On Mike the Moron and handling infectious diseases

Five days ago, Mike Hosking (now known as Mike the Moron) was in full display with his levels of basic ignorance and blatant stupidity. Of course there are the characteristics of a radio jerkoff. But even so, his self-interested rant then that included such waffle pearls of wisdom as:- 

Two things just initially. One, it’s not wise to sound quite this nervous at this early stage. And two, the upside is, we are far from alone in this and as such, given it’s a global issue, there is nothing as powerful as self-interest to see us all through a crisis. I think ultimately it’ll all work out fine.

The mad headlines still persist. One said the virus is spreading nine times faster outside China. That might be true, but only because within China the numbers have curtailed away dramatically. When you start with a tiny base, being able to spin a dramatic headline isn’t hard.

Now even 5 days ago, during the moron’s imitation of a dithering Donald Trump, it was quite apparent that the only reason that the virus was so contained in China was the massive state and community reaction to contain it. It was somewhat belated and inept initially in Wuhan because of the initial see and hear no evil approach. But once it was clear that there was an dangerous outbreak then it has been hard to fault the containment in early arrival states like China or South Korea or Singapore once they realised that they had a epidemic.

What was also apparent 5 days ago was that there were some countries where the governments were inept in the initial phases of infection and the infection rate was rising with only minimal and largely ineffective levels of constraint. US, Italy and Iran being the obvious examples.

I was struck by a comment on quora which strikes at the nub of why and how societies have to handle infectious diseases that have no vaccines or preventative treatment. The question was “Is Covid-19 likely to be at pandemic proportions for 2 years?“. The answer that impressed me (and others) was from Scott Hsieh.

Here’s the problem with Covid-19:

If we do nothing, it goes out of control. There is nearly universal agreement on this point. Every week the number of infected people doubles or triples, according to the best estimates of R0 today. Within about two months, hospitals start to collapse under the pressure (Italy) and can survive only by building emergency new facilities using help from the rest of the country (Wuhan). However, if you really are doing nothing, then two months later the rest of the country falls down and no one can help you. At this point, there are no more ICU beds left and the mortality rate goes from 2% to 5-10% because we run out of respirators.

On the other hand, if we declare a state of emergency … schools shut down, airports virtually close, and the country goes on lockdown. All for what, like 3,000 cases?? Then if the disease is successfully suppressed a few months later, everything opens back up and we look around and say, gee, why did we even do that?! Why did the country shut down when the ordinary flu killed 100x more people this year? Didn’t we way overreact?

But the difference between 5,000 cases and 5 million cases is 10 weeks of inaction. That is why governments around the world are taking severe and enormous action now, because we are at the edge of the precipice.

To answer the original question — will Covid-19 be considered a pandemic in two years? That depends on us. Please, if you have a cough and/or a fever, stay at home and stay away from others. You probably have a cold, but if you’re a minimally symptomatic carrier, you can do your part by making sure your particular Covid-19 ends at you and doesn’t get passed on to another person.

That is the crux of dealing with pandemics. As a society you act early and coherently or you wind up with very high death rate and maximum economic and societal dislocation.

Just to put this back into a historic New Zealand context. The most deadly equivalent epidemic here was the influenza epidemic of 1918/19 – and it was (too put it mildly) a clusterfuck. This is the epidemic that formed the basis of the pandemic response plans for NZ for the last century – most recently…

The Pandemic Plan, published in 2010 and now being used to address the coronavirus pandemic, was explicitly based on addressing the issues that emerged in 1918.

The influenza pandemic killed at least 9000 known people in a population of what was less than 1,150,000. There are a lot of questions on that – but it is the best researched estimate. A lot of troops still had not returned from the first world war. The fatality figures were from later trawling of attributions of cause of death – and are likely to underestimate the those where diminishing the immune system from flu caused other medical issues.

I’d guess that the actual fatality rate by our current standards was somewhere between 0.8 to 1.2% of the resident population, falling far harder on the Maori population, and even harder in the pacific countries like Samoa that we were responsible for at the time. Essentially, the whole of the population got influenza in some level of virulence by 1920, when it died out in the face of herd immunity.

New Zealand got hit hard by influenza. Most of the issue can be laid directly at the foot of :-

Basic errors by the Government and local officials made the disaster much worse: A lack of planning, political squabbling, and a reluctance to disrupt the economy fuelled the spread of the virus which, six weeks after it began, had killed upwards of 9000 New Zealanders, including a shocking five percent of the Māori population.   

In other words the exact kinds of things that Mike the Moron was urging to be considered as recently as 5 days ago when he was urging that..

My sense right here, right now, is for most, it’s way too early. These are tough, uncertain days, but they’re still early days.
Holding your nerve is a skill, hopefully not missing in this government.

In Auckland in 1918

The alarm was quickly sounded by doctors. A report in the New Zealand Herald on October 22, quoting doctors, said influenza should be declared a notifiable disease as soon as possible.

Doing so would allow aggressive action to contain the virus; But it would not happen for another two weeks.

It was increasingly clear there was a problem when nurses started falling sick. Dozens of nurses were too sick to work, and Auckland Hospital struggled to maintain staffing levels. At its height, more than 100 of the hospital’s 180 nurses were too ill to work.

By October 29, the epidemic was fully unleashed throughout the city. 

To give you an idea of the issues in 1918 and why the response was so slow

But even in the midst of the outbreak, outside of Auckland, it was unclear how serious the pandemic was, even to the Government.

and

The national Medical Officer of Health, Dr Joseph Frengley, finally decided to leave Wellington for Auckland in early November to see what was happening for himself.

He immediately realised it was a disaster. He asked the Minister of Health, George ‘Rickety’ Russell, to join him in Auckland. Ads were placed in newspapers around the country pleading for nurses to come to Auckland to help.

While this was happening, the virus was rapidly, and silently, spreading.

This lack of coordination and belated attention by government meant that when the much of the limited medical resources got concentrated in Auckland by train and boat. While the third wave of influenza started elsewhere. That was facilitated by (for the time) large concentrations of people travelling and having social contacts in a manner that seem designed to cause spread.

Two factors were integral to its quick spread, Rice says: Soldiers returning from WWI, who boarded trains to return to their homes across New Zealand, and large community gatherings that celebrated the end of the war. 

Unlike today’s focus on social distancing and limiting mass gatherings, people flooded the streets in the midst of the influenza pandemic to celebrate the Armistice. 

It happened twice: First, on November 8, when an inaccurate report declared the war over, then again on November 12, when the war actually ended. On both occasions, people flooded the streets to celebrate, undoubtedly spreading the virus further.

Australia by contrast in 1918 managed to act early, quarantined their borders, and made influenza a notifiable disease early.

He points to how Australia responded to the influenza outbreak: It quickly set-up a maritime quarantine in mid-October, which all but stopped the virus entering the country. Its death rate was 2.7 in every 1000, less than half of New Zealand’s European death rate of 5.6 per 1000 and much less than the Māori death rate of 45 per 1000. 

Our current estimates of fatality rates for covid-19 look to be upwards of 1%  and probably closer to 2% where it has been known to have been verified. But that is after we have used vastly better medical support than was available in 1918. The primitive ventilators on 1918 probably did more harm than good then. Antibiotics to deal with the opportunistic bacteria taking advantage of suppressed immune systems (eg pneumonia ) were unknown. And there are far far more medical staff per head of population than were available in 1918.

Covid-19 is a far more lethal disease in terms of fatalities. If even basic medical support wasn’t there, as it was during the black death which killed at least 30% of Europe’s population, then the fatality rates are more likely to be order of 5-10%. It gets pretty important to protect the medical resources that we have because they reduce fatality rates enormously.

Covid-19 is a sneaky disease, one that is likely to become more endemic than the influenza of 1918. It has a longer incubation period than the 1-2 days of influenza. This following example is of a 29 year old women in Australia who was picked up with covid-19 early after flying back to Australia for a wedding..

After she landed, she went to the doctor for a general health check-up and discovered she had coronavirus.

“They said we think we should check you for coronavirus and I said, ‘you’re being ridiculous, I haven’t got coronavirus’,” she told 7.30.

“Turns out they were right and I was wrong.”

No-one knows where she picked up the virus.

“It felt like a bit of a con, to be honest, to walk into hospital feeling fairly healthy, yet everyone’s in hazmat suits,” she said.

The initial symptoms were not severe.

“I had a little bit of a fever, I was a little bit tired.

“So, it was really hard to accept the diagnosis because I didn’t feel physically unwell.”

But then her condition deteriorated.

“I became very, very fatigued and I had quite intense headaches and a level of chest pain,” she said.

The worst period was around days eight to 10.

“I felt like I was 80 years old,” the 29-year-old said.

“I struggled to sit up in bed, to get out of bed, to do all the basic things that we probably all take for granted.”

Remember that she is youngish, was in hospital in isolation and had hazmat precautions from the medical staff from a few days after contacting the disease. She wasn’t being infected by the host of other diseases that we meet every day in our work and home environments. This was just about the best possible conditions to meet an infectious disease when you aren’t vaccinated against it. 

It sounds to a ex-medic like me, that she was in real medical danger. Healthy enough to survive covid-19, but just about any other disease would have had a  good chance of killing her from depressed immune system – and probably still does.

On day 13, she received that second negative and was free to go.

“Now I have no coronavirus in my system,” Ms Wilkins said.

“I’m not infectious and I’m not contagious according to medical advice, which is nice.

“But what I do have is a low immune system.”

That long incubation period before becoming symptomatic is dangerously long.

In the resulting models, estimated median incubation time (IT) of COVID-19 was 5.1 days; mean IT was 5.5 days. For 97.5% of infected persons, symptoms appear by 11.5 days. Fewer than 2.5% are symptomatic within 2.2 days. Estimated median IT to fever was 5.7 days. Among 108 patients diagnosed outside mainland China, median IT was 5.5 days; the 73 patients diagnosed inside China had a median IT of 4.8 days. Using exposures designated as high risk and a 7-day monitoring period, the estimate for missed cases was 21.2 per 10,000. After 14 days, the estimated number of missed high-risk cases was 1 per 10,000 patients.

Which basically means that by the time you have a fever, you have had a very good chance of having already infected others. By the time that the doctors and nurses see you – then they can expect to see a lot of people arriving soon afterwards, followed by even more days later, and a tsunami of sick people days later. That is exponential growth..

When and if you recover, you’re still going to be susceptible to any other opportunistic disease. We don’t even know yet if any immunity you have to civid-19 will persist and you cannot be reinfected easily.

Which is why the government acted early on steadily closing the borders, reducing social contacts, and using our low debt levels to pushing out income and cost support for people and businesses. Getting over the threat of civid-19 is going to be a slow and arduous process taking at least months.

In the meantime we still have Mike the Moron. Yesterday just before the borders got closed, he was still yammering on like the ignorant idiot that he is. From his blithe and stupid caution 5 days ago, he was complaining that …

But for right now, why isn’t this country locked down? China has given us the answer. Not necessarily in a way we find comfortable. But the numbers don’t lie, they are largely out the other side by locking their country down. Europe is all the evidence you need as to what happens if you don’t act.

We seem in the midst of some bizarre, slowly unfolding series of decisions released in a cumbersome, lethargic, and needlessly ineffective way.

Ah yes. Well it shows that even a dimwit who normally appears to be more concerned with who pays him for his idiot driven luxury car wrecking habit is in fact capable of learning.  In 4 days he has gone from thinking that government should be cautious about doing anything to pre-empting decisions. Of course that probably only because his cowardice has overcome ignorant paymaster fueled bluster. But hey – who was even aware that this motormouth moron was capable of learning?

Of course he could just have a look at the pandemic plan so that he could anticipate what happens next and demand that it happens immediately. Because I suspect that this government is proceeding through the previously planned steps. While we’re now proceeding through the “Keep it out” phase. Next we go into “Stamp it out”.

But really, I just want some bumper stickers to proclaim and publicize the genius of Mike the Moron, the radio station who gives him air-time, and the newspaper that allows him to repeat it. But really, can we afford to provide media time for morons like the dithering and invariably wrong Mike Hosking in this time of crisis? He makes most of the trolls on this site look intelligent.