Category: health care Page 3 of 35

On December 20, 2022

Back in November I wrote that China’s Zero Covid policy was the right thing done the wrong way. Briefly after, consequent to some protests against Zero-Covid, China basically abandoned the policy.

The main problem is the same that exists in almost every country: even the most competent elites in the world today are, when not graded on a scale, incompetent buffoons incapable of running anything properly. Zero-Covid should have been about making necessary infrastructure changes to clean air so that over time restrictions could be eased.

This does not mean Zero-Covid did not have benefits: by shifting the oncoming wave downstream, China has significantly decreased mortality. Current protocols mean that Covid is much less deadly than if they’d given up early. A lot more people are vaccinated and the protocols for treating Covid are much better than earlier.

But massive public health measures should have been an opportunity, again, for improving infrastructure.

In the short term I would suggest that this will cause a supply shock, not make one less likely. If you need things made in China, stock up with a two to three month supply.

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There will obviously be a wave of hospitalizations in China. Their hospital capacity per capita is much lower than most of the West’s. They do have the ability build temporary hospitals fast, but the choke-point isn’t facilities, it is trained staff. The CCP has plenty of warm bodies they can throw at low skill hospital jobs, but no great surplus of doctors and nurses.

The longer term consequence is the same as the longer-term consequence in the West. The best reason to do Zero-Covid was never about short term deaths, it was about avoiding Long Covid and a population which gets infected over and over again by a virus which screws up immune systems and damages organs, including the brain. The population level effects of Long Covid will be massive. The UK and US already have about 2% of their workforce disabled because of it.

China is a decade out from the start of a demographic crisis, with an aging workforce. Their dependency ratio (the number of people working / number of people not working but who must be supported) will rise and keep rising.

Long Covid will have a devastating effect on the population. There is no particular reason to expect Covid to miraculously disappear. We’ve had chronic serious diseases that lasted for centuries or millennia and the damage Long Covid does is not a serious enough evolutionary disadvantage for there to be significant pressure for its reduction. Indeed, if, as seems to be the case, much of it is related to immune dis-regulation, it’s likely to be selected for.

China’s elites policy was the right one, but public health measures at massive scale are what you do to buy time to clean up the water/air/find a cure. Since no cure has been found for Covid, and there is no cure on the horizon, well, infrastructure needed to be changed.

China isn’t worse about this than most other places. There has been no mass refitting of ventilation infrastructure in almost any major country (Japan seems to be a partial exception).

But it is tragic to see incompetence and short-sightedness destroy the last major uninfected pool of people in the post-Covid world.

China will pay a grave price for this, and Western triumphalism at the end of Zero-Covid is like cheering when the last stronghold falls to an invader. “It was so embarassing that they were holding out when we surrendered so easily.”

Pathetic and sad.

The Long Term Effects of Covid On the Economy Are Going To Be Devastating

On December 14, 2022

Further, the effect of Covid on people over 50 is going to be massive, and that means you if you’re under 50 when you get to being over 50, because the evidence coming in is that Covid damages the immune system: depletes t-cells and disorganizes recognition of pathogens.

An estimate, but…

2 million to 4 million full-time workers are out of the labor force due to long Covid. (To be counted in the labor force, an individual must have a job or be actively looking for work.)

The midpoint of her estimate — 3 million workers — accounts for 1.8% of the entire U.S. civilian labor force. The figure may “sound unbelievably high” but is consistent with the impact in other major economies like the United Kingdom, Bach wrote in an August report. The figures are also likely conservative, since they exclude workers over age 65, she said.

As she says, this correlates to estimates elsewhere.

I want to be as clear as possible about this: the effect of Long Covid on the economy is going to dwarf that of closures or of Covid TrueZero (a policy of cleaning up our air with filters and UV light, while using proper N95 masks, travel bans and other public health measures in the meantime.) Remember, Long Covid is still going on. It could go on for years, or even decades. There is no guarantee it mutates into a form which does not cause immunity and organ damage.

That effect becomes more pronounced as you get older, and the tipping point is somewhere around the age of 50. This is going to lead to a further significant decline in lifespans if we can’t find a cure, but don’t assume we will: we’ve spent trillions and not found a cure for cancer and our society has passed its tipping point and is now in decline (this is true globally.)

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China did ZeroCovid STUPID, as a number of people have pointed out, and have now reduced their efforts. We’ll see if they stay reduced after the Chinese population discovers what happens when you “let’er rip”, but if China continues, that’s the end of one of the last major population blocs which wasn’t riddled with Covid. Remember, again, that Covid can do significant damage which you don’t notice, that has no symptoms now. But it will later.

China’s Zero Covid policy was the right policy, done wrong, and when you do the right thing the wrong way, you discredit it. China’s anti-Covid policies took longer to be discredited than Western ones because while stupid they weren’t as stupid as ours, but they still overly relied on lockdowns rather than infrastructure improvement and refused to use n95 masks.

So, globally, this is going to lead to long term economic issues, both in lack of workers and supporting unhealthy people, or just letting them suffer and die, which will still have economic effects. (It’s obvious that en-masse we don’t really care about the morality of it).

And you, personally, will probably live less years and be less healthy. The more times you get infected, the more true this will be.

China’s Zero-Covid Is the Right Policy Done Stupid (How China/The West Could Kill Covid)

On November 29, 2022

Imagine policy on two axes: Good vs. Bad Policy, and either type of policy done well vs. done badly.

Invading Iraq was Bad Policy, and it was done badly beyond the initial conquest.

Quantitative easing was Bad Policy (unless you were very rich, it was good for the rich and bad for everyone else) and it was done well: It saved the rich then made them much richer. (They aren’t concerned about long term downsides.)

Social Security, Medicare, or Canada’s Universal Health care system (when first created and for a few decades afterwards) was Good Policy done well.

Zero-Covid in China is Good Policy, but in most cities, and generally across the country, it has been done badly. (A lot of these criticism are taken from Naomi Wu, who is worth reading — don’t be fooled by her appearance.)

Understand first that China doesn’t have nearly as many hospital beds, and especially ICU beds, per capita, as most of the West. If Covid gets out of control, a higher percentage of people will die than did in most Western countries. Indeed, probably many more. Even if they only lost as many as the US has so far, we’re talking about five million people or so, but it would easily be double that.

Second, understand that China has an onrushing demographic issue and is still a manufacturing state. They need workers. They fundamentally regard their population as a productive asset, while most Western elites regard their populations as passive assets to be consumed. (One argument for why Japan has handled Covid better than most developed nations is that they need their population. They regard the people as a productive asset.)

A third principle to understand: Long Covid would disable a lot of Chinese. That number, today, would probably be around 40-50 million, and would increase every day. Again, in China, people are productive assets, and you especially don’t want working age people disabled.

There is also a moral argument: Stopping people from dying or being disabled is ethically the right thing to do.

Keeping Covid under control via a “Zero Covid” policy is thus firmly in the Good Policy bucket. Even if there are some short- and mid-term economic costs (and actually, in a lot of metrics, China has done better economically than the “let’er’rip” countries) the long-term costs are much more significant.

Now the next thing to understand is that the way most people think of China, in terms of authoritarianism, is essentially wrong. Oh, China is an authoritarian one-party state, for sure, but regional elites have a lot of freedom. Only about 30 percent of the overall government budget is controlled from the center, for example. In the US, that figure is about 45 percent. States and cities are often rich, not poor (i.e., they have discretionary money), but they also have a lot of policy freedom within the guidelines set from the center.

So, different cities have done Zero-Covid differently. In Shenzen, where Naomi Wu comes from, there has been a total of one week in full lockdown. That’s it. Other cities have had more. When Hong Kong and Shanghai lost control in the summer, they had not been doing the same thing as most cities – they, in fact, didn’t lock down early, or totally, but tried a more “Western” approach.

We’re now seeing some fairly significant anti-Zero-Covid protests in some cities, including Beijing. This thread is a fairly good and balanced summary:

1. Demands: Xi's Covid response is the main source of protestors' frustration. No surprise, Beijingers are tired of the near-daily testing requirements and lockdowns. While I also heard some demonstrators calling for broader reforms, those demands weren't as unified.

— Brian Spegele (@BrianSpegele) November 28, 2022

The issue isn’t that Zero-Covid is Bad Policy, it is that it has been done stupidly. To pick out a few major points:

One: Surgical masks are still being used. n95 masks are much more effective, and China has the capacity to manufacture them on a mass scale, almost trivially.

Two: Most Chinese homes don’t have p-traps (that little bend in your pipes under your sinks and toilet). P-traps keep water in the trap so that fumes from the sewer system below don’t get into your house. Not only does that mean your home smells better, it’s reduces disease transmission significantly.

Three: There is no mass move to install proper filtration or use of ultraviolet light in ventilation systems.

All of these actions would be low-hanging fruit for China. They can easily manufacture and install p-traps, filtration, and UV: China is the manufacturing capital of the world, and with the construction slow down there are plenty of people who need the work and are capable of doing it with respect to upgrading ventilation. It would be a win/win — more economic activity and an improved chance of achieving Zero-Covid.

Public health methods like testing, track and trace, and lockdowns work, but the real method is to fix the air quality and transmission through structural changes — exactly as we did in the 19th and early to mid-20th century to defeat diseases like Cholera, but with the water and sewage systems. Studies on the effectiveness of filtration, p-traps, n95 masks, proper ventilation, and so on show decreases in transmission that are massive — often over 90 percent.

Public health measures like mass testing and lockdown should be largely temporary; you use them until you figure out how to deal with a disease more permanently. In Covid’s case, that is NOT going to be vaccines. While they are helpful, they are not a silver bullet. Instead, what is required is the infrastructure transformation — make buildings and cities more healthy, thus reducing transmission massively (and in the meantime, for mitigation, move to n95 masks).

China has no excuses here: The science is clear and they have the industrial and installation capacity.

For China to achieve “Zero Covid,” they must move beyond emergency public health measures to permanent fixes. We know how to do it, and they actually have the capacity to do it.

That would be Good Policy, done well.

China’s mistake is trying to control Covid, not end it. The West’s mistake is not even trying to control it, let alone end it.

Every Covid Infection Does More Damage & Makes You Less Healthy and More Likely to Die

On November 14, 2022

Okay. From very early on in the plague, I’ve been saying getting infected multiple times was a terrible idea, and a worse plan.

The key to being right in advance is being willing to run before things are completely proven, but when they are obvious. It was obvious that reinfections were terrible for people. Now the firm data is coming in. (Read the entire thing here.

“Compared to those with no reinfection, those who had reinfection exhibited an increased risk of all-cause mortality” of over 2x those with no reinfection. Three times for hospitalization, heart problems, and blood clotting. There was also increased incidence of diabetes, fatigue, kidney problems, mental health disorders, musculoskeletal problems, neurologic disorders, and lung problems.

I mean, one might be tempted to just say, “Reinfection makes you more likely to have all health problems,” and not be too far wrong. It may be that things get better, but this study found increased risks right out to six months, which is as far as it studied.

Bonus! As I’ve said almost right from the start, each reinfection makes things worse.

Every time you get infected by Covid, it has a chance to do even more damage, and if that damage heals after the acute phase, it’s damn slow — if.

Now, let’s talk about “immunity debt.” The way the immune system works isn’t like going to the gym, and slowly getting stronger by lifting heavier weights. Instead, it’s like cops or customs agents with mug shots. “If you see this guy, shoot him.” One thing Covid does to evade immunity is mess up the mug shots so that they aren’t recognized. This means that you get other diseases after Covid, to which you were previously immune — because it’s messed up the recognition system. This is probably a big part of why there are so many auto-immune disorders popping up in Covid survivors; mess up the mug shots enough, and the immune system will start going after innocent civilians, i.e., parts of your own body. (Having had ulcerative colitis when I was young, I can tell you this can be more not-fun than most of you can imagine.)

Getting Covid is very likely to make your immune system worse, not better, and the above is only one mechanism by which this is true.

Too much of the Covid debate has centered on vaccines, which were not, and are not, a silver-bullet. The best results have been in countries that took public health measure approaches, of which vaccines are only a small part.

But for you individually, the “takeaway” is simple: don’t get multiple infections. Don’t let your kids get multiple infections. No matter how strong the social pressure, short of “lose your job” (and maybe not even then, if you can easily get another), do not stop protecting yourself, whatever level you consider appropriate. (I don’t wear masks outside unless it’s a crowded locale, for example, and I keep my tiny apartment ventilated all times. Most people should have a HEPA air purifier running all the time where they live, and your employer should be doing something similar if you work inside.)

Covid is already causing a permanent reduction in lifespans and an increase in illness. It’s not just Covid infections clogging up hospitals, it’s people with other illnesses getting them at increased rates. Keep protecting yourself.

And remember, with proper public health measures, we probably could have ended this plague in the first four months or so. Our lords and masters chose not to. Stupid? Evil? Why not both? I have suspicions (Covid made them a lot richer), but at the end of the day, they were okay with you and the people you care about dying or having serious health problems, likely for the rest of your lives.

Remember how much they were and are willing to hurt and kill you. Remember, also, this goes for all parties in power or near power in most countries. This certainly isn’t significantly different between Democrats and Republicans in the US.

The Adderall Shortage Is Just the First Major Shortage

On October 20, 2022

People who have read me for a while know that for years I’ve been warning of prescription drug shortages or even stoppages. Well, now we have one that’s large enough to have made headlines:

A national shortage of Adderall has left patients who rely on the pills for attention-deficit/hyperactivity disorder scrambling to find alternative treatments and uncertain whether they will be able to refill their medication.

The Food and Drug Administration announced the shortage last week, saying that one of the largest producers is experiencing “intermittent manufacturing delays” and that other makers cannot keep up with demand.

Some patients say the announcement was a belated acknowledgment of a reality they have faced for months — pharmacies unable to fill their orders and anxiety about whether they will run out of a medication needed to manage their daily lives.

Experts say it is often difficult for patients to access Adderall, a stimulant that is tightly regulated as a controlled substance because of high potential for abuse. Medication management generally requires monthly doctor visits. There have been other shortages in recent years.

“This one is more sustained,” said Timothy Wilens,

Now, it may be possible to move to generics, and a lot of the reason for this is how regulated amphetamines are as part of the war on some drugs. Back in the 60s it was possible to buy pure amphetamines over the counter just as at one time one could buy cocaine, morphine and codeine OTC.

That said, supply lines are under pressure and those pressures, though they will fluctuate, are going to get worse over the next years and decades.

Going off Adderall can be nasty, but there are other drugs where it’s downright hell, including SSRIs and Benzos. I know one guy whose careful titration of Xanax took a year, and when another friend’s was without for two days because of a prescription problem his body started just moving and speaking on its own. (GABA is what allows you to not do things, and benzos crush your bodies natural production.)

Then, of course, there are drugs people need because without them they will die or become seriously ill.

As we go forward, all of these things will be subject to the possibility of supply shocks and shortages. I would say, indeed, that more drug and medicine shortages and supply shocks are inevitable.

It’s hard to say what to do about this, because you can’t build up a supply of your own: doctors can’t let you have a 6 months buffer, say, of benzos (which if you take them every day, is about what I’d guess you’d need to have enough to safely take yourself off them with small reductions over time.)

But be aware of this issue and see if you can figure out a way to protect yourself. And remember, even without shortages, there will be future “insulin situations” — where those who have a drug people must have jack the price up so high many people can’t afford it.

Plan ahead if you can, and be well.

Update: Someone who wants to remain anonymous offers the following suggestions:

If your on a script then it might be a good idea to see if you can start pushing a day or so early to get it refilled to try and see if it gets filled early, If it does then maybe you can slowly start to build up a very small reserve of even just a day, this can then over a small amount of time build up larger stocks which can give you a lifeline. If this is possible or even if it isn’t, look into other ways of meeting your stock and med needs. It might be even worth checking local triage procedures to see where in the totem pole you’d end up in a ration type situation. At the extreme ends it might even be necessary to procure stock through “other” means as safely as possible. Right now that’s all I can think of: my morphine for now has PRN/as needed dosing so I have some leeway of supply but SHTF situations are, as ever, dependent on a “see what happens” approach.

Covid Variants Continue Immune, Vaccine and Treatment Resistance Evolution

On October 13, 2022

From Salon:

BQ.1 and BQ.1.1 are both spreading extremely fast in parts of Europe. According to Cornelius Roemer, a viral evolution expert at the University of Basel, the number of BQ.1.1 infections has been doubling every week. That kind of exponential growth is sure to drive the variant to becoming dominant globally in short order.

“The degree of immune escape and evasion is amazing right now, crazy,” Yunlong Richard Cao, an immunologist at Peking University in Beijing, told Nature this week. Cao co-authored a paper, which has yet to be peer-reviewed, that seems to show previous infections by BA.5 and antibody drugs, including Evusheld and Bebtelovimab, aren’t enough to stop a BQ.1 infection.

“Such rapid and simultaneous emergence of multiple variants with enormous growth advantages is unprecedented,” Cao and his colleagues warned in the study. “These results suggest that current herd immunity and BA.5 vaccine boosters may not provide sufficiently broad protection against infection.”

Meanwhile, BA.2.75.2, an offshoot of the Centaurus omicron subvariant, also shows stark ability to evade antibodies.

So. Expect a bad winter. Remember that this exponential increase in new variants has always preceeded a new variant becoming dominant, and that given international travel, they always spread. If you get a vaccine, get a bi-valent one, but I’d suggest filtering enclosed areas and that wearing n95 masks is a good idea. Remember that even a mild case of Covid can lead to invisible organ damage, especially to the brain and heart, and that repeated infections have a good chance of giving you long Covid.

This isn’t a game, and it isn’t about ideological talking points or culture war bullshit. This is a disease, which because we refuse to take the steps necessary to eliminate it, that keeps mutating to avoid whatever half-assed steps we are taking, and which can seriously fuck you up.

Be well.

Vaccine And Mask Effectiveness

On October 4, 2022

I have mostly avoided the vaccine debate, but let’s take a brief pass.

This isn’t because vaccines don’t work.

This doesn’t mean I’m entirely happy with MRNA vaccines, I’m not and I think there’s some validity to them having negative side-effects. I’m even more unhappy with the uneven way they were applied, which allowed for Covid to gain repeated mutations which made vaccines less effective. I personally would have taken Sputnik-V if it were allowed in my country.

But the vaccines are protective against death and serious illness is indicated by the population studies I’m aware of. This is also true of masks.

Alberta Health data & analysis (from Feb 7) shows that schools w/ mask mandates had 3x less outbreaks & adults in those communities had 3x less hospitalizations.
Indirectly it shows that school infections *do drive* community spread.#BringBackMasks

1/ pic.twitter.com/t8W658Kkmx

— Malgorzata (Gosia) Gasperowicz (@GosiaGasperoPhD) September 28, 2022

Now, I do not favor and never did favor a policy primarily based on vaccines. I have always believed that public health measures like properly done shutdowns (much briefer than we had if you do them early), track and trace, quarantine, paid sick leave, travel bans for anything but absolutely necessary travel (with mandatory quarantine) and so on were the way to go. I wanted all loans frozen for the duration of shutdowns, or paid for by central banks (if they can create trillions for rich people, they could easily have done so for ordinary people.)

We fumbled Covid, probably because it was making the rich rich very very fast, and that lost trust in measures that were somewhat effective, but were sold as silver bullets. They weren’t, absent both public health efforts and a worldwide effort and/or travel banks. This has now morphed into culture war bullshit, where what you think depends not on your actual study of the issues, but on what your politics are.

That’s very sad, and very stupid.