cause blood-oxygen levels to drop even without the patient being aware or experiencing difficulty in breathing. You should have a pulse oximeter available so you can monitor your blood oxygen level – see our chapter on “17. Medical Equipment & Supplies You Should Have” which discusses these and other devices, below.

[294] Some people suggest the “almost half who experience no symptoms” actually don’t have the virus at all, and it is just a false positive result from the virus test process. We’re not sure about this, because some studies seem to suggest that a good percentage of the symptomless people are actually infectious and can pass the virus on to others, meaning they obviously are infected, themselves. We talk more about testing further on in this chapter.

[295] See, for example, https://www.medrxiv.org/content/10.1101/2020.10.20.20216143v1 or https://cov.cx/a1b36 – this article examined the literature and found reports of cases appearing after as long as 34 days in quarantine. Maybe one or two cases could be overlooked and be explained as bad data or accidental late infection from some unknown source, but there are multiple reports of infections appearing more than 14 days after an event that may have transferred the virus to a person who then quarantines.

[296] The answer to that question is complicated and depends a bit on the situation. For example, if you are New Zealand, and fighting to keep your entire country totally free of the virus, it is essential not to allow it back into the community, and so you could justify a longer period of quarantine because the stakes are higher. If however, you’re in a community with multiple active clusters of infection, the downside is not so severe and perhaps you can be more tolerant of shorter quarantines.

[297] Percentages are taken from this document https://www.vox.com/2020/7/29/21327317/symptoms-of-covid-19-coronavirus-fever-cough-toes-rash-loss-of-taste-smell or https://cov.cx/a1b37

[298] This article correlates how high your fever goes with how serious an infection you have : https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03045-8 or https://cov.cx/a1b38 Does that mean that you should take an antipyretic drug to lower your fever? The answer to that is a resounding “don’t know”. It seems to us that the fever is probably showing the degree with which your body is desperately battling the virus, and controlling the fever is merely attacking a symptom/result rather than the cause, it might even be harmful. As the article concludes, (much) more research is needed.

[299] Shortness of breath can be described variously as

A tightness in your chest
Inability to catch your breath
Can’t breathe deeply
Not getting enough air into your lungs
A feeling of suffocating or smothering or drowning,
Needing to consciously make an effort to breathe in or out
Needing to breathe in again before you’ve finished breathing out

[300] See https://covid.joinzoe.com/us-post/skin-rash-covid or https://cov.cx/a1b39

[301] See https://www.studyfinds.org/coronavirus-symptoms-order/ or https://cov.cx/a1b40

[302] See https://bestlifeonline.com/strange-new-covid-symptoms/ or https://cov.cx/a1b41

[303] See https://covid.joinzoe.com/us-post/covid-clusters or https://cov.cx/a1b42

[304] See https://www.nature.com/articles/s41591-020-0916-2 or https://cov.cx/a1b43

[305] We also observe, wryly, how the vast majority of people persist in describing their colds as “the ‘flu”. 99% of the time, they are wrong. They don’t have the ‘flu. They have a common ordinary cold. But they feel more self-important by describing it as ‘flu, and perhaps more justified in staying in bed.

[306] Taken from various sources, including https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm or https://cov.cx/a1b44 – the list above is not complete

[307] This 14 Aug article quotes a Harvard Professor of Epidemiology as saying “The incompetence [of the CDC in particular] has really exceeded what anyone would expect”. The article goes on to point out that we are now testing fewer people each week, but with more problems in administering the tests. How is it possible that we are getting worse rather than better? See https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/ or https://cov.cx/a1b45

[308] This is a great article that discusses testing through the lens of a woman who repeatedly tested negative for the virus, while having a severe infection, even needing hospitalization and oxygen. https://www.gq.com/story/julia-ioffe-false-negative-covid-testing or https://cov.cx/a1b46

[309] That’s a very important distinction, and obviously so. But, unbelievably, for a while, both the CDC and some states (PA, TX, GA, VT, possibly others) in the US were reporting tests for current infection numbers and including the other type of tests – tests for past infection numbers – in those results. That of course skewed the national understanding of virus activity numbers until it was discovered. See https://www.theatlantic.com/health/archive/2020/05/cdc-and-states-are-misreporting-covid-19-test-data-pennsylvania-georgia-texas/611935/ or https://cov.cx/a1b47 and https://www.wlrn.org/news/2020-05-20/cdcs-national-dashboard-includes-covid-19-data-that-expert-says-mixes-apples-to-oranges#stream/0 or https://cov.cx/a1b48

[310] The main two points are to try and understand the difference between “known patients” and “total patients”, and also to identify what level of potentially growing herd immunity might be present in a community. We discuss herd immunity later on in this document.

[311] Test turnaround times have varied from month to month. Sometimes, they have been fast, other times they have been appallingly slow. So our description, while a sadly true depiction of some of the time, is not accurate for every day between March and now. But it is not true to say “after problems, things improved and now are much better. In mid-November, new reports of problems with testing started surfacing. See https://apnews.com/article/us-covid-19-testing-strained-holidays-db20ebbcc1fa8a411be8f9ebc241af3b or https://cov.cx/a1b49

[312] Knowing you are clear and can return back to normal aspect is almost as important as knowing you are infected. If you’ve had to self-quarantine, and if you can’t work, you’ll be very keen to be able to end your quarantine and get back to your normal life.

[313] I remember one time there was a high-profile arson event in New Zealand, and the police ended up asking anyone and everyone remotely connected with the business and its location where they were on the night of the fire. They asked me because, like probably hundreds of other people, I’d worked in the building some years before, and at first, a flash of panic came over me. I had no idea, and couldn’t remember. I had no alibi, and of course, in the tv detective shows, having no alibi unerringly makes you the guilty person.

With what I’m sure what a look of pure guilt on my face, I told the two policemen that I didn’t know and couldn’t remember. They looked at each other, shrugged, and one of them handed me his card. “Give us a call if you remember,” he said. They left. I never called, and they never came back. My guess was most of the people they were contacting, some weeks later, were telling them the same thing. Perhaps only guilty people have alibis?

[314] This article quotes experts as saying test results need to be received in 2 – 3 days to be of any value. Maybe, indeed, after three days they are useless, as the expert described, but the two-day delay needs to be understood as being massively less desirable than one or zero days of delay, too. See https://www.cnbc.com/2020/08/15/forty-percent-of-us-covid-19-tests-come-back-too-late-to-be-clinically-meaningful-data-show.html or https://cov.cx/a1b50

[315] Most exciting of all is a new test that promises results in 30 seconds. See https://www.jpost.com/israel-news/india-israel/india-israel-30-second-coronavirus-test-in-very-last-stage-649372 or https://cov.cx/a1b51

[316] See https://www.statnews.com/2020/08/15/fda-clears-saliva-test-for-covid-19-opening-door-to-wider-testing/ or https://cov.cx/a1b52 and https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-yale-school-public-health#:~:text=Today%2C%20the%20U.S.%20Food%20and,testing%20for%20COVID%2D19%20infection. or https://cov.cx/a1b53

[317] See https://www.msn.com/en-us/health/medical/fda-authorizes-abbott-s-fast-5-covid-19-test/ar-BB18pgyi or https://cov.cx/a1b54

[318] See https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/ or https://cov.cx/a1b55

[319] See https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/ or https://cov.cx/a1b56 . Since that article, there has been a great further development that now means that pooled testing doesn’t need to have multiple tests run on people when one of the pooled test samples is positive, making the process even faster and more beneficial. https://www.pressreader.com/usa/chicago-tribune/20200824/281715501993620 or https://cov.cx/a1b57

[320] You might note that while I’m pointing to a community infection rate of about one in 2,000, if we look at the test results, we see that about one in every 13 is testing positive – see https://www.worldometers.info/coronavirus/country/us/ or https://cov.cx/w-us – I’m using the results on 30 August. Why the huge difference?

The difference is because at present, in most cases, you have to think you have the virus before you can be tested for it. So of course, most people who think they have the virus, and usually have been prescreened by a physician, will test positive. But as the country gets more testing facilities, and with more people being truly randomly tested (for example, prior to being allowed onto a plane or into an event), testing will shift from “mainly testing sick people” to “testing everyone, sick or not”, and the percentage of positive tests will start to more closely reflect the prevalence of the virus in the population as a whole.

[321] This is a footnote you can skip unless you’re keen on the underlying details, or if you think you’ve spotted an error in my reasoning. At present (early September), based on actual reported numbers, there have been 87.4 million tests done in the US, and there are a total of 6.5 million Covid cases. So, it might seem that rather than one in 200 people having the virus, more like one in 13 people do. That would massively reduce the number of false positives, of course.

This is simultaneously right and wrong. How can something be both right and wrong at the same time, you ask? Welcome to the wonderful world of statistics and sampling! At present, the thing is that most people being tested are almost certainly infected – it is very difficult for ordinary healthy people to be tested. But if truly random people were being tested, rather than already sick people, the one in 200 number becomes closer to reality and so too does the overwhelming number of false positives. In other words, if you think you have the virus, and a test shows you do, the test is probably correct. But if you don’t think you have the virus, and are surprised to see a test result saying you do, the test result is probably wrong.

[322] Human factors and other random errors always intrude on perfection. So while you’ll see some tests claiming higher degrees of accuracy, it is important to acknowledge that in the “real world” things are never as good as the theory hopefully suggests.

[323] Probably due to three factors – better test design, better test administration, and better lab work.

[324] This is most vividly exemplified in the unattributed comment that early PCR accuracy may have been in the range of 66% – 88% in the real world in this article : https://nymag.com/intelligencer/2020/06/how-accurate-are-covid-19-tests.html or https://cov.cx/a1b58

[325] These concerns have been expressed even by the man who invented PCR tests, many years ago. We discuss this issue in the introductory comments to our “daily diary” article on 19 November, see https://thecovidsurvivalguide.com/2020/11/297-2.htm or https://cov.cx/a1b59

[326] One of the unusual things about this virus is that it seems to be at its most infectious before the infected person even realizes they have been infected.

[327] See, for example, https://www.foxnews.com/health/coronavirus-covid-19-highly-contagious-days-symptoms or https://cov.cx/a1b60 and https://www.webmd.com/lung/coronavirus-incubation-period or https://cov.cx/a1b61

[328] See https://www.msn.com/en-us/health/medical/here-s-how-long-it-takes-to-test-positive-for-coronavirus-after-exposure/ar-BB14SvmO or https://cov.cx/a1b62

[329] That’s a bit like advertisements with the weasel words “up to”, isn’t it. “Enjoy up to 50% better fuel economy” can also mean “enjoy only 0.1% better fuel economy”!

[330] See https://gulfnews.com/lifestyle/health-fitness/covid-19-testing-too-soon-gives-false-negative-result-says-study-1.1591799861871 or https://cov.cx/a1b63

[331] See https://www.self.com/story/coronavirus-testing-protests or https://cov.cx/a1b64

[332] See https://www.nejm.org/doi/full/10.1056/NEJMp2025631 or https://cov.cx/a1b65

[333] But do you spot the weakness in this “best answer”? It assumes we know when we might have been infected. Sometimes that can be the case – if we spent several hours in close quarters, indoors, with a person who was then shown, the next day, to be infected, we’d have reason to worry. But most people at present are becoming infected not as a result of a known risky experience, but as a result of just general life and living. In other words, for most of us, in most cases, we don’t know when to start getting tested.

[334] Unfortunately, a “you don’t have the virus” test result is also plagued with imprecisions, in particular, the fact that it takes a number of days between when you are infected and when a test will register the virus’ presence. So a negative (ie “you’re not infected”) test result is never going to be up to date or conclusive. It can never be more than indicative (unless you’ve been in isolation with no possibility of recent infection).

[335] There’s a great explainer in this article https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/ or https://cov.cx/a1b66

[336] See https://www.worldometers.info/coronavirus/ or https://cov.cx/w-c

[337] This is not the same as testing 21.6% of the population. Some people get many tests, so the actual percentage of the population tested is considerably lower.

[338] Update, in mid-October, the US had slipped further down to 20^th place. However, by mid-December, it was back at 18^th place again.

Chapter 7 How Long Does an Infection Last

[339] Taken from https://covid.joinzoe.com/post/covid-long-term or https://cov.cx/a1b67

[340] We’re very uncomfortable with these concepts. If you have no symptoms, do you really have the disease at all? We’ll accept that for some people, the disease is so mild that the symptoms are barely noticeable at all. But in some cases, the definition of “has/had the disease” is based purely on not-always-accurate testing for the current or past presence of the virus, making these numbers far from exact.

[341] See https://www.webmd.com/lung/covid-recovery-overview#2-4 or https://cov.cx/a1b68

[342] See https://www.msn.com/en-us/health/medical/how-long-does-it-take-to-recover-from-the-coronavirus/ar-BB15hPBf or https://cov.cx/a1b69

[343] See https://www.popsugar.com/fitness/how-long-does-fever-last-with-coronavirus-47392121 or https://cov.cx/a1b70

[344] See https://www.businessinsider.com/coronavirus-covid19-day-by-day-symptoms-patients-2020-2 or https://cov.cx/a1b71

[345] Largely copied from this article https://www.nytimes.com/2020/04/30/well/live/coronavirus-days-5-through-10.html or https://cov.cx/a1b72

[346] Remember our recommendation to keep a diary of your symptoms. Be sure to start it right away.

[347] See https://www.stuff.co.nz/national/health/coronavirus/300001328/coronavirus-secondweek-crash-is-time-of-peril-for-some-covid19-patients?rm=a or https://cov.cx/a1b73

[348] See https://www.vox.com/2020/7/14/21324201/covid-19-long-term-effects-symptoms-treatment or https://cov.cx/a1b74 and https://www.stuff.co.nz/national/health/coronavirus/122431932/coronavirus-i-think-i-have-long-covid-but-im-struggling-to-be-diagnosed or https://cov.cx/a1b75 and https://www.theguardian.com/commentisfree/2020/jun/28/coronavirus-long-haulers-infectious-disease-testing or https://cov.cx/a1b76

[349] See https://www.trialsitenews.com/so-called-long-covid-a-bigger-problem-than-many-know/ or https://cov.cx/a1b77

[350] See https://www.medrxiv.org/content/10.1101/2020.07.29.20164293v1 or https://cov.cx/a1b78

[351] See https://www.nytimes.com/2020/10/27/health/covid-antibodies-autoimmunity.html or https://cov.cx/a1b79

[352] See https://www.reuters.com/article/health-coronavirus-lungs-int-idUSKBN27K00X or https://cov.cx/a1c19

[353] See https://www.msn.com/en-us/health/medical/the-98-longest-lasting-covid-symptoms-you-need-to-know-about/ss-BB17W417 or https://cov.cx/a1b80

[354] See https://www.survivorcorps.com/ or https://cov.cx/a1b81 for more information

[355] I’ve been very impressed with the material they are sending to their clients on how they are responding to the challenges of Covid-19. If you’re in their service area and you need Covid help, they’d be a great resource. See https://www.caduceusmedicalgroup.com/ or https://cov.cx/a1b82

[356] See https://www.cdc.gov/media/releases/2020/s0814-updated-isolation-guidance.html or https://cov.cx/a1b83

[357] See https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html or https://cov.cx/a1b84

Chapter 8 How to Know if You Are Cured

[358] The CDC had been using three days with no fever as part of its “you are no longer infectious” tests, but then shortened it to one day. Maybe split the difference and call it two?

[359] We tell you this because it is official advice. But for much of the last eight months, this suggestion has little connection to reality. Hopefully, the growing number of fast and inexpensive tests will start to make this a practical suggestion at long last.

We’d also not obsess too much if you are getting PCR type tests and they show the virus is still present. This may be a “false positive” result by the test, caused by the test being unable to distinguish between the active live virus particles and the dead remnants of the virus that is now “safe” and no longer active.

[360] See https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html or https://cov.cx/a1b85 and https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html or https://cov.cx/a1b86

Chapter 9 Self Quarantining

[361] There can be very selfish as well as altruistic reasons to do this. If you are careless, maybe you infect someone else you know, then they in turn infect other people that you both know, including possibly others of your immediate family and closest friends. The disease heartlessly travels through groups of people, and just because you have been careful not to infect your closest family members doesn’t mean you haven’t infected someone else, who in turn infected someone else again, and that person now meets your close family members and brings the virus right back home again.

Remember the concept of “everyone is no more than six connections away from anyone else in the world”. It is the same with the virus, and usually, rather than six connections, the number is much smaller.

So if the thought of saving the lives of strangers isn’t strong motivation, keep in mind that your careful quarantining may be both directly and indirectly also saving the lives of those people closest to you.

[362] It seems that in general 42% of all infections are passed on by people before they have any symptoms, and 35% of infections are passed on the day symptoms are first noticed or the following day. See https://www.stuff.co.nz/national/health/coronavirus/300105935/covid19-most-coronavirus-transmission-isnt-being-caught-in-time or https://cov.cx/a1b87

[363] Of course they should act with caution and get tested to see if they have the virus so they know what they should be doing themselves. But don’t all quarantine together if you are a mix of infected people and people who don’t yet know their status.

[364] This is a fascinating article with amazing pictures of the clouds that come up from a toilet flush. https://www.studyfinds.org/what-happens-when-you-flush-with-toilet-lid-up/ or https://cov.cx/a1b88

[365] And, absolutely – and truly for medical reasons – to do all the washing up, too! Who said there aren’t upsides to having the virus…..

[366] Taken from this site https://www.minnicks.com/learning-center/indoor-air-quality/what-does-merv-rating-mean-on-a-furnace-filter-why-should-i-care/ or https://cov.cx/a1b89

[367] This is a potentially big deal. A reduced airflow means that the heat exchanger in your system isn’t transferring as much heat between itself and the air blowing over/through it. If you are in cooling mode, this could mean your coils freeze over, and then transfer less cooling to the air, which makes the system work harder, and ultimately you could have liquid rather than evaporated coolant going back to the outside compressor, which would be very bad. If you are in heating mode, the heater unit might get too hot and crack, and possibly then allow carbon monoxide (assuming you have a gas furnace) into the airflow. Possibly your unit has a way of varying the fan speed to adjust for the thicker density of higher-grade filters. See https://www.energyvanguard.com/blog/unintended-consequences-high-merv-filters or https://cov.cx/a1b90

[368] Both in the sense of domestic pets, and also larger cats such as lions and tigers, too

[369] See https://www.studyfinds.org/mink-study-first-covid-transmission-animals-humans/ or https://cov.cx/a1b91

[370] See, for example, https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html or https://cov.cx/a1b92

[371] See https://medicalxpress.com/news/2020-08-genomic-analysis-reveals-animal-species.html or https://cov.cx/a1b93

Chapter 10 How to Avoid Infection – In General

[372] See https://www.advisory.com/daily-briefing/2020/06/02/covid-health-effects or https://cov.cx/a1b94

[373] See https://www.vox.com/2020/5/8/21251899/coronavirus-long-term-effects-symptoms or https://cov.cx/a1b95

[374] See https://www.independent.co.uk/news/health/coronavirus-long-term-health-disease-covid-19-lungs-heart-brain-a9546671.html or https://cov.cx/a1b96

[375] See https://web.archive.org/web/20201031053240/https://www.today.com/health/coronavirus-long-term-health-covid-19-impact-lungs-heart-kidneys-t178770 or https://cov.cx/a1b97

[376] See https://www.usnews.com/news/health-news/articles/2020-06-04/loss-of-smell-taste-might-be-long-term-for-some-covid-19-survivors or https://cov.cx/a1b98

[377] See https://www.medrxiv.org/content/10.1101/2020.07.23.20160762v1.full.pdf or https://cov.cx/a1b99

[378] See https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19 or https://cov.cx/a1c01 . This was a dubious statement when first made – “no evidence” is a very absolute statement to make, isn’t it. And to still be saying this in mid-August is becoming another example of where WHO is either asleep at the switch or allowing political considerations (its egalitarian dislike of “immunity passports”) to interfere with medical reality.

[379] Actually, this is not as counter-intuitive as it may seem. People with mild cases clearly have very effective immune systems. People with severe cases clearly have very ineffective immune systems and their struggle against the virus has needed to be aided by lavish applications of every possible modern medical technique and medicine.

[380] See https://www.nytimes.com/2020/08/16/health/coronavirus-immunity-antibodies.html or https://cov.cx/a1c02

[381] As examples, and in case the NYT article is no longer online, this paper https://www.cell.com/action/showPdf?pii=S0092-8674%2820%2931008-4 or https://cov.cx/a1c03 and this paper https://www.medrxiv.org/content/10.1101/2020.08.11.20171843v2 or https://cov.cx/a1c04

[382] I’ve not been able to find their official statement, but consider its paraphrase here as being reliable https://www.cbsnews.com/news/transcript-scott-gottlieb-discusses-coronavirus-on-face-the-nation-august-16-2020/ or https://cov.cx/a1c05 . Update – the CDC is either clarifying or walking back its earlier statement (which is perhaps why I can’t now find it). This is their apparently current official opinion : https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html or https://cov.cx/a1c06

[383] A new article is now quoting a study of nearly 20,000 patients in New York, finding that there were stable levels of protective antibodies for three months. See https://apnews.com/article/virus-outbreak-archive-310caebd08336e2df27c468dfc79f9b8 or https://cov.cx/a1c07

[384] Six months ago, in early February, there were barely a dozen cases in the entire US.

[385] See the section on Test Accuracy, above. We showed how a 98% accurate test could still come up with 40 false positives for every true positive. With some tests having only a 50% accuracy, those numbers become even more extremely biased in favor of false positives.

[386] See https://www.theguardian.com/world/2020/aug/24/case-of-man-with-coronavirus-for-second-time-stokes-reinfection-fears-hong-kong or https://cov.cx/a1c08

[387] However, it is important to stress that the reason for his reinfection can not be said to be because of the different strain of the virus that infected him a second time. There is no clear evidence (at least, not yet!) that the two different strains are treated differently by the body’s immune system. The only relevant point is that this man had been exactly confirmed to have a specific strain of the virus the first time, and we therefore exactly knew, when he was found to be with the virus again, and it was a different strain, that it wasn’t a “long haul” illness simply flaring up again, but a fresh new illness.

[388] And went on the record with my disagreement. I’m not now trying to be wise after the fact.

[389] This was mentioned on The Guardian’s live blog. Hopefully this link will take you to it : https://www.theguardian.com/world/live/2020/aug/25/coronavirus-live-news-gaza-in-lockdown-following-first-local-cases-hong-kong-man-re-infected?CMP=share_btn_tw&page=with:block-5f44e7c38f08767dd7f0e657#block-5f44e7c38f08767dd7f0e657 or https://cov.cx/a1c09

[390] See https://www.stuff.co.nz/national/health/coronavirus/300091506/coronavirus-two-cases-of-covid19-reinfection-in-europe-with-more-likely or https://cov.cx/a1c10

[391] See https://www.msn.com/en-us/health/medical/nevada-man-had-covid-19-twice/ar-BB18tZF0 or https://cov.cx/a1c11

[392] See https://www.theguardian.com/world/2020/oct/06/flurry-of-coronavirus-reinfections-leaves-scientists-puzzled or https://cov.cx/a1c12 and https://www.dailymail.co.uk/news/article-8889269/Russian-professor-69-infected-Covid-19-twice-says-herd-immunity-impossible.html or https://cov.cx/a1c13

[393] See https://www.webmd.com/lung/news/20201014/dutch-woman-first-to-die-after-covid-19-infection or https://cov.cx/a1c14

[394] Taken from https://medium.com/microbial-instincts/what-the-d614g-mutation-means-for-covid-19-spread-fatality-treatment-and-vaccine-7dda1c066f0d or https://cov.cx/a1c15

[395] Maybe the mutation was from less to more harmful. Or maybe not. This recent article says it was a mutation from less to more infectious, but possibly at the same time, from more lethal to less lethal. You’d think this might be obvious, or at least carefully studied to understand, but instead it is yet another example of the confusion that surrounds so much of the virus and its properties. https://news.trust.org/item/20200818024342-3xads or https://cov.cx/a1c16

[396] The main reason why harmful viruses evolve to become less harmful is in cases where the virus is “too harmful” and quickly kills off its host person before the person has had a chance to go around spreading the virus to other people.

But the Covid-19 virus is not “too harmful” and spreads readily at present, so there is no evolutionary pressure to favor a less harmful version appearing and dominating. This is just wishful thinking by people who should know better.

[397] See https://medicalxpress.com/news/2020-06-sars-cov-mutating-slowly-good.html or https://cov.cx/a1c17 Apparently, RNA viruses can sometimes have an extra function that “checks” the accuracy of its replication. The SARS-Covid-19 virus has this extra function which is why it evolves at a medium speed rather than high speed.

[398] See https://www.livescience.com/coronavirus-mutations.html or https://cov.cx/a1c18

[399] See https://www.sciencemag.org/news/2020/07/pandemic-virus-slowly-mutating-it-getting-more-dangerous or https://cov.cx/a1c20

[400] To be more exact, it is probable that having multiple colds in a year is likely to be due to many different virus strains out there, all of which result in what we vaguely call a cold. So rather than being infected multiple times in quick succession by the exact same virus, it is more likely we are being infected by several different viruses. See https://flucamp.com/catching-the-same-cold-twice-fact-or-myth/ or https://cov.cx/a1c22 But to continue that line of reasoning, there are already multiple strains of the Covid-19 causing virus out there. Will an infection caused by one of them, or a vaccine targeted at one of them, provide us immunity for others of them? This is not yet known. However, in that context, it is fair to say that as time passes and more Covid-19 virus strains mutate/evolve, it is likely the answer to this question, whatever it might be today, is likely to tend more to the “no” end of the range of answers than the “yes” end.

[401] Hmmm – here’s an amusing thought – “Covid-19, now with guaranteed immunity for three months – a free re-infection for anyone who doesn’t get the full guaranteed three months”!

[402] For example, this interesting article published on 22 September about herd immunity possibly having been achieved in Manaus, Brazil, matter of factly refers to “The blood survey clearly showed that with time, people’s antibodies become harder to detect. That could mean individual immunity to the virus is not permanent.” See https://www.technologyreview.com/2020/09/22/1008709/brazil-manaus-covid-coronavirus-herd-immunity-pandemic or https://cov.cx/a1c23

[403] Well, yes and no. On about 14 August Russia announced it had approved a vaccine and was proceeding to mass-produce it. That statement was greeted by incredulity both within and outside of Russia, because the vaccine is being approved prior to even starting its Phase Three trial. It was approved based on the results of a limited short trial of 76 people, and the results of that trial have not been publicly released for evaluation and discussion.

[404] Another consideration is that not all the 150 or so vaccines being developed work in the same way of creating immunity. There are some quite novel and innovative techniques being trialed, and which may provide different degrees of future immunity for differing lengths of time.

[405] See https://www.biospace.com/article/fda-s-guidance-on-a-covid-19-vaccine-must-be-at-least-50-percent-effective/ or https://cov.cx/a1c24

[406] Interesting data on vaccine longevity here https://www.immune.org.nz/vaccines/efficiency-effectiveness or https://cov.cx/a1c25

[407] See https://www.theguardian.com/environment/2020/nov/04/denmark-announces-cull-of-15-million-mink-over-covid-mutation-fears or https://cov.cx/a1c26

[408] There are even occasional but unpersuasive suggestions of other possible infection mechanisms such as via fecal contamination.

[409] I’m using the word “belief” rather than “knowledge” advisedly. As you’ll shortly see, much of the body of work on how respiratory diseases are transmitted is based on a single very old study and somehow has never been challenged or reviewed in over 100 years.

[410] Well, yes and no in that case. The “exchange of bodily fluids” is safe, but the act of being very close to another person, and breathing heavily close to them, gives plenty of opportunities for virus particles to be exchanged in the “normal” ways.

[411] This article has great pictures of plumes https://www.studyfinds.org/what-happens-when-you-flush-with-toilet-lid-up/ or https://cov.cx/a1c27

[412] Here’s an article that is a subtle example of that. It is all about the theory and the potential, but is totally silent on the reality. The study it refers to was conducted in 2012, and while it shows the potential for whatever is in the toilet bowl to rise up into the air, it of course says nothing at all as to the most important point – are the viral fragments of Covid-19 found in feces actually dangerous? https://whdh.com/news/study-suggests-coronavirus-can-be-spread-through-toilet-plume/ or https://cov.cx/a1c28

This is a similar article that adds how viral RNA has been found in public toilets in China. https://www.nytimes.com/2020/06/16/health/coronavirus-toilets-flushing.html or https://cov.cx/a1c29 But the NY Times’ own reporting of the viral RNA find – https://www.nytimes.com/2020/04/28/health/coronavirus-hospital-aerosols.html or https://cov.cx/a1c30 – says “scientists do not know yet whether the viruses remain infectious or whether the tests just detected harmless virus fragments”.

[413] I don’t know why this is. There was a rush of studies to test how long the virus could stay viable on all sorts of different surfaces – hard or soft/absorbent, and at different temperatures and humidities – see, for example, https://www.webmd.com/lung/how-long-covid-19-lives-on-surfaces or https://cov.cx/a1c31 . My guess (and, don’t forget, I’m not a doctor) is that while it is possible to pick up some virus particles onto your hands this way, and even to then transfer them to your eyes/nose/mouth, the number of virus particles is generally too low to then create a viable infection.

An added guess, and this is a real reach, is that the main pathway into the body may be via the nose rather than the mouth. Here’s a brand new study (as of 19 Aug) on this currently speculative point – https://www.marketwatch.com/story/johns-hopkins-scientists-examining-weird-side-effects-of-covid-19-say-this-could-be-how-virus-gains-a-foothold-in-the-body-2020-08-19 or https://cov.cx/a1c32

An alternate explanation is that there has been such efficient/effective cleaning, and people have been so great at washing their hands, that this theoretically very dangerous risk has been mitigated by good practices. Call me cynical if you must, but I’d rate this as low in terms of possible explanations.

[414] When WHO was still obdurately refusing to acknowledge the risk of aerosol transmission in early July, 239 scientists and medical researchers wrote WHO a letter demanding it changes its official position. WHO’s earlier position remains prominently on its website https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations or https://cov.cx/a1c33 with a focus on surface/fomite transmission and secondarily droplet transmission, and a negation about the potential for aerosol transmission. Its new supplementary statement grudgingly admits this possibility while downgrading the importance it had earlier given to fomite transmission : https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions or https://cov.cx/a1c34

[415] See https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions or https://cov.cx/a1c34

[416] See https://www.theguardian.com/world/2020/oct/05/did-early-focus-on-hand-washing-and-not-masks-aid-spread-of-covid-19-coronavirus or https://cov.cx/a1c35

[417] Have you ever noticed how whenever this phrase is used, it is usually code for “this is really stupid and we can’t justify it, but we’re doing it anyway”?

[418] When my home county of New Zealand ended its 102 day stretch free of any virus outbreaks with a new mysterious outbreak that the public health authorities couldn’t trace to any previous infection, there was thought the virus might have re-entered New Zealand on the surface of frozen food packages that had been shipped to the country from Melbourne, Australia, which was in the throes of a flare-up of virus numbers. The public health authorities then let slip a few unguarded comments about how unlikely any type of surface transmission of the virus was, and after testing both the frozen food storage depot in NZ and in Australia, found no sign of any possible contamination.

I’ve tried to find a good quote, but the best I can find now is rather weak, “The medical advice we have received indicates that the transferal of COVID-19 through mail and parcels is low risk. Respiratory droplets largely transmit Covid-19, and there is no good evidence that surface transmission is occurring in operational environments such as ours”.

[419] This is a good article that tracks the evolving view from first “surfaces are dangerous” to now “surfaces are not a key risk factor” https://www.wired.com/story/its-time-to-talk-about-covid-19-and-surfaces-again/ or https://cov.cx/a1c36

[420] Just as a comment about this, there is nothing magic about the six-foot rule. Some countries have 1½ meters (5 ft), some have 1 meter (3 ft 3 in) as their versions of our 6’ rule. It is primarily a “nice round number” that compromises between “dangerously close” and “impractically far away”.

[421] This duality of benefit is one of the reasons why you should be wearing a mask, even if you don’t like it (no-one likes wearing a mask) and are willing to take the risk of being infected as a result of being maskless. If you have no mask, you are also gratuitously increasing the risk of the people around you – both now and subsequently – who are now being “gifted” with more of your breathed-out air and possibly virus particles. By all means engage in risky behaviors yourself, but once you start risking harm to other people, please be considerate and moderate such actions.

[422] See https://time.com/5883081/covid-19-transmitted-aerosols/ or https://cov.cx/a1c37

[423] This is touched on in the Time article above and further discussed in greater detail in this excellent document, section 1.4, “When you say that the resistance to aerosol transmission is rooted in history, what do you mean?”. See https://docs.google.com/document/d/1fB5pysccOHvxphpTmCG_TGdytavMmc1cUumn8m0pwzo/edit#heading=h.n29zu41x8ctd or https://cov.cx/a1c38

[424] You might be wondering how it is that an aerosol droplet is not affected by gravity. Does it have some magical anti-gravity property? Alas, no. There’s a much simpler explanation. An aerosol droplet is so light that it is buoyed up in the air by colliding with air molecules, sort of a bit like a game of volleyball, with each air molecule bouncing the aerosol particle up again, until eventually, an air molecule “misses” the “ball” and it falls to earth. Yes, this is a massive over-simplification, but hopefully it provides an understanding. More information can be found here and elsewhere https://en.wikipedia.org/wiki/Deposition_(aerosol_physics) or https://cov.cx/a1c39 .

[425] Sort of the opposite of the story (of uncertain validity) of “It was so cold my urine froze before it hit the ground”.

[426] See https://www.nationalgeographic.com/science/2020/04/coronavirus-covid-sneeze-fluid-dynamics-in-photos/ or https://cov.cx/a1c40

[427] See https://www.nejm.org/doi/full/10.1056/NEJMicm1501197 or https://cov.cx/a1c41

[428] A half-life means that half of the aerosol falls to the ground in the first half-life measure of time. Half of the remaining half falls in the next half-life. Half of the remainder falls in the next half-life, and so on.

[429] See https://www.statnews.com/2020/03/16/coronavirus-can-become-aerosol-doesnt-mean-doomed/ or https://cov.cx/a1c42

[430] This study says that the virus remained viable for up to three hours, although we don’t know if “up to” also means “at least”, which it possibly may. See https://theconversation.com/coronavirus-drifts-through-the-air-in-microscopic-droplets-heres-the-science-of-infectious-aerosols-136663 or https://cov.cx/a1c43

[431] Perhaps surprisingly, one of the best examples of a good airflow set up is on a plane, with the air streaming from the top of the cabin down to the bottom. This blows fresh air onto your face, and takes your exhaled air down to the ground and out rather than to other passengers.

[432] See https://www.buildingscience.com/sites/default/files/01.03_2015-08-03_ventilation_multifamily_ricketts.pdf or https://cov.cx/a1c44 – discussion starting on slide 16

[433] This sort of begs the question, “Why is the annual ‘flu virus seasonal?”. The short answer is “We don’t know”. There are a number of different theories, and some studies supporting one or other of the studies. I personally think the change in lifestyle from “being cooped up in winter with more people close by” to “being outside in the fresh air in the summer” is a major part of the issue, and particularly because the ‘flu is generally less infectious than Covid-19, maybe that is enough of a variance as to make all the difference.

This is a good explainer. https://www.popsci.com/science/article/2013-01/fyi-why-winter-flu-season/ or https://cov.cx/a1c45

[434] See https://www.wsbtv.com/news/local/atlanta/need-sanitize-your-n95-face-mask-try-your-instapot/YCDAGFMEYJCKHNAMYFKX5IFKPQ/ or https://cov.cx/a1c46

[435] An interesting rule of thumb that gives a great insight into the impact of temperature on chemical reactions is that an increase of 10°C (18°F) will double the speed of the reaction. Does it therefore follow “If I increase the temperature by 65°C, I will double reaction speed by 6 ½ doublings (ie about 100-fold)?” More or less, yes, although other factors could come into play.

The point of this is to wonder if the breakdown of the virus works on a similar basis. If it does, then it allows us to work back from one hour at 100°C to 100 hours of longevity at 35°C (95°F) or 200 hours at 25°/77° and so on. With such longevity, a few degrees of ambient temperature change isn’t very profoundly impactful.

[436] Any impact as a result of outdoor temperatures is minor compared to other impacts such as social distancing and mask-wearing and so is almost impossible to separate out of the overall trends.

[437] See the first part of this article https://www.mirror.co.uk/news/world-news/coronavirus-survives-frozen-meat-fish-22564733 or https://cov.cx/a1c47

[438] See https://www.accuweather.com/en/health-wellness/uv-radiation-from-the-sun-increases-by-a-factor-of-10-by-summer-and-could-be-key-in-slowing-covid-19/703393 or https://cov.cx/a1c48

[439] Here’s a roundup of various factors and theories, albeit published on 13 March before a lot was known. See https://www.accuweather.com/en/health-wellness/higher-temperatures-affect-survival-of-new-coronavirus-pathologist-says/700800 or https://cov.cx/a1c49

[440] Ignoring rain and wind, which perhaps should be considered, at least for that portion of our lives spent outside. Wind simultaneously spreads and disperses the virus, with the dispersal being good and the spread being bad. However, on balance, the dispersal factor probably outweighs the spread factor, because the number of virus particles per cubic unit of air rapidly dwindles down to a too-low number to be a substantive risk. Rain is generally good because it “washes” any aerosol particles out of the air.

[441] The study, which analyses other studies, is fairly short and can be seen here : https://www.dw.com/en/coronavirus-transmission-humidity-aerosols/a-54639765 or https://cov.cx/a1c50

[442] Source – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1474709/pdf/envhper00436-0331.pdf or https://cov.cx/a1c51

[443] See https://medicalxpress.com/news/2020-06-humidity-linked-covid-.html or https://cov.cx/a1c52

[444] I don’t know about where you live, but where I live, in a suburb of Seattle, I’d say at least half the people I encounter in supermarket aisles are going the wrong way – including, sometimes, me (not deliberately, but accidentally).

[445] A good way to think about aerosols is to imagine the other person is smoking a cigarette. You know that if you are walking behind a person who is smoking (smoke is an aerosol), you’re all the time smelling their smoke. But if you’re walking towards a smoker, you only notice the smell when you are close, and it quickly recedes behind you once you’ve passed the smoker.

[446] See https://www.chron.com/news/article/Can-you-get-coronavirus-via-secondhand-smoke-The-15504536.php or https://cov.cx/a1c53

[447] Well, it depends on how you measure distance, doesn’t it. As you surely know, we are uncomfortably squashed up against each other in airplane seats with zero separation at all between the part of us closest to our neighbor and the part of them closest to us. But if you measure from center to center, or if you just note the width of each airplane seat, you’re at about 17” – 18” of separation. Way too close, however it is measured!

[448] An average airline seat in coach class is about 17” wide. Even business class and first class seats aren’t all that wonderfully better, but you are then getting the benefit of greater “pitch” – the distance between rows as well as the distance between seats. Business class seats are about 20” – 21”, first class seats are 22” – 23” wide.

[449] See https://www.dailymail.co.uk/news/article-8339837/Government-scientist-says-2m-social-distancing-rule-based-fragile-evidence.html or https://cov.cx/a1c54

[450] The concept of masks is not to make other risky behaviors now slightly less risky. Masks are supposed to make current behavior safer, not to enable riskier behaviors.

[451] Formerly known as The British Medical Journal before it puzzlingly wished to turn its back on its illustrious past and “modernize” itself

[452] See https://www.bmj.com/content/370/bmj.m3223 or https://cov.cx/a1c55

[453] ibid

[454] The rule change is discussed here https://www.msn.com/en-us/health/medical/the-cdc-now-says-you-can-catch-covid-from-someone-in-exactly-this-long/ss-BB1agYdC or https://cov.cx/a1c56 and the exact rule is here https://www.msn.com/en-us/health/medical/the-cdc-now-says-you-can-catch-covid-from-someone-in-exactly-this-long/ss-BB1agYdC or https://cov.cx/a1c57

[455] See https://www.wsj.com/articles/to-battle-covid-airlines-bet-on-disinfectants-that-come-with-questions-11601474460?mod=djemHL_t or https://cov.cx/a1c58

[456] I’m becoming a bit obsessive about this, and am avoiding not only unmasked people, but also people with useless masks that don’t really protect either the wearer or the people around them. It dismays me greatly that there aren’t any standards or controls on mask quality/performance.

Chapter 11 Avoiding Infection at Work and Home

[457] Not only are the obligations of an employer to maintain a safe (from the virus) workplace unclear, and the obligations of a retailer to provide a safe environment for customers also unclear, but some employers are seeking liability waivers so they won’t be liable and can’t be sued if they don’t do whatever is needed and appropriate to make their work environment as safe as prudent/possible!

[458] For more hype and hope, see this collection of British newspaper front pages https://www.bbc.com/news/blogs-the-papers-54882074 or https://cov.cx/a1c59

[459] It is, of course, a much wider issue than just workplace safety. The same considerations apply to transportation, entertainment, social groups, and any other type of activity that involves people more or less in close proximity to other people.

[460] A problem is that these employee loss costs are obscured, making no manager clearly responsible for them, whereas the safety costs are obvious and required “upfront”. In our culture of short-term profit measurement and fast ROI requirements, it can be hard to justify expenditures that in the longer term and when judged on humanitarian grounds make splendid sense.

[461] Companies have slowly come to realize the costs of poor health and bad lifestyles when it comes to smoking, so there is a precedent to cite and reason for hope – maybe that same awareness can flow to respiratory diseases in general, rather than just smoking-related, and to at-work measures as well as advocating employee lifestyle choices.

[462] See https://www.wired.co.uk/article/lifts-coronavirus-logistics-return-to-office or https://cov.cx/a1c60

[463] A related suggestion – when using any sort of instant messaging service, all participants should use headphones, even if they are in private offices. It keeps noise levels down in the office space, and makes it easier to manage the audio in a group meeting.

Noise rises or falls in a feedback loop. In a noisy environment, people speak louder to be heard, which increases the noise, requiring other people to speak louder, which increases the noise, requiring the first people to speak louder, and so on. Or, hopefully, the opposite. If one person is quiet, the next person doesn’t need to be so loud either, and so on.

Keeping ambient noise down means people don’t have to shout, and if people speak quietly, they don’t emit as many aerosol particles and respiratory droplets.

We urge you to keep your work environment as library-like as possible in terms of sound levels.

[464] It is important that any form of instant messaging be as convenient as possible.

I remember working in a company, decades ago, that had both regular phones for everyone on their desks, and also semi-hands-free intercom type sets as well. Not everyone was privileged to have an intercom set, and – not having one myself – I didn’t see any benefit in them. “Who needs an intercom unit when you already have a phone, and when you can get up and walk to see them too.”

But when I eventually got one of the units myself, I was astonished at how convenient it proved to be, and how it resulted in much more efficient communication, both from me to other people and from other people to me.

The moral of this story is to choose some type of instant communication system that is indeed close to instantaneous, and then make sure everyone is trained in how to use it. Even now we cringe when we see people with only one screen rather than two or more connected to their computer, and painfully closing one program window before opening another, and only having one browser tab active. If you and/or your coworkers don’t know about Alt-Tab (in Windows) it is well past time to learn what a powerful friend it is.

Computers have become such a commonplace accepted thing these days that there is less perceived need to teach people how to use them most efficiently. Something as simple as adding a second screen to a computer can make a person 25% more productive, and some studies go further to point to even more efficiency with a third monitor. See https://www.inc.com/tim-crino/careacademy-ankur-jain-kairos-health-care.html or https://cov.cx/a1c61 . Now consider this :. Generally, a company expects to get more than three times the benefit from an employee compared to their cost. So even a $20/hr office worker is expected to be making $60+/hr for the company. If that $20/hr worker is made 25% more productive, that means they are now making $75/hr for the company. A second computer screen probably costs less than $300. That means in half a week, the cost of the monitor has been returned in productive benefits. In a year, the $300 monitor has resulted in $3000 worth of extra productivity.

Yes, this is nothing to do with Covid-19, but it is all to do with common sense and overlooked business improvement. To turn it back to Covid-19, maybe by making the worker 25% more productive, you can now reduce their hours each week with no negative impact to the company, and making both that worker and everyone else safer as a result.

[465] It would certainly be good if you can speed up the elevator travel speed, but that is more likely to be a more costly enhancement, and – surprisingly – with less impact on total time and capacity.

[466] Don’t get hung up on the concept of “fairness” in the sense of “It isn’t fair that this would benefit some people rather than others”. That’s a classic glass-half-empty attitude, and also overlooks an important consequential benefit to everyone else.

First, the glass-half-full perception – why should people who can benefit from a workplace change not be allowed to benefit from that workplace change? A benefit to any employees flows through to a benefit for the company as a whole. Alternatively, how are the people who didn’t get the benefit of a workplace change harmed? They’re not harmed at all, their life continues as before.

Actually, their life changes too, which brings us to our second point. Every person you can either take out of the workplace or improve medical safety for, is a benefit for everyone else, too, because it reduces the number of potentially risky contacts and interactions in the workplace for everyone else. Taking one person out of an office or off a shop floor means one less person for everyone else to brush shoulders with and risk getting infected from.

[467] I’ve been involved in numerous building projects, both commercial and residential; both new construction and fitting out existing space, and of sizes up to, I think, about 50,000 sq ft. While I’ve been involved in every last detail down to the number of power outlets per foot of wall space, carpet weights, lighting temperatures, and so on, the HVAC has never been something I – or any of the other people working on the projects – have ever stopped to question or ask about beyond confirming it will be adequate to keep us warm in winter and cool in summer and will have enough zones to maintain even temperatures throughout the space. We’ve never thought to ask any more about it. Filter changes? Maybe the landlord did it, but I’d never thought to ask. And so on. Chances are that lack of focus is true of most other businesses and their managers, too.

[468] Air quality is another feature with permanently lasting benefits. It is astonishing to see how poor the air quality is in some buildings currently – but not in obvious ways. Instead, there are insidious and subtle problems, commonly in the form of higher than optimum percentages of carbon dioxide that can interfere with concentration and energy levels. Cleaner fresher air might boost a company’s productivity, reduce its error rates, and make its staff happier and more cheerful. That’s a huge return on a few pennies more of electricity an hour, and changing better filters more often.

[469] See https://www2.purpleair.com/collections/air-quality-sensors or https://cov.cx/a1c62

[470] This article discusses the issue and suggests some equipment https://spectrum.ieee.org/tech-talk/telecom/wireless/indoor-airquality-monitoring-can-allow-anxious-office-workers-to-breathe-easier or https://cov.cx/a1c63

[471] Every situation is different, but if you have an engineer’s report showing elevated levels of CO₂, or other air quality issues, you may be able to get the landlord to do most of the upgrading at their cost. If not, the landlord might agree to spend money on upgrades in terms for the company extending its lease for another some years – the landlord probably saves on a realtor fee for re-leasing the space, and the hassle of doing so, plus if releasing the space, they’d be up for some build-out costs anyway, and possibly some free rent.

Especially at present, with all the future uncertainty hanging over all our heads, in most parts of the country, landlords are desperate to keep good tenants.

[472] See https://www.ashrae.org/file%20library/technical%20resources/ashrae%20journal/2020journaldocuments/72-74_ieq_schoen.pdf or https://cov.cx/a1c64

[473] Here are two excellent articles. There are dozens more. https://fastlifehacks.com/n95-vs-ffp/ or https://cov.cx/a1c65 and https://www.thedailybeast.com/5-myths-on-face-masks-amid-the-coronavirus-pandemic or https://cov.cx/a1c66

[474] So why do some masks have vents? Because they have been designed for purposes where the mask only needs to provide one-way filtering. For example, if you are a painter, you want the mask to block paint being breathed in, but there is no need to filter the air you breathe out.

[475] This is not a major threat, because there is an increasing downplaying of the threat of catching the virus after touching something infected. But it remains a small threat and is easy to minimize.

[476] Well, even that is somewhat of a compromise. If one wished to be obsessive, particularly in very high-risk environments, one might require testing more than once a day. Remember the big weakness with all tests is that it requires several days – at least two, possibly three, maybe even four or more – between when a person gets infected and when a test will correctly report the infection.

So a test at 9am doesn’t mean “this person absolutely has no infection”; it means “two or three days ago, this person was not infected, but we don’t know what happened to them since then”.

This means it is possible that a person could test negative at 9am but positive at 1pm – not because they became infected during that morning, but because an infection they acquired two or three days ago finally became of sufficient strength to register on the test.

The really big issue is whether a person is infectious before or after a test detects their infection. In some cases, particularly with non-PCR testing, it is possible there is a day or two of infectiousness before a test registers an infection.

[477] This is an important point to appreciate. Nothing is black and white. Everything is a case of greater or lesser risk/odds. Even the most cautious and fastidious person can get unlucky (and similarly, even the most careless of people can sometimes seem to lead a charmed life free of consequence!). So don’t think “I completely trust my partner to be careful, so I don’t need to worry about what they’re doing”. It isn’t a case of trust, and tragically, sometimes all the care in the world can be negated by a very unlucky event.

[478] In case it isn’t obvious, the opposite applies, too. Every time you go out, you return back home as a potential threat to anyone/everyone else in your home, too. It may be easier to delicately raise issues of at-home protocols on the basis of volunteering that you don’t want to risk giving an infection you might acquire to the other people, rather than accusing them of being risks to you!

[479] This is a good article that sadly debunks the wish/belief that having a few plants improve our air quality. They say you’d need one plant per square foot of space to have a notable impact on air quality, and that by doing so, you’d end up with too much humidity. https://www.theatlantic.com/science/archive/2019/03/indoor-plants-clean-air-best-none-them/584509/ or https://cov.cx/a1c67

Chapter 12 Avoiding Infection on Planes, etc

[480] Social distancing around a luggage carousel? .Good luck with that!

[481] Taken from the data at https://www.tsa.gov/coronavirus/passenger-throughput or https://cov.cx/tsa-c

[482] See https://www.icao.int/covid/cart/Pages/default.aspx or https://cov.cx/a1c68

[483] After a slow start, the airlines have been eager to embrace this. It shifts a lot of the hassle factor for ensuring safe flights from them and to us, and also provides a visible indication of “doing something” to reassure would-be passengers.

[484] See https://blog.thetravelinsider.info/2020/04/checking-your-temperature-for-covid-19-is-meaningless-and-even-dangerous.html or https://cov.cx/a1c69

[485] See https://www.dw.com/en/how-safe-is-air-travel-during-covid-19/a-55435284 or https://cov.cx/a1c70

[486] See https://www.businessinsider.com/is-flying-safe-right-now-coronavirus or https://cov.cx/a1c71

[487] See https://www.medrxiv.org/content/10.1101/2020.07.02.20143826v3 or https://cov.cx/a1c72

[488] See https://finance.yahoo.com/news/covid-19-risk-airplanes-really-120021101.html or https://cov.cx/a1c73

[489] See https://danto.info/Not_Traveling_4th_Week_October-2020-JSM.htm or https://cov.cx/a1c74

[490] See https://research.esr.cri.nz/articles/preprint/A_case_study_of_extended_in-flight_transmission_of_SARS-CoV-2_en_route_to_Aotearoa_New_Zealand/13257914 or https://cov.cx/a1c75

[491] See two more studies cited in this article https://www.forbes.com/sites/suzannerowankelleher/2020/09/19/covid-19-can-spread-on-long-airline-flights-per-two-new-studies/?sh=6caf176476a9 or https://cov.cx/a1c76

[492] See https://wwwnc.cdc.gov/eid/article/26/11/20-3353_article or https://cov.cx/a1c77 and the apparent acquisition of infection via an airplane toilet

[493] See https://www.webmd.com/lung/news/20200410/100-american-flight-attendants-have-covid-19 or https://cov.cx/a1c78

[494] See http://news.emory.edu/stories/2018/03/airline_disease_transmission_study/ or https://cov.cx/a1c79

[495] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134995/pdf/main.pdf or https://cov.cx/a1c80

[496] It took NZ over a month, but in October they returned back to zero cases again, other than among arrivals from other countries during their period of mandatory, Army-supervised, quarantine, and occasionally a “leaked” case thought to be from a quarantined person to one of the people working in the quarantine facility.

[497] See https://airwaysmag.com/airports/breaking-greece-suspens-qatar-flights/ or https://cov.cx/a1c81

[498] See https://www.staradvertiser.com/2020/06/02/hawaii-news/hawaiian-airlines-adopts-virus-stopping-policies/ or https://cov.cx/a1c82

[499] See https://amzn.to/2XvHtRe or https://cov.cx/a1c83

[500] See https://www.travelandleisure.com/airlines-airports/how-airplane-cabin-air-works or https://cov.cx/a1c84

[501] The average human radiates 100 – 120 watts of heat while sitting at rest. So every ten people are giving off as much heat as a one-bar electric heater.

Chapter 13 Avoiding Infection in Hotels, etc

[502] Don’t call the (800) reservations number, but the hotel’s direct number, and when the phone is answered, make sure you are speaking to someone actually physically at the hotel, rather than in a central call center somewhere else.

[503] One of my pet peeves is being required to provide name/address/phone numbers/email/credit card number when booking a hotel, and then find, upon arriving at the home, that I have to write it all down again onto a reservation card that the computer has printed out, but only with my name at the top, none of the other details.

Oh, and if you do have to do that, be sure to use your pen, not their pen, to ensure that there’s no risk of catching the virus from a much-used pen!

[504] See https://www.ahla.com/sites/default/files/Survey_Frequent%20Travelers%20View%20on%20Hotel%20Cleaning%20and%20Safety%20Initiatives.pdf or https://cov.cx/a1c85

[505] See https://www.ahla.com/sites/default/files/safestayguidelinesv3_081420_0.pdf or https://cov.cx/a1c86

[506] There are two main reasons hotels don’t commonly use these types of ducted air distribution systems. The first is noise – the systems provide an easy route for noise from one room to impact on others nearby. The second is security – while not all ducted systems feature the large size rectangular ducting that people crawl through in action movies, some do and that is obviously not acceptable from a security point of view.

On the other hand, we were astonished to visit a 1960s vintage and low-quality motel in rural Montana, recently, that did have a central air system. So you can’t take anything for granted!

[507] The nice thing about in-room heating units is that you know for sure you’re not getting air from somewhere else, and you are free to then plan your airflow strategy more or less separate from your heating strategy.

[508] Actually, although sometimes I’ve been directly told that, but more often I’ve been outright lied to by staff who don’t want to get in an argument about why they can’t provide cooled air to my room, or who simply don’t understand how their system works.

I’m the type of guy who travels with a temperature probe so when I’m told “just give it half an hour to equalize the temperature in your room, it takes time” I can reply “how can it equalize the temperature down to the level I’m asking for if the air that’s coming out of the register is hotter than that at present?”. It also gives one credibility when an engineer reluctantly appears in your room to wave your own temperature probe around and means you’re more likely to hear the truth rather than more lies designed to shut you up and delay the ultimate argument until after the person in question has gone off shift.

[509] There are also four-pipe systems, with two completely independent water flows rather than a shared return water feed. These are more efficient than three pipe systems, but also more costly. For our purposes, the distinction is of course meaningless – the only thing that matters is that “your” air comes from your room and stays in your room.

[510] Apparently it really is a known “thing” that needs preventing – people will book a night in a hotel with a view to jumping out the window to commit suicide. Some hotels with windows that can open, but with stops/locks on them to prevent opening more than an inch or two, will agree to remove the stop/lock but only if you sign a form first promising to be careful and not jump/fall out the window.

[511] The “collective wisdom” of the internet is particularly disappointing on this issue. In researching this topic, we were appalled at how much nonsense was being offered as fact in authoritative seeming articles.

[512] Here’s a great article looking at one element of sealed-window type hotels and their air flows https://www.energyvanguard.com/blog/adventures-in-hotel-bathroom-ventilation or https://cov.cx/a1c87

[513] In actual fact (in case you wondered) the big problem in sealed rooms is typically not too little oxygen but too much CO2. Too much CO2 will give you headaches and make you drowsy/inattentive long before the oxygen concentration drops to a dangerous level.

[514] Image from this excellent presentation https://www.buildingscience.com/sites/default/files/01.03_2015-08-03_ventilation_multifamily_ricketts.pdf or https://cov.cx/a1c88

[515] Ibid, although this depends on the form of overall ventilation.

[516] There are plenty to choose from on Amazon – https://amzn.to/2EEisvY or https://cov.cx/a1c89

[517] One more point about a portable air filter. Keep it sealed inside a zip-lock bag or some other sort of reasonably air-tight container when traveling with it. The last thing you want is the bumps and vibrations of traveling to knock the dirt and virus particles off its air filter and into your suitcase, onto your clothes, etc.

[518] Many people do this anyway, because such rooms are quieter, for the same reason – fewer people walking to/from their rooms and outside the door.

[519] As a related comment, if you’re staying in a dishonest hotel that charges a dastardly Amenities or Resort Fee of some sort or another, and if the hotel has also closed its gym and/or pool, ask for that fee to be adjusted. The fee of course is nothing other than another way of charging you money, but play their own game back at them – “You are charging me $25/day for using your pool and gym, and both are closed at present, so you should cancel your fee”.

[520] This can be offered on the basis of “It is safer for you as well as me”.

[521] Keep in mind that disinfectant is a powerful poison. After disinfecting the cutlery and crockery, you then need to rinse the disinfectant off before using them.

Note also that with diminishing focus on surfaces as potential pathways for the virus to spread, this is optional, although if you had to choose one thing in particular to disinfect, we’d suggest cutlery that might be “fresh from their mouth to your mouth”, then glassware second, then crockery third.

[522] Can you really trust the same housemaids who are regularly observed and shown in YouTube videos from hidden cameras to clean drinking glasses with a cloth that they’ve just used to wipe the toilet with, to now do a better job of truly disinfecting and ensuring the hygiene of all the various surfaces in your room?

[523] That is also making an assumption that the pillowcase is changed. Probably it is, but for sure, not every hotel and housemaid changes every pillowcase after every stay.

[524] Amazon of course has plenty, but be sure to get a travel pillow for sleeping on a bed with, rather than a neck pillow for while you’re in an airline seat! See https://amzn.to/34CF3UL or https://cov.cx/a1c90 We’d also suggest you try the travel pillow at home first, to make sure it is acceptably comfortable. Even two travel pillows are smaller (for travel purposes) than one single hotel pillow and might make a lot of difference to your sleeping comfort.

[525] I’d suggested, earlier, asking if this would be possible when you do your prior-to-booking phone “interview”. If someone hopefully offers to make a note in your reservation of that request, I suggest you thank them, and ask what sort of occupancy level the hotel is expecting in the nights prior to your arrival. If it is under 90% and you’re just asking for any regular/standard room, there’s little to be gained by accepting this offer, because the reality is that room assignments are usually done by computer and there’s no easy way, short of actually blocking the room off for the previous night, to ensure a room remains empty.

Certainly, don’t rely on any such “notes on your reservation”, which in my experience are often never looked at, or, if they are looked at, seem to be ignored. Ask as if you’re asking for the first time when checking in.

Chapter 14 Include Your Doctor in Your Decision-Making

[526] I am not suggesting that simply reading and writing a lot makes me an expert on the virus! And also, reading this book now doesn’t make you an expert, either. But I do suggest it makes you more informed than 99%+ of the rest of the community, so all is not lost.

[527] This is an important point, too. The truth changes regularly in terms of what are considered good and not so good treatments for the virus.

Think of hydroxychloroquine – it started off with a burst of positive publicity, then got sandbagged by negative reports, but since that time, albeit unreported by most mainstream media, there was been a steady drip-feed of new studies being released, almost all positive. But now there’s an automatic turning away from any mention of HCQ by people who have closed their mind to the topic – they’ll say something like “the three leading studies all showed it to have no benefit and was dangerous to patients’ hearts” (even though the studies have subsequently been convincingly criticized and the heart danger was theoretical rather than real, and what about the 90+ studies subsequently that have been positive), and their automatic dismissal is not the correct thing to do.

[528] Indeed, much of the research into the virus is more based on statistics and data analysis than on the actual medical treatments – when it comes to evaluating outcomes and determining their significance, the medical side of evaluating “did the patient live or not” and “how many days in hospital before discharge” is totally trivial, but the analytical side of “is this a significant or insignificant difference” is key.

[529] An infection is like a forest fire. To start with, you light a match, and can blow it out with a small breath. It sets fire to a piece of paper. You can stamp that out. The paper starts a small piece of wood burning. You can throw a jug of water on it. The piece of wood sets other pieces of wood on fire. Your garden hose will see to that. But leave it much longer, and you’re going to need a fire truck, and leave it longer still, and you’ll need helicopters with monsoon buckets, hundreds of fire-fighters, and so on.

It is exactly the same with a virus, and for the same reasons. Time is essential when fighting a viral infection with weak anti-viral drugs that work in the early stages of an infection but not later on.

[530] See https://www.bloomberg.com/amp/news/articles/2020-10-17/treat-covid-19-early-to-save-patients-lives-sars-veteran-urges or https://cov.cx/a1c91 Hong Kong has a very low infection rate (710 per million, as of early November) and a 2% case fatality rate (14 per million). The world average is a 2.5% CFR, which is also the US rate. So the Hong Kong approach isn’t transformative, but it does seem to be beneficial.

[531] Of course, the reality is there is no such thing as a 100% safe drug. Every drug known to man, and even every natural product, starting with oxygen and water, can be harmful in some ways and forms, depending on how it is applied or taken. Every drug has side effects (but not every person gets every side effect). The universality of side effects gives doctors an automatic justification for refusing any treatment they may wish to reject.

Everything in life, including medicine, is always a case of balancing, minimizing, and optimizing risk; we can never eliminate it. “First, do no harm”, while appealingly simple, is also unhelpfully simplistic.

[532] You know your doctor and the relationship you have with him. Maybe this is something you can discuss upfront, and surely, if you’re seeing him for some other reason, maybe it can be worked into the conversation.

[533] We have a link to a list of doctors known to be open to the concept of “early treatment” in our Reference section in the appendixes.

[534] This is because there is an enzyme in the grapefruit that can impact how quickly your body eliminates some types of drugs. See https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix or https://cov.cx/a1c92

[535] Simply asking Google exactly that question – “What is a macrolide” will quickly take you to a page such as this one with a helpful answer – https://www.rxlist.com/script/main/art.asp?articlekey=11422 or https://cov.cx/a1c93

Chapter 15 Non-official Treatments to Consider

[536] See https://rt.live/ for the latest update.

[537] See https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-frequently-asked-questions or https://cov.cx/a1c94

[538] Remdesivir was approved as a Covid-19 treatment in late October, but we don’t think a $3120 costing drug, plus the cost of the hospitalization required while being given it, is exactly a broad-based solution for most people and with early and mild infections.

[539] Most trials continue to observe their test subjects out to about the two-year point.

[540] See https://www.wsj.com/articles/covid-19-vaccine-rollout-to-feature-app-tracking-monitoring-of-vulnerable-groups-11604582313 or https://cov.cx/a1c95

[541] 100% of all early-use studies of HCQ have shown positive effects, with the average improvement in patient outcomes being 64%. See https://c19study.com/ or https://cov.cx/a1a24

[542] See https://www.medrxiv.org/content/10.1101/2020.10.29.20222661v1 or https://cov.cx/a1c96

[543] It is not entirely clear when he first received a positive test. Some sources are suggesting some time on Wednesday 28 September, others are suggesting early on Thursday, and he made an official announcement by Twitter shortly after midnight on what had become Friday, 2 October.

[544] The Regeron treatment is explained here – an article written a couple of days prior to Trump’s infection announcement https://www.cnn.com/2020/09/29/health/regeneron-covid-19-early-antibody-treatment-results/index.html or https://cov.cx/a1c97

[545] As reported here https://www.bbc.com/news/world-us-canada-54396670 or https://cov.cx/a1c98

[546] See https://www.dailymail.co.uk/news/article-8800117/Donald-Trump-taken-Walter-Reed-hospital-COVID-treatment.html or https://cov.cx/a1c99

[547] See https://news.trust.org/item/20201004174312-useuk or https://cov.cx/a1d01 – it is unclear from the wording when he started taking the steroid but no later than some time on Saturday and possibly sooner. More details of this treatment are in this article https://www.statnews.com/2020/10/04/trump-receiving-dexamethasone-steroid-usually-given-patients-with-severe-covid19/ or https://cov.cx/a1d02

[548] To be clear, I am not saying “because President Trump took this drug, you should too. I am simply saying “President Trump’s doctors didn’t just tell him to do nothing and stay at home.” The only real point here is to show that the statements from CDC/NIH/FDA/WHO/etc that there is nothing to be done during the early and mild stages of a Covid infection are not universal truths unquestioningly accepted and acted upon by everyone. This is not a black and white issue.

If you are in a dialog with your doctor, it is fair to ask, if told there is nothing that can be done “Why then did President Trump disclose he immediately started taking five different over-the-counter products?”.

[549] See https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf or https://cov.cx/a1d03 for the text of the Act. Unfortunately, the simple concept of this act requires 312 pages of written content, making it difficult for normal people to digest and understand.

Yet again, we wonder how it is that the entire US Constitution – including the 27 amendments – is only 7,591 words (about 20 – 25 pages) yet a single amendment to a single act now takes 312 pages.

[550] See https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act or https://cov.cx/a1d04 and, as a further example, https://www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence or https://cov.cx/a1d05

[551] See https://app.sermo.com/covid19-barometer or https://cov.cx/a1g08 – this is from their Study 14.

[552] See https://covid19criticalcare.com/ or https://cov.cx/a1d06

[553] See https://www.evms.edu/covid-19/covid_care_for_clinicians/ or https://cov.cx/a1d07

[554] Yes, we know – simply having had the virus oneself doesn’t make anyone an automatic expert on it, neither Dr McCullough nor President Trump, nor anyone else.

[555] See https://img1.wsimg.com/blobby/go/f2ee8902-0ee5-4100-996d-e73b761ae165/McCullough%20PA%20Ambulatory%20Treatment%20of%20COVID%20Up.pdf or https://cov.cx/a1d08

[556] See https://www.trialsitenews.com/this-doctor-has-covid-he-has-a-plan-for-all-of-us/ or https://cov.cx/a1d09

[557] See https://www.youtube.com/watch?v=fdbwTNNsF1E or https://cov.cx/a1d10

[558] See https://journal.chestnet.org/article/S0012-3692(20)34898-4/fulltext or https://cov.cx/a1g04

[559] See https://pscflorida.com/wp-content/uploads/2020/12/PSCFlorida-ICON-Protocol.pdf or https://cov.cx/a1g05

[560] See http://mc.msu.ru/m/protokol-mnoc.pdf or https://cov.cx/a1d11 – this is in Russian, but you can copy the text and paste it into a translation program such as https://translate.google.com/ or https://cov.cx/a1d12

[561] This study in particular shows massive changes in outcome for patients who took Bromhexine after being admitted to hospital. https://bi.tbzmed.ac.ir/Files/Inpress/bi-23240.pdf or https://cov.cx/a1d13 There are other studies with weaker findings (particularly due to having too-small groups of people in their studies). This paper, written back in May, wonders if it might be useful in conjunction with either HCQ or quercetin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249615/ or https://cov.cx/a1d14

[562] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363620/ or https://cov.cx/a1d15 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191632/ or https://cov.cx/a1d16

[563] There’s also a question for you to ponder. Some people smugly discount the speed with which some drugs are accepted in some countries. But is the FDA’s comparative slowness to approve new drugs, compared to the speed of similar bodies in other countries, proof that the FDA has higher standards? Or does it merely show the FDA to be a more slow-moving body than those in other countries?

[564] I should explain that comment. Normally, developing a vaccine is the very best of all outcomes when designing a response to a virus threat. But a vaccine is only the very best outcome if it is long-lasting, highly effective, and close to universally taken. Current vaccine candidates are showing promise in terms of their effectiveness, but we don’t yet know how long they may last, and current surveys suggest at least one-third of the country will refuse to be vaccinated.

So what happens for the other third of the population? Or even for the protected people when their shot starts to wear off? And what happens if/when a new strain of the virus mutates which the vaccine doesn’t protect against (as may have already happened in Denmark)?

Due to what so far appears to be an uncertain vaccine benefit, and associated with that, finite rather than enduring acquired immunity after an infection, it seems there will be a likely continuation of outbreaks and public health impacts, even after a vaccine comes along.

Maybe – hopefully – we’ll uncover a better vaccine in the future. But until and if that ever happens, researchers need to be working on cures as well as vaccines.

[565] See, for example, https://indianapublicmedia.org/amomentofscience/can-oxygen-be-toxic.php or https://cov.cx/a1d17 and https://www.medicalnewstoday.com/articles/318619 or https://cov.cx/a1d18

[566] I don’t mean to suggest that the EVMS recommendations are the ultimate gold-standard that should be slavishly followed at all, and some aspects of their recommendations give me pause. But it is a credible set of written guidelines from a credible source, at a point where there are very few such sets of written guidelines, and as a reference point to guide a discussion with your medical team, it is as good as any. See https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf or https://cov.cx/a1d19

[567] See https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf or https://cov.cx/a1d19

[568] In the sense of CDC or WHO type officialdom and formal statements

[569] See https://www.covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2/ or https://cov.cx/a1d20

[570] The “recommended daily value” is just that – a recommended daily value. It is seldom/never the same as a “do not take more than this” upper limit, and possibly the recommended daily value has been arrived at with only very little underpinning medical research and scientific proof.

It is a good starting point to work from, but it is not an exact number in any way at all. It is more likely to be a minimum amount than a maximum amount.

[571] See https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-how-much-vitamin-d-do-i-need/ or https://cov.cx/a1d21

[572] See https://www.kidney.org/news/newsroom/newsreleases/0150 or https://cov.cx/a1d22

[573] See https://www.covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2/ or https://cov.cx/a1d20

[574] Caduceus Medical Group, https://www.caduceusmedicalgroup.com/ or https://cov.cx/a1b82

[575] See https://www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/ or https://cov.cx/a1d23

[576] This is a great flow-chart for evaluating Qt risk https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/QTC-monitoring-guidance.pdf or https://cov.cx/a1d24

[577] Be careful of people who do say they are familiar with all the studies. That is more likely to actually mean “I am aware of the studies I am aware of, but I am not aware of the studies I am not aware of” – that seems like an obvious statement, but it is surprising/dismaying how many people fall into that trap.

I can’t tell you how often I’ve heard people say “All the studies show HCQ provides no benefit and may actually be harmful”. But the person who makes that statement absolutely never has carefully evaluated, themselves, all the HCQ studies (205 as of mid-December and shown on this site https://c19study.com/ or https://cov.cx/a1a24) – not only that, but whatever source they’re relying on probably has not done a complete and careful review, either.

Closely linked are the people who say things like (as was the case in a well-watched YouTube video I don’t want to glorify with a link to) “There have been over 1,000 HCQ studies and not a single one has shown any benefit”. It beggars belief that the person making that statement has actually found 1,000 different studies, let alone carefully evaluated each one, and consistently found that every positive study, even the refereed ones, are invalid, and every negative study, even the ones that are not refereed, are valid.

[578] See https://covid19criticalcare.com/math-hospital-treatment/ or https://cov.cx/a1d25

[579] See https://www.ocala.com/story/business/2020/09/22/ocala-developed-covid-19-therapy-local-study/5865410002/ or https://cov.cx/a1d26

[580] See https://www.thailandmedical.news/news/covid-19-rehab-supplements-that-could-help-with-chronic-fatigue-syndrome-myalgic-encephalomyelitis-manifesting-in-recovered-covid-19-patients or https://cov.cx/a1d27

[581] See https://www.cnbc.com/2020/08/07/coronavirus-vaccine-dr-fauci-says-chances-of-it-being-highly-effective-is-not-great.html or https://cov.cx/a1d28

[582] I was astonished to see this WSJ article reporting on how people who are vaccinated will be given a smartphone app to track if they develop any serious side effects. The article says

“Government health officials and drugmakers plan to roll out extra tools to detect whether Covid-19 vaccines cause any serious side effects once the shots are cleared for widespread use, aiming to fill gaps in existing safeguards given the expected speed and scope of the rollout”

The article goes on to say that instead of the usual six months of monitoring test subjects for side-effects, the FDA is allowing only a two-month period. Maybe we should wait another four months then before choosing if we’re vaccinated or not?

This seems to be an open admission that a vaccine will be approved and released without the normal degree of rigorous testing. Personally, I’d prefer to wait for a well-tested vaccine rather than be given one of unknown risk and a smartphone app I can use to report any serious side-effects subsequently! See https://www.wsj.com/articles/covid-19-vaccine-rollout-to-feature-app-tracking-monitoring-of-vulnerable-groups-11604582313 or https://cov.cx/a1d29

[583] This article has an interesting timeline in it – several months for phase 1 trials, several months to two years for phase 2, and 1 – 4 years for a phase 3 trial. There’s even a post-approval fourth phase of trialing in many cases, too. So, taking the middle points, and ignoring all the time prior to phase 1 (there is likely a phase 0 trial with human subjects, previous trials with animals, and prior to that, in vitro evaluations in the laboratory with cultured mediums), and all the paperwork preparation time and FDA response times, that is over 3 ½ years on average, and possibly longer than 6 ½ years on the normal timetable. See https://www.fda.gov/patients/drug-development-process/step-3-clinical-research or https://cov.cx/a1d30

What is being sacrificed on this expedited timetable? If the answer is “nothing”, then why aren’t all drugs tested and evaluated at the same speed? Clearly, something is being marginalized or lost in this expedited trial scenario.

As this second article says, one of the purposes of a phase 3 trial is to evaluate the efficacy and safety of the new drug in the medium and long term. “Medium and long term” is a phrase that demands to be measured in years, not weeks. See https://symbiosisonlinepublishing.com/pharmacy-pharmaceuticalsciences/pharmacy-pharmaceuticalsciences65.php or https://cov.cx/a1d31

[584] What would that number be? Is it a simple majority – if slightly more than half the people who are vaccinated suffer no harm, is that enough? But it isn’t just a simple counting of numbers. There are degrees of harm – both in terms of reactions to a vaccine, and in terms of reactions if/when infected by the virus.

[585] See http://npic.orst.edu/factsheets/ddtgen.pdf or https://cov.cx/a1d32

[586] See https://en.wikipedia.org/wiki/Thalidomide or https://cov.cx/a1d33

[587] See https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html or https://cov.cx/a1d34

[588] See for example https://academic.oup.com/biostatistics/article/20/2/273/4817524 or https://cov.cx/a1d35

[589] I believe the definition of “effective” being used is “did not get an infection serious enough to require a visit to a doctor”. And note also that the 50% level is the minimum effectiveness the FDA is requiring as a condition of approving the vaccine, but it is possible that ultimately approved vaccines may be much more effective than this.

[590] There is a possibility that a vaccine might also provide “some” benefit by causing infections to be weaker than they’d otherwise be, and so while not zeroing out infection rates or hospital admissions, the partially effective vaccine might be more impactful in terms of ultimate mortality/survival rates.

So there could be an entire spectrum of outcomes after being vaccinated. Some people will never get any type of measurable infection, some will get a weaker infection than before, and some will still be impacted much the same as if they’d never been vaccinated.

The current measurement and criteria is very inadequate.

[591] See https://www.theguardian.com/environment/2020/nov/04/denmark-announces-cull-of-15-million-mink-over-covid-mutation-fears or https://cov.cx/a1d36

[592] See https://thehill.com/news-by-subject/healthcare/528619-pfizer-chairman-were-not-sure-if-someone-can-transmit-virus-after or https://cov.cx/a1f95

[593] There’s actually a formal name for this. It is called a Phase 4 trial. See https://www.news-medical.net/health/What-is-a-Phase-4-Clinical-Trial.aspx or https://cov.cx/a1d37

[594] See https://www.msn.com/en-us/news/world/coronavirus-vaccine-should-be-mandatory-in-australia-pm/ar-BB187BNS or https://cov.cx/a1d38

[595] See https://www.bbc.com/news/world-australia-55048438 or https://cov.cx/a1d39

Chapter 16 Medicines, Supplements, Vitamins, etc

[596] See https://www.drugwatch.com/health/off-label-drug-use/ or https://cov.cx/a1d40 for a thoughtful discussion of the topic

[597] See https://www.webmd.com/a-to-z-guides/features/off-label-drug-use-what-you-need-to-know#1 or https://cov.cx/a1d41

[598] This is a good explainer about off-label use, written from a Canadian perspective but generally applicable to the US too https://www.cadth.ca/sites/default/files/pdf/off_label_use_of_drugs_pro_e.pdf or https://cov.cx/a1d42 and this is a more technical article that tells you a great deal more https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/ or https://cov.cx/a1d43

[599] We recommend you re-read the footnote way back near the beginning, in our first chapter, about internet “recommendation management” companies that can magically cause negative articles to disappear and flood the internet with positive articles. It can sometimes be very difficult to separate the serums from the snake oils.

We also repeat the awkward statement that just because a person is a credentialed doctor does not make them an unassailable authority and automatically “ex officio” an expert on and correct about every element of medical science. There are some truly strange doctors out there. If you’d like a relevant direct example, there is this https://www.npr.org/2020/10/01/914433778/web-of-wellness-doctors-promote-injections-of-unproven-coronavirus-treatment or https://cov.cx/a1d44

[600] Within reason, and time allowing, I try to reply to emails in the spirit in which they are written. If you send me a thoughtful email and reasoned argument that does not align with my own, I’ll try to respond in kind. Your emails and opinions help me as I seek to continue to evolve and enhance this document, for all our future benefits.

[601] See https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products or https://cov.cx/a1d45 At the time of writing (8 October) there are 118 warning letters listed. Four weeks later, the total had swelled to 127 warning letters.

But please understand that the absence of an FDA warning letter does not mean that any product is approved, or safe, or accurately described. It might just mean the FDA hasn’t received a complaint about the product yet.

[602] I recommend you use exactly that simple search string. By just mentioning the name of the drug/treatment and the word Covid, you cast the widest net for both positive and negative articles, rather than influencing the results with a question seeking specific types of articles. But, of course, search every which way that seems to give you the best information.

[603] It is possible to construct high-quality trials that actually will go most of the way towards providing a proof of absence, but there are so many ways that researchers can unwittingly create flawed tests, or do a flawed analysis of the results, that there often remains some ambivalence as to whether a negative outcome is more generally applicable as a “proof of absence” or narrowly a mere “absence of proof” in the scenario that was tested.

This is also not to say that any test with apparently positive results is automatically right, whereas tests with apparently negative results are automatically wrong. It truly is all very complicated, with sincere experts sometimes arguing totally opposite sides of an issue, all convinced of the rightness of their opinion and the wrongness of the other opinion.

[604] See https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx or https://cov.cx/a1d46

[605] Main page https://www.evms.edu/covid-19/covid_care_for_clinicians/ or https://cov.cx/a1d47
Summary two pages https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf or https://cov.cx/a1d48
Detailed protocol https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf or https://cov.cx/a1d49

[606] See https://covid19criticalcare.com/ or https://cov.cx/a1d06

[607] Main page https://www.covid19treatmentguidelines.nih.gov/ or https://cov.cx/a1d51
PDF including all sections of their guidelines https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf or https://cov.cx/a1d52

[608] See https://medicalxpress.com/news/2020-05-blood-thinners-treatment-covid-science.html or https://cov.cx/a1d53 although the article cautiously does not go as far as to recommend aspirin usage

[609] See this article from the International Aspirin Foundation – although perhaps not the most obviously impartial of sources! https://www.aspirin-foundation.com/forum/aspirin-and-covid-19/ or https://cov.cx/a1d54

[610] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/ or https://cov.cx/a1d55

[611] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438973/ or https://cov.cx/a1d56

[612] We certainly understand and are similarly concerned about the growing and very worrying problem of drug-resistant bacteria and the underlying massive over-prescription of antibiotics.

Sometimes it seems doctors prescribe antibiotics more as a placebo than out of any real expectation it will do any good, and because patients demand it and it is easier to prescribe it than to spend extended time attempting to educate a patient. There may even be, in the minds of some doctors, concerns about getting a bad rating on one of the growing number of websites that allow patients to rate their doctors.

[613] See https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31863-8/fulltext or https://cov.cx/a1d57

[614] If it is not practical for ongoing monitoring in your doctor’s office, consider getting the AliveCor KardiaMobile 6L so you can monitor your Qt interval at home, possibly in conjunction with sending your results over the internet to your physician or any other interpreting service to double-check what is happening to your Qt interval.

See our chapter on Medical Equipment and Supplies You Should Have for more information on this device.

[615] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395502/ or https://cov.cx/a1d58 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432030/ or https://cov.cx/a1d59 and https://www.medicalnewstoday.com/articles/mandatory-bcg-vaccination-may-slow-spread-of-covid-19 or https://cov.cx/a1d60

[616] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360951/ or https://cov.cx/a1d61

[617] See https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm or https://cov.cx/a1d62

[618] See https://www.who.int/news-room/fact-sheets/detail/tuberculosis or https://cov.cx/a1d63

[619] See https://www.bbc.com/news/health-54465733 or https://cov.cx/a1d64

[620] See https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm or https://cov.cx/a1d65

[621] See http://covidsilverbullet.com/wp-content/uploads/2020/07/Bartlett_COVID_Case_Study.pdf or https://cov.cx/a1d66

[622] See https://www.factcheck.org/2020/08/asthma-medicine-not-proven-as-covid-19-cure/ or https://cov.cx/a1d67 and https://fortune.com/2020/07/24/budesonide-coronavirus-covid-richard-bartlett/ https://cov.cx/a1d68 or (and many others)

[623] It is very untrue to suggest “David has never met a quack treatment he doesn’t embrace”! I’m as skeptical as anyone, but I’m also open to wherever persuasive studies lead me.

[624] See partway down this page https://www.covid19treatmentguidelines.nih.gov/tables/table-3a/ or https://cov.cx/a1d69 and the dedicated section https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/ or https://cov.cx/a1d70

[625] See https://www.youtube.com/watch?v=fdbwTNNsF1E or https://cov.cx/a1d71 – from memory, it is mentioned 1/3 to 1/2 of the way through.

[626] See the detailed discussion and links here https://covid19criticalcare.com/math-hospital-treatment/scientific-review-of-covid-19-and-math-plus/#1596446829797-a8266904-e8a9 or https://cov.cx/a1d72

[627] See https://hartfordhealthcare.org/about-us/news-press/news-detail?articleId=28305&publicid=497 or https://cov.cx/a1d73

[628] Please keep in mind that although the symptoms of influenza and Covid-19 are similar, the viruses causing each are totally different. So it doesn’t automatically follow that an anti-viral agent that works against the various influenza viruses will also work against the SARS-CoV-2 virus that causes Covid-19.

[629] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467067/ or https://cov.cx/a1d74

[630] See https://www.contagionlive.com/news/fda-clears-favipiravir-covid19-facility-outbreak-prevention-study or https://cov.cx/a1d75

[631] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467067/ or https://cov.cx/a1d76 and https://www.trialsitenews.com/the-dhaka-trial-clear-cut-evidence-favipiravir-effective-against-covid-19-with-compelling-results/ or https://cov.cx/a1d77 and https://www.sciencedirect.com/science/article/pii/S1876034120305931 or https://cov.cx/a1d78 and https://www.trialsitenews.com/can-favipiravir-compete-against-remdesivir-in-north-america-targeting-covid-19/ or https://cov.cx/a1d79

[632] See https://www.trialsitenews.com/avigan-favipiravir-meets-endpoints-in-phase-3-japanese-clinical-trial-sponsor-will-register-as-a-therapy-for-covid-19/ or https://cov.cx/a1d80

[633] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467067/ or https://cov.cx/a1d81 Note that the entire 14-day course is not needed if the patient has fully recovered prior to then.

[634] See https://www.trialsitenews.com/favipiravir-sales-skyrocket-in-india-targeting-mild-covid-19-cases/ or https://cov.cx/a1d82

[635] Cynics have wondered that if water remembers such things, when does it forget? Maybe never? Does all water on the planet “remember” everything that has been dissolved in it? And so on. Homeopathy really is a bizarre concept.

[636] See https://arizonahomeopathic.org/homeopathy-and-covid-19/ or https://cov.cx/a1d83

[637] See https://homeopathic.com/italian-mds-study-results-on-homeopathic-treatment-of-50-covid-19-patients-none-of-whom-needed-hospitalization/ or https://cov.cx/a1d84

[638] See https://www.homeopathyusa.org/ or https://cov.cx/a1d85

[639] See https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hn-2236006 or https://cov.cx/a1d86

[640] See https://loico.com/international-researchers-pick-up-loicos-idea-of-throat-disinfection-to-counter-covid-19/ or https://cov.cx/a1d87 and https://loico.com/update-on-preventive-throat-disinfection-antisepsis-to-counter-covid-19/ or https://cov.cx/a1d88 and https://loico.com/update-on-covid-19-and-oral-antisepsis/ or https://cov.cx/a1d89

[641] See https://loico.com/the-logic-of-surviving-the-coronavirus-pandemic/ or https://cov.cx/a1d90

[642] See https://c19study.com/ or https://cov.cx/a1a24 (I see the count is rising – on 6 October, up to 128 studies, on 4 November, 161 studies, and on 17 December, 205 studies, 139 of them being peer-reviewed)

[643] This article cogently makes exactly that point : https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535 or https://cov.cx/a1d91

[644] See https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext or https://cov.cx/a1d92 and https://www.sciencemag.org/news/2020/06/two-elite-medical-journals-retract-coronavirus-papers-over-data-integrity-questions or https://cov.cx/a1g09

[645] See https://veja.abril.com.br/saude/especialistas-contestam-estudos-que-nao-viram-beneficios-na-cloroquina/amp/ or https://cov.cx/a1d93

[646] See https://www.sciencedirect.com/science/article/pii/S2052297520300998 or https://cov.cx/a1d94

[647] The IHME projection dated 19 November, see the current projection at https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend or https://cov.cx/a1d95

[648] See https://hcqtrial.com/ or https://cov.cx/a1d96

[649] See https://www.dicardiology.com/article/fda-reports-deaths-and-injuries-use-antimalarial-hydroxychloroquine-covid-19-patients or https://cov.cx/a1d97

[650] See https://app.sermo.com/covid19-barometer or https://cov.cx/a1g08 – this is from their Study 14.

[651] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043740/ or https://cov.cx/a1d98

[652] See https://c19study.com/i or https://cov.cx/a1d99

[653] See https://covid19criticalcare.com/ or https://cov.cx/a1d06

[654] See https://covid19criticalcare.com/i-mask-prophylaxis-treatment-protocol/ or https://cov.cx/a1d50

[655] See https://www.trialsitenews.com/real-world-evidence-the-case-of-peru/ or https://cov.cx/a1e02 and https://www.researchgate.net/publication/344469305_Real-World_Evidence_The_Case_of_Peru_Causality_between_Ivermectin_and_COVID-19_Infection_Fatality_Rate or https://cov.cx/a1e03

[656] See EVMS and ASHP and https://www.sciencedirect.com/science/article/pii/S0166354220302011?via%3Dihub or https://cov.cx/a1e04 and https://www1.racgp.org.au/newsgp/clinical/insufficient-evidence-to-currently-support-ivermec or https://cov.cx/a1e05

[657] So, if you weigh 150 lbs, your dose would be 150 x 70 mcg = 10.5 mg at the low end or 150 x 90 mcg = 13.5 mg at the higher end. See also https://www.trialsitenews.com/zagazig-university-randomized-controlled-ivermectin-study-results-confirms-pi-hypothesis-drug-effective-against-covid-19/ or https://cov.cx/a1e06

[658] See https://www.trialsitenews.com/argentina-study-supports-ivermectin-for-covid-19/ or https://cov.cx/a1e07

[659] See https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/ivermectin/ or https://cov.cx/a1e08

[660] See https://onlinelibrary.wiley.com/doi/10.1002/jmv.26514 or https://cov.cx/a1e09

[661] Here’s an article I wrote way back in 2002 on the topic. https://old.thetravelinsider.info/2002/0517.htm or https://cov.cx/a1e10

[662] See https://www.tandfonline.com/doi/full/10.1080/08830185.2020.1756284 or https://cov.cx/a1e11

[663] See https://www.discovermagazine.com/health/the-latest-supplement-touted-as-a-covid-19-treatment-melatonin or https://cov.cx/a1e12

[664] See https://www.sciencedirect.com/science/article/abs/pii/S0024320520303313 or https://cov.cx/a1e13

[665] See https://www.diabetes.co.uk/diabetes-medication/biguanides.html or https://cov.cx/a1e14

[666] See https://www.medicinenet.com/diabetes_drug_metformin_may_reduce_covid_19_death-news.htm or https://cov.cx/a1e15 and https://www.medrxiv.org/content/10.1101/2020.07.29.20164020v1 or https://cov.cx/a1e16 which reports a 70% reduction in mortality. This article lists other research findings https://www.diabetes.co.uk/news/2020/jul/more-evidence-suggest-metformin-could-help-treat-covid-19.html or https://cov.cx/a1e17

[667] Table 1 of this document summarizes potential ways metformin might positively impact on Covid-19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395819/ or https://cov.cx/a1e18 and this report goes into more detail on some of the possible benefits https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190487/ or https://cov.cx/a1e19

[668] See https://clinicaltrials.gov/ct2/show/NCT04510194 or https://cov.cx/a1e20

[669] See https://www.bbc.com/future/article/20161208-why-vitamin-supplements-could-kill-you or https://cov.cx/a1e21

[670] See https://www.studyfinds.org/health-benefits-multivitamins-in-mind/ or https://cov.cx/a1e22

[671] See https://www.medrxiv.org/content/10.1101/2020.05.25.20110239v1 or https://cov.cx/a1e23

[672] See https://www.webmd.com/vitamins/ai/ingredientmono-390/propolis or https://cov.cx/a1e24 and https://www.healthline.com/health/propolis-an-ancient-healer or https://cov.cx/a1e25 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415165/ or https://cov.cx/a1e26 and https://www.sciencedirect.com/science/article/pii/S0753332220308155 or https://cov.cx/a1e27 and https://onlinelibrary.wiley.com/doi/10.1111/dth.13780 or https://cov.cx/a1e28

[673] See https://www.webmd.com/vitamins/ai/ingredientmono-503/royal-jelly or https://cov.cx/a1e29

[674] See https://www.frontiersin.org/articles/10.3389/fimmu.2020.01451/full or https://cov.cx/a1e30

[675] See EVMS, and https://www.medpagetoday.com/infectiousdisease/covid19/87373 or https://cov.cx/a1e31 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392107/ or https://cov.cx/a1e32 and https://www.mountsinai.org/health-library/supplement/quercetin or https://cov.cx/a1e33

[676] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392107/ or https://cov.cx/a1e34

[677] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629407/ or https://cov.cx/a1e35

[678] The reason for the quotes around the word “examine” is because the examinations that have been conducted, at least for me, have been very superficial seeming, comprising little more than checking pulse rate, looking at my tongue, and that seemed to be about all.

[679] See https://massivesci.com/notes/traditional-chinese-medicine-covid19-treatment-trials/ or https://cov.cx/a1e36

[680] See https://covid-19.chinadaily.com.cn/a/202003/17/WS5e702f52a31012821727fa19.html or https://cov.cx/a1e37

[681] See https://www.nature.com/articles/d41586-020-01284-x or https://cov.cx/a1e38

[682] See https://www.bbc.com/news/world-asia-53094603 or https://cov.cx/a1e39

[683] See https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31143-0/fulltext or https://cov.cx/a1e40

[684] See https://www.athenahealth.com/knowledge-hub/clinical-trends/natural-remedies-and-the-fight-to-treat-COVID-19 or https://cov.cx/a1e41

[685] See https://www.healthline.com/health-news/herbal-remedies-covid-19-what-to-know or https://cov.cx/a1e42

[686] This article is a bit overly critical, perhaps, but very readable https://www.vox.com/2015/1/15/7547741/vitamin-c-myth-pauling or https://cov.cx/a1e43

[687] See https://lpi.oregonstate.edu/COVID19/IV-VitaminC-virus or https://cov.cx/a1e44

[688] See https://www.sciencedirect.com/science/article/pii/S0899900720302318 or https://cov.cx/a1e45

[689] See https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-c/faq-20058030 or https://cov.cx/a1e46

[690] See https://www.stlukes-stl.com/health-content/medicine/33/000994.htm or https://cov.cx/a1e47

[691] See https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157 or https://cov.cx/a1e48

[692] This study in particular is very optimistic – a 25-fold reduction in the rate of ICU admissions apparently due to Vitamin D. See https://medium.com/microbial-instincts/the-first-clinical-trial-to-support-vitamin-d-therapy-for-covid-19-906a9d907468 or https://cov.cx/a1e49 . We also find this study supportive of Vitamin D – https://www.ctvnews.ca/mobile/health/more-than-80-per-cent-of-hospitalized-covid-19-patients-had-vitamin-d-deficiency-study-1.5162396 or https://cov.cx/a1e50

[693] See https://c19study.com/d or https://cov.cx/a1e51

[694] See https://www.cnbc.com/2020/09/14/supplements-white-house-advisor-fauci-takes-every-day-to-help-keep-his-immune-system-healthy.html or https://cov.cx/a1e52

[695] See https://www.yalemedicine.org/stories/vitamin-d-myths-debunked/ or https://cov.cx/a1e53

[696] See https://www.stlukes-stl.com/health-content/medicine/33/000340.htm or https://cov.cx/a1e54

[697] See https://medicalxpress.com/news/2020-09-zinc-blood-death-patients-covid-.html or https://cov.cx/a1e55

[698] See https://medium.com/microbial-instincts/more-studies-shed-light-on-the-value-of-zinc-in-covid-19-a4595271270d or https://cov.cx/a1e56

[699] See https://lpi.oregonstate.edu/mic/minerals/zinc or https://cov.cx/a1e57

[700] This page lists high-in-zinc foods https://www.myfooddata.com/articles/high-zinc-foods.php or https://cov.cx/a1e58

[701] See https://ods.od.nih.gov/factsheets/Zinc-Consumer/ or https://cov.cx/a1e59

[702] See https://www.webmd.com/vitamins/ai/ingredientmono-982/zinc or https://cov.cx/a1e60

[703] See https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/ or https://cov.cx/a1e61

[704] See https://thecovidsurvivalguide.com or https://cov.cx/covid

[705] See https://www.trialsitenews.com/university-of-minnesota-medical-school-investigators-to-lead-study-investigating-efficacy-of-metformin-targeting-covid-19/ or https://cov.cx/a1e62

[706] Cited in the ICON treatment plan and here : https://www.theguardian.com/science/2020/dec/11/coronavirus-uk-scientists-identify-drugs-that-may-help-severe-cases or https://cov.cx/a1g07

[707] Colchicine is a low-cost anti-inflammatory drug currently used to treat gout and rheumatic disease. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367785/ or https://cov.cx/a1e63 and https://www.medrxiv.org/content/10.1101/2020.08.06.20169573v2 or https://cov.cx/a1e64 . It is also featured in the later stage treatments in the McCullough plan.

[708] See https://www.msn.com/en-us/news/world/russia-s-richest-man-seeks-global-market-for-local-covid-19-drug/ar-BB1bkTSK or https://cov.cx/a1e65

[709] See https://www.medrxiv.org/content/10.1101/2020.10.29.20222661v1 or https://cov.cx/a1e66 for positive results in India (300 micrograms/kg rounded down in two doses, three days apart, then a single top-up dose monthly subsequently) and a study showing 73% effectiveness https://www.medrxiv.org/content/10.1101/2020.10.29.20222661v1 or https://cov.cx/a1e67 and also https://www.trialsitenews.com/france-based-medincell-initiates-ivermectin-clinical-trial-targeting-covid-19-with-prophylactic-strategy/ or https://cov.cx/a1e68

[710] See https://racetoacure.stanford.edu/ or https://cov.cx/a1e69

[711] See https://www.theguardian.com/world/2020/nov/19/rheumatoid-arthritis-drug-tocilizumab-appears-to-help-covid-patients-in-icu or https://cov.cx/a1e70

[712] See https://www.nytimes.com/2020/11/05/health/coronavirus-ferrets-vaccine-spray.html or https://cov.cx/a1e71 and https://www.trialsitenews.com/columbia-university-led-study-identifies-powerful-nasal-spray-to-combat-covid-19-as-prophylaxis/ or https://cov.cx/a1e72

[713] See https://www.biorxiv.org/content/10.1101/2020.07.15.203489v1.full.pdf or https://cov.cx/a1e73

[714] See https://www.nature.com/articles/s41421-020-00197-3 or https://cov.cx/a1e74

[715] See https://www.trialsitenews.com/philippines-trial-sites-enrolling-patients-for-regulatory-approved-investigation-into-use-of-folk-medicine-for-covid-19-adjunctive-therapy/ or https://cov.cx/a1e75

Chapter 17 Medical Equipment and Supplies You Should Have

[716] See https://www.fda.gov/about-fda/fda-basics/what-does-fda-regulate or https://cov.cx/a1e76

[717] See https://www.fda.gov/news-events/approvals-fda-regulated-products or https://cov.cx/a1e77

[718] See https://www.fda.gov/consumers/consumer-updates/it-really-fda-approved or https://cov.cx/a1e78

[719] See https://www.aspenlaser.com/the-difference-between-fda-registered-fda-approved-and-fda-cleared/ or https://cov.cx/a1e79

[720] Well, we would observe that only 2/3 of all people with a Covid infection develop a fever, and that most people are at their most infectious before they develop symptoms. So a temperature test works in only one way rather than two. A high temperature might mean the person has the virus (or some other issue causing their temperature to rise), but a low temperature does not guarantee they are free of the virus.

But, on the basis of risk reduction rather than risk elimination, it is a strategy to consider.

[721] This article on 7 October says 30% of Americans will check the temperature of their guests before allowing them in for Thanksgiving parties this year. https://www.studyfinds.org/hosting-pandemic-americans-temperature-checks/ or https://cov.cx/a1e80 . We wonder if these people will also check their own family’s temperatures at the same time!

[722] See https://amzn.to/33ErT93 or https://cov.cx/a1e81

[723] An Apple Watch 6 starts at $399. A separate ECG device and pulse oximeter, together, can cost as little as $120 and may be more accurate than the $399 Watch (particularly the oximeter).

[724] This is a much less rigorous status than FDA approval and denotes more of a passive acceptance by the FDA of a manufacturer’s statement of functionality.

[725] See https://www.wareable.com/apple/how-to-take-ecg-reading-on-apple-watch-6817 or https://cov.cx/a1e82

[726] This is a good explainer of the Qt interval and also the “corrected” Qtc interval. https://www.nursingcenter.com/journalarticle?Article_ID=1123271&Journal_ID=417221&Issue_ID=1123211 or https://cov.cx/a1e83

[727] This page has a relatively straightforward method https://medium.com/@aerobatic/how-to-read-your-qt-interval-5dffb04717dc or https://cov.cx/a1e84 . This page goes into more technical detail https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.048253 or https://cov.cx/a1e85 and says that “adequate” Qt measurements were achieved in 85% of tests, increasing to 94% when the watch was placed on other parts of the body for the reading. Some expertise is required to make these readings in terms of judging where the start and end of the Qt interval can be found on the chart.

[728] The interval can vary from beat to beat, you should try measuring one specific beat’s interval in several different ways.

[729] See https://litfl.com/qt-interval-ecg-library/ or https://cov.cx/a1e86

[730] See https://apps.apple.com/us/app/ep-calipers/id982313078 or https://cov.cx/a1e87 and https://apps.apple.com/us/app/qtc-calculator/id1354439139 or https://cov.cx/a1e88

[731] In approximate terms, 97% – 99% = normal, 96% = okay, 95% = less than normal, 94% = get ready to go to hospital. So the range between the low end of good and “dial 911” is only about 3%.

[732] See https://spectrum.ieee.org/view-from-the-valley/biomedical/devices/should-you-trust-apples-new-blood-oxygen-sensor or https://cov.cx/a1e89

[733] This review compared the Apple Watch to an FDA approved pulse oximeter and found results varied from 0 points all the way to seven points, with the Watch showing a lower reading. In other words, you might become very alarmed from your Watch reading for no good reason. https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/ or https://cov.cx/a1e90 Low readings have been reported in other reviews such as this one, too. https://www.inc.com/jeff-haden/the-new-apple-watch-6-may-have-a-problem-oddly-enough-thats-okay.html or https://cov.cx/a1e91

[734] An ECG (electrocardiogram) is exactly the same as an EKG, which is simply an abbreviation of the German spelling of the word (elektrokardiogramm).

[735] See https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19 or https://cov.cx/a1e92

[736] Actually, there are other non-medical uses. For example, in sports and aviation for evaluating blood oxygen levels as a fatigue and endurance factor in sports and to check on oxygen sufficiency when flying at higher altitudes.

But whatever the use, wouldn’t people, no matter what purpose, always want the most accurate oximeter possible – especially when the difference between “good” and “bad” levels is so close?

[737] See Supplemental Figure 1 in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231944/ or https://cov.cx/a1e93

[738] This points to the distinction between precision and accuracy. This is a distinction you probably never need to know, but if you are interested, by all means, now that you’re here in the footnote anyway, keep reading.

They are both measures of the quality of a measurement, but they measure different aspects. Precision measures how repeatable a measurement is. For example, if you have four hygrometers, and they all consistently show the same value, they are probably very precise. Accuracy measures how close to the exact correct value an instrument shows.

So say the true humidity is 50%. You have one hygrometer that sometimes shows 49%, sometimes 50%, and sometimes 51%. You have a second hygrometer that always shows either 45% or 46%. The first hygrometer is more accurate, even though it varies more. The second hygrometer is more precise, even though its reading is further away from the actual value.

Which is better? If you can calibrate the precise unit so you know how to adjust from its precise reading to the true value, it is better than an accurate unit. But, to now come back to the real world of low price hygrometers, it doesn’t really make much difference for your purposes (but would be much more relevant with pulse oximeters…..).

[739] See https://www2.purpleair.com/collections/air-quality-sensors or https://cov.cx/a1e94

[740] See http://www.purpleair.com/map?mylocation or https://cov.cx/a1e95

[741] See https://spectrum.ieee.org/tech-talk/telecom/wireless/indoor-airquality-monitoring-can-allow-anxious-office-workers-to-breathe-easier or https://cov.cx/a1e96

[742] See https://spectrum.ieee.org/the-human-os/sensors/chemical-sensors/devices-monitor-coronavirus-in-the-air or https://cov.cx/a1e97

[743] If you can’t control the air in the entire residence (or office) the other approach is to minimize the sharing of the air. In that case, radiant air heaters with no fans provide a way to heat an area with the least amount of air movement.

[744] This can be more important than you might guess. If the fan speed lowers too much, that means that cool air is taking away enough of the heat being generated and the furnace gets too hot and fails.

In summer, it means the hot air isn’t taking away enough of the cold from the cooling coil, which then freezes and becomes less efficient, and potentially risks the coolant not evaporating, and very bad (ie expensive) things happening to the compressor.

[745] Well, in the US, usually CADR ratings are based on cubic feet per minute (cfm). But be careful. Sometimes, and in Canada, for example, CADR ratings are more commonly expressed in terms of cubic meters per hour. To convert from cubic meters/hr to cubic feet/minute, multiply the cu m/hr number by 0.59 and you’ll get cu ft/min. For example, 100 cu m/hr = 59 cu ft/min.

[746] See https://www.ahamdir.com/room-air-cleaners/ or https://cov.cx/a1e98

[747] See https://ww2.arb.ca.gov/our-work/programs/air-cleaners-ozone-products/california-certified-air-cleaning-devices or https://cov.cx/a1e99

[748] See https://ww2.arb.ca.gov/our-work/programs/air-cleaners-ozone-products/potentially-hazardous-ozone-generators-sold-air or https://cov.cx/a1f01

[749] This article in mid-November reports over 1,000 hospitals already with severe staff shortages, and expects the number of struggling-to-keep-up hospitals will increase – https://www.npr.org/sections/health-shots/2020/11/20/937152062/1-000-u-s-hospitals-are-short-on-staff-and-more-expect-to-be-soon or https://cov.cx/a1f02

[750] Would I be obsessive to say that I’d even take my own concentrator with me to the hospital? That way, if they do run out of oxygen tanks, and don’t have other available equipment, I’ve got my own with me.

[751] See https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19 or https://cov.cx/a1f03

[752] See https://www.dallasnews.com/business/technology/2020/06/02/a-dallas-company-touts-its-spray-on-coating-as-a-covid-19-killer-for-surfaces/ or https://cov.cx/a1f04

[753] See https://www.epa.gov/coronavirus/there-anything-i-can-do-make-surfaces-resistant-sars-cov-2-covid-19 or https://cov.cx/a1f05

[754] See https://www.epa.gov/coronavirus/can-i-use-fogging-fumigation-or-electrostatic-spraying-or-drones-help-control-covid-19 or https://cov.cx/a1f06

[755] See https://www.epa.gov/newsreleases/epa-takes-action-help-americans-disinfect-indoor-spaces-efficiently-and-effectively or https://cov.cx/a1f07

[756] For example, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848581/ or https://cov.cx/a1f08

[757] See https://www.consumeraffairs.com/news04/2008/02/sharper_image.html or https://cov.cx/a1f09

[758] See https://www.randrmagonline.com/articles/88901-ozones-efficacy-in-deactivating-coronavirus-like-pathogens or https://cov.cx/a1f10

[759] See https://www.epa.gov/indoor-air-quality-iaq/ozone-generators-are-sold-air-cleaners#harmful-ozone or https://cov.cx/a1f11

[760] See https://www.inputmag.com/guides/do-not-buy-ozone-generator-for-coronavirus-covid-19 or https://cov.cx/a1f12

[761] As an unrelated but hopefully helpful comment, we urge you to avoid blacklights. This is not because of any concerns about their UV radiation causing skin cancer, but rather because of potential damage to your eyes. Because our eyes don’t see UV light, and because blacklights are often in darkened rooms, our pupils are dilated to let the most amount of light in, and the blacklight floods in and can damage our eyes without our realizing it. Short exposures are okay, but avoid longer exposures, don’t stare directly at the bulbs/tubes, especially when the other lighting is low.

[762] This article has a great discussion on UV-C light issues https://www.energyvanguard.com/blog/do-uv-lamps-really-improve-indoor-air-quality or https://cov.cx/a1f13

[763] Rarely, you might find sanitizer that uses benzalkonium chloride.

[764] See https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use or https://cov.cx/a1f14 – we don’t think this is a complete list, but at least it is a start.

[765] This is a nice measured article on the topic https://www.seattletimes.com/seattle-news/health/evidence-is-growing-but-what-will-it-take-to-prove-masks-slow-the-spread-of-covid-19/ or https://cov.cx/a1f15

This article looks primarily at N95 type respirator masks but has excellent material on fabric and surgical masks too https://fastlifehacks.com/n95-vs-ffp/ or https://cov.cx/a1f16

This article rebuts the myth about masks causing CO2 buildup and assorted other nonsense claims https://www.thedailybeast.com/5-myths-on-face-masks-amid-the-coronavirus-pandemic or https://cov.cx/a1f17

This site is full of excellent articles about masks and consistently shows the benefits associated with wearing one https://www.n95decon.org/ or https://cov.cx/a1f18

[766] This is a good article about how masks work with virus particles https://www.usatoday.com/story/news/factcheck/2020/08/09/fact-check-masks-effective-covid-19-despite-drywall-dust-claims/3322819001/ or https://cov.cx/a1f19

[767] See https://advances.sciencemag.org/content/6/36/eabd3083 or https://cov.cx/a1f20

[768] See https://www.studyfinds.org/face-shields-masks-with-valves-wont-stop-coronavirus-spread/ or https://cov.cx/a1f21

[769] See https://www.studyfinds.org/worst-face-masks-covid-19-bandanas-neck-gaiters-more-harmful-than-no-mask/ or https://cov.cx/a1f22

[770] See https://www.dailymail.co.uk/sciencetech/article-8661867/Coughing-uncovered-elbow-lets-droplets-hand.html or https://cov.cx/a1f23

[771] See https://www.theguardian.com/world/2020/aug/26/non-woven-masks-better-to-stop-covid-19-says-japanese-supercomputer or https://cov.cx/a1f24

[772] See https://covid19.healthdata.org/united-states-of-america or https://cov.cx/ihme – this chart being taken from their 21 August projections.

[773] We hasten to add this is a “best guess” projection as of 21 August, and based on what the people managing the model anticipate happening both in terms of the virus activity and public health/social responses to it. It might be wildly wrong, it might be way too pessimistic, or it might be too optimistic, and of course, it might also be close to exact.

The Seattle group issuing these projections, IHME, started off with early projections that changed greatly from each release to each future release, now we notice the changes are smaller and as each month passes, have a chance to see how accurate their projections are, and their record is improving and becoming more persuasive.

[774] See https://www.reuters.com/article/us-health-coronavirus-israel-masks/israeli-mask-maker-sonovia-expects-99-coronavirus-success-after-lab-test-idUSKBN23T183 or https://cov.cx/a1f25

[775] See https://news.iu.edu/stories/2020/05/iu/releases/18-research-shows-electroceutical-fabric-eliminates-coronaviruses-on-contact.html or https://cov.cx/a1f26

[776] See https://thehill.com/policy/healthcare/516945-eyeglasses-may-help-protect-against-coronavirus-study or https://cov.cx/a1f27

[777] See https://www.studyfinds.org/what-happens-when-you-flush-with-toilet-lid-up/ or https://cov.cx/a1f28

Conclusion

Appendices

[778] Safely submerged in a footnote, you may be interested to guess which drug is most commonly fake. Sorry, guys, it is Viagra. See, for example, https://www.medpagetoday.org/meetingcoverage/smsna/34493 or https://cov.cx/a1f29

[779] See https://thecovidsurvivalguide.com/online-pharmacies/ or https://cov.cx/covop

[780] Here’s a longer list with some interesting comments. https://en.wikipedia.org/wiki/List_of_abbreviations_used_in_medical_prescriptions or https://cov.cx/a1f30