Black death? No problem. Flu: uh-oh

Plague in China? Not really a big problem in today's world. Let the good doctor explain:



doctors on the Navajo reservation see a few cases of plague every year or so. 

And when you see these cases, you are familiar with symptoms and diagnose them early, so the mortality is low. 

this survey discusses cases in the past: (1950s to 1990_) and the prevention programs there.

So Bubonic plague is not a big danger of an epidemic right now: but it might surprise you that the 3rd plague epidemic that started in China killed about 12 million in China and India in the late 1800s.

But China is not the only place where rodents carry this disease:

plague is present in rodents in the SW of the USA and could start an epidemic at any time, but it is unlikely since doctors are aware of the problem. 

But other diseases kill, and alas, the covid hit the Navajos badly: And it was introduced there by a person attending a church service.

and the spread was made worse because of multigeneration homes.

A variety of factors — including a high prevalence of diseases like diabetes, scarcity of running water, and homes with several generations living under the same roof — has enabled the virus to spread with exceptional speed, according to epidemiologists.

more here:

As of June 1, the Navajo Nation reported 5,250 positive COVID-19 cases, 1,745 recoveries and 241 deaths. In the Shiprock area last month, three siblings who buried their mother, father, and brother were forced to watch the burial services remotely because they, too, were infected with the disease.

The poverty and federal neglect of the people on the reservations is not new, nor are delays in getting sufficient funding for the IHS hospitals and clinics on the reservations, but of course, now the press has noticed because they will pretend these longstanding problems are somehow new and they can blame Trumpieboy for the government red tape that slowed health money from getting there quickly.

Nez said that he was growing exasperated with delays in receiving federal emergency funds and requirements that tribal nations, unlike cities and counties, apply for grants to receive money from federal stimulus legislation. The extra hurdles have produced weeks of bureaucratic delays, he said. “We’re barely getting bits and pieces,” Nez said. “You have counties, municipalities, already taking advantage of these funds, and tribes are over here writing our applications and turning it in and waiting weeks to get what we need.” 

sounds familiar.  The red tape prevents ordinary people who need the stimulus money wait forever, while the rich groups who know how to work around the system get the money, and some of them really didn't need it because they had lots of invested money they could have used. But nevertheless, they applied and got the funds:

Politico has a little list of politically oriented groups who got loot and who helped them get it.

Michael Voris, a far right radical critic of the Vatican, notes how the Catholics grabbed their share of the wealth



Sigh.

As for us: We are still in partial lockdown: I went to the bank and was stopped because I went with the maid, and to keep her distance she sat behind the driver on the motorcycle, and that is still forbidden. (we were stopped on the street by a cop enforcing that law). I also arranged for a hairdresser to come and cut my hair, because I am unwilling to go inside the small shop to have it done.

The streets which have been deserted here are much more crowded and almost back to normal, and we have a lot more trucks going by: many with deliveries but also with concrete blocks and gravel or dirt, meaning construction has restarted.

the rumble of the trucks on the street next to our house is probably why I wasn't aware that we had a minor earthquake in our area.


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update: Professor Lal has a lecture about the third Black death epidemic I mentioned above, and how it affected India.
As India becomes more nationalistic, their history is being rewritten to remember the many wars and massacres and diseases.



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update: GetReligion evaluates the reporting bias in an AP article on the Catholic church receiving money, and a lot of those biases can be found in the above video too.

one of the problems? The program was for small businesses, and often parishes are not able to get the money, so the diocese asked to get it for them even though they had over 500 employees.

The real question is where did the money do, and of course, it needs to be put into perspective of other groups who got money.

Family news: GIGO

we survived the heavy rains from the tropical storm/typhoon, which hit the Visayas but kept off the coast enough not to hit us badly except for rain and floods and the downing of some trees.

We are on partial opening now: We can shop for "non essentials" but only on our designated days. So the dept store next door is open, sort of, with distancing. 

I still can't get my checks processed but any day now the courier service to send the check to the Manila branch for processing will be open, and once that is done I only have to wait 21 work days for the checks to clear.

Oh well. 

No, I am not going to change my pension to the Philippine bank: I don't quite trust them.

How is the Philippine doing? I'm not sure: We still have cases, including a few neighborhoods in Manila on complete lockdown.

and if you think that any of reports of how many cases there are in the Philippines is accuarate, you are being naive.

For most of the world, the "statistical analysis" of numbers is GIGO: Garbage in, garbage out.

My cynicism about the reporting by the MSM is that, except for Dilbert/Scott/

Adams, no one wants to admit that no one knows anything: Lots of analysis of data, but the rule is "garbage in/garbage out".

lots of plans based on assumptions that might not be true, because "garbage in/garbage out".

Testing is good, but a lot of the tests are inaccurate... so again GIGO.

So the US has more cases because they are testing more, but China's obviously fake data is quoted by the MSM as if it were true. Really? Doesn't anyone notice that China blocked outsiders from going to Wuhan to help figure what is going on, or that several million left that city to go to their home villages for Chinese new year: so how many cases in those rural villages who had parties with their extended families? Who knows. But the Chinese statistics are frequently quoted... GIGO

the fact that NoKorea shut down a border city and that there are reports of cases in China's North East suggest something is going on there. Hmm..

sDoes this mean there is also an outbreak in eastern Russia, which has a lot of Chinese "immigrants" living there? Who knows.

so the virus is all over, but the US MSM seems to think it's more important to spin it against Trumpieboy than actually report.

Here in the third world, not only will most cases never be reported, but a lot of kids will die because they are not getting their routine shots for Measles, diphtheria, whooping cough, etc.

And with the shut down, I am seeing a lot more abandoned dogs, so I worry about rabies cases in the near future.

But the economic slowdown will kill a lot more from malnutrition in the next year than will die of the virus. Especially vulnerable: Families who rely on wages from their relatives who work overseas and re now laid off...But except for migrant rights organizations, few are reporting this.

the high rate in the USA is because... New York City.

One big mistake made by NYcity etc: Not stopping infectious cases that are better but still infectious being sent back to their nursing homes.

why? because regulations mandated that if they came from a nursing home, that nursing home would be required to accept them back.

So the still infectious patients were sent back to infect others in their nursing home, because regulations said they were not sick enough to stay in a hospital.

Now, of course, the solution would be to open up the little used outside beds (Samaratan's purse or the hospital ships etc) for them. But apparently that wasn't in the regulations so no one looked into this alternative solution.

WTF? 

Is this malice, ignorance, or what?

no, this is how bureaucracies work: regulations rule. Inflexible rules are what is followed, never mind reality.

I've had experience with this type of insanity, since I have worked for the feds.

For example, back in the late 1990s when Minneapolis had cases of vancomycin resistant staph, i.e. an infection, usually of skin and wounds but also that can cause pneumonia and sepsis, that couldn't be treated, nevertheless our nursing home was being pressured to accept one of these still infectious patients.

Now, our nursing home was not just elders but included a lot of diabetics being treated for wounds and ulcers: 

On the reservation, most elders had someone to care for them either in the house or nearby, so our tribal health workers only went three times a week to supervise wound care. But some lived in very isolated areas, and in Minnesota, it would go 40 below and snow would block the roads; as a result, some of our frail elders and diabetics with partially healed leg ulcers spent the winter in the nursing homes: (the alternative for this slow intensive wound care was, alas, amputation).

Ah, but although using masks/gloves etc. was being done, the dirty little secret is that perfect isolation was impossible. Yet the bureaucrats were pressuring us to accept a patient whose infected wound might coast the lives and limbs of those already in our nursing home because... because why? Human rights I believe. Or because regulations said we had to. Reality be damned.

so some blame Trump for these nursing home deaths, but actually the governor, Cuomo, would be the one who bears the blame, since he "made" the decision. 

But of course, the real decision was made by state health authorities: They remain nameless bureaucrats, safe and sound.

they will of course claim they knew nothing...  And will hide behind the "regulations" that mandated this, even though the regulations were out of touch. And since it is almost impossible to fire a government employee, they will keep their jobs.

But not all state health commissioners can pretend they didn't know that it was a danger.

In Pennsylvania, the head of their health commission actually took his/her mother out of her nursing home and put her in a hotel room for safety.

But the mother didn't require care; and that, alas is the problems. As the "experts" note, removing elders from nursing homes too often mean they won't get good care, and that if they return to their families, they are at higher risk at catching the virus from family members who go outside for shopping or for work

The nursing home scandal is huge: but even then, the delay in getting testing made it worse.

Again, this is blamed on Trumpieboy but actually it was strict government regulations that delayed approving tests from private companies or outside countries, since they might not be accurate. So regulations meant to make sure the tests were accurate ended up meaning no tests at all. (and accuracy remains a problem in some tests).

(and the bad news: The tests might not be completely accurate: Again GIGO).



Finally, much of what you read is political finger pointing: it assumes magical thinking,  as if what we now know was known in January, it assumes opinions on what to do are uniform, when often there are many different opinions on what to do, and it ignores the disease was more infectious than influenza, since it also hit medical personnel.

And then the idea that isolated rural communities are the same as NYC with it's crowded slums and subway, might not be correct. That is why the rural communities in many still closed states are literally revolting/ignoring the guidelines: they feel they are at low risk.

Finally: there is a lot of hysteria about contact tracing due to privacy concerns.

those last two statements (rural low risk, contact tracing) are related.

Uh, we've been doing contact tracing for years for TB when I worked for the IHS, and state health departments would always trace contacts for STDs, at least before HIV became a civil right.

when it comes to the wuflu, contact tracing is vital to stop the spread in rural areas with high risk populations: e.g. migrants, immigrants, people in extended families and Native Americans, all of whom tend to live together in the same house and who care for their elders at home as part of this extended family.

(One of my friends in Albuquerque has been tracing contacts among immigrant families, and is due to change her job to a local reservation to do the same.)

How the disease spreads in small connected communities in rural areas is described in this excellent article about the spread of the virus on the Navajo reservation.

One would think that the Navajo, who live in isolated homes, not in villages like the nearby Pueblo tribes, would be safe, but that's not true.

It seems that a man who had no symptoms carried the infection from a nearby big city attended a church service... and this spread the virus to those who went to the service, and took it home. Often housing includes extended family members, so they got sick.

It's not just poverty, but comorbidity (a high rate of obesity and diabetes). It would be miles to the local medical center, often a clinic or hospital of the IHS. Now, I have worked for the IHS: the places are often understaffed and the personnel are overworked, and due to the limited budget often expensive stuff is not available.

But the dirty little secret behind the spread is because the families take care of their own, so the virus spreads through the family.

I suspect a similar reason is behind the high rate among the working class. minority and immigrants communities in NYCity. 

The US is notorious for putting grannie in nursing homes because both spouses have to work to keep the family going, yet even in the USA, there are 40 million part time or full time caregivers who rarely get noticed, and these caregivers allow most of the elderly to live at home.

And in many families, often someone stay home to do the care, sometimes working part time or even quitting their job to do so.

This is the same way we care for our elders here in the Philippines, and in most of the world.

by the way: our partial shutdown continues because of a diagnosed case in the next neighborhood, and our churches remain closed for services.

Sigh.


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update