Monday, March 30, 2020

Unintended Consequences? Polio and COVID 19

Polio children in iron lungs

We must consider the unintended medical consequences of societal lockdowns hoping to prevent the spread of COVID 19. Unintended consequences are exemplified by past polio epidemics that left some of my classmates crippled. For the most severely afflicted, a polio infection required, not a ventilator, but an iron lung for children to breathe. The polio virus had likely been around for thousands of years, but in the 20th century severe epidemics began. Why?

In 1992 Dr Krause from the National Institute of Health published, “There are numerous examples of old viruses that have caused new epidemics as a consequence of changes in human practices and social behavior. Epidemic poliomyelitis emerged in the first half of this century when modern sanitation delayed exposure of the virus until adolescence or adulthood, at which time it produced infection in the central nervous system and severe paralysis. Before the introduction of modern sanitation, polio infection was acquired during infancy, at which time it seldom caused paralysis but provided lifelong immunity against subsequent polio infection and paralysis in later life. [emphasis mine] Thus, the sanitation and hygiene that helped prevent typhoid epidemics in an earlier era fostered the paralytic polio epidemic.”

Indeed, it was the more affluent people with higher standards of living that were most affected by polio epidemics, because their children were more likely isolated from milder strains.

As is the case for most rapidly mutating viruses, there will be various strains. Some will cause mild effects while others could be deadly. A strain’s virulence may depend on a person’s age and health. There are several strains of influenza virus, so vaccines are adjusted each year. There were 3 strains of poliovirus that were identified. Vaccinations eradicated two types and now groups like the Rotary are funding work to eradicate the remaining type. The observation that early exposure to polio viruses provided life-long immunity raises the question regards dealing with COVID 19. To what degree is sheltering in place preventing people from becoming naturally immune when infected with a mild strain?

The larger the population of naturally immune people, the greater the “fire-break” that prevents the spread of a more deadly strain. Just as social distancing minimizes the exponential growth of a deadly strain, it also prevents the exponential growth of naturally immune people. If so, perhaps a more targeted approach would be better. Our elderly population are the most vulnerable and are often confined to crowded facilities. People with compromised health conditions should self-isolate. We definitely need to minimize the spread to those vulnerable people. Perhaps designating one hospital to specialize on COVID and another for non-COVID medical care is a good strategy. Stopping medical care for a far greater number of people with other severe problems out of fear of spreading COVID 19 is not wise. And is it wise to quarantine everyone?

The fact that many people have tested positive for COVID 19 virus but had no symptoms suggest there are various mild strains that could naturally impart immunity. These mild reactions are primarily seen in people younger than 50 years old. However, once those younger cohorts gain immunity, they will be less vulnerable as they age.  

Recently in the New England Journal of Medicine Dr Fauci wrote, " If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively."

Dr John Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine, director of the Stanford Prevention Research Center, and co-director of the Meta-Research Innovation Center at Stanford

In contrast to Imperial College model suggesting over a million Americans could die, Ioannidis argued, “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average.”  The Imperial College and Ioannidis’s model will be tested soon, as American COVID deaths stands at 2,871 as of March 30th.

Nonetheless, it will be difficult to determine how effective a societal lockdown was if COVID 19 behaves like influenza.  Flu infections dramatically drop beginning around April. Relative to seasonal warming, a lockdown may have a minimal effect. Perhaps by inhibiting the spread of a natural immunity, we may be setting the stage for another big wave of COVID 19 next year. These are questions must be debated.

Influenza deaths versus seasons

Jim Steele is Director emeritus of San Francisco State’s Sierra Nevada Field Campus and authored Landscapes and Cycles: An Environmentalist’s Journey to Climate Skepticism

Tuesday, March 24, 2020

Accelerating infection rates? Or accelerated testing?

Accelerating infection rates? Or accelerated testing?

It appears the spread of COVID 19 is not accelerating as the media suggests. The increase in confirmed cases is a result of accelerated testing.

According to data shared by the Atlantic on March 17, only 25,000 Americans had been tested for COVID 19 resulting in 4,400 confirmed infections by March 12. That suggests a 17.6% infection rate per tested specimens. This infection rate very likely over-estimates the infection rate of the American population, as most tests are performed on people concerned about respiratory symptoms that could also be caused by the common cold or the flu. Likewise younger people who are less likely to get infected are unlikely to seek testing.

If the pandemic spread is accelerating, then infection rates per test should be increasing. But they are not according to my calculations.

The Atlantic provided access to a data base listing the number of COVID 19 tests for each state.
Not all states had reported, but as of March 23, the number of tests had accelerated to 317,240 total. Based on the current number of confirmed cases, 49,940, the number of cases per test was just 15.7%. At the very least, the smaller percentage of confirmed cases per test suggest there has been no acceleration in the spread of the disease. Journalists reporting on the spread of COVID 19 should not just report the number of confirmed cases but the number of cases per the number of tests.

Because many confirmed cases have only mild symptoms, the mortality rate is also informative. Of the currently confirmed 49,940 American cases, there have been 634 deaths. That is a mortality rate of less than 1.3% of confirmed cases. For comparison, the death rate for the closely related SARS virus was over 9%, but there were far fewer infections. The COVID19 death reate is ten times greater than influenza. However since October 2019, many more people are infected by the flu, over 38 million,  and the number of deaths is estimated between  23,000 and 59,000, far greater than COVID 19.

If COVID 19 behaves like the flu, then warming weather should cause infections to drastically decline as we progress toward summer

Sunday, March 22, 2020

Warming Improves Our Health - part 1

What’s Natural

Warming Improves Our Health - part 1

It’s deeply disturbing to hear people uncritically regurgitate media misinformation suggesting global warming threatens our health far worse than the COVID pandemic. Scientific evidence unequivocally shows colder weather is the major killer. As Figure 1 illustrates, the percentage of all deaths attributed to weather and temperature increases during the cold months. In contrast mortalities rates fall during warmer months. Researchers examining 74 million deaths across the globe from 1985-2012 found 7.3% were caused by temperatures cooler than the optimum compared to just 0.4% attributed to temperatures above the optimum.  Extreme temperature events, both hot and cold only accounted for 0.9% of all deaths.  

Likewise, a 2014 National Health Statistics reports found, “During 2006–2010, about 2,000 U.S. residents died each year from weather-related deaths. About 31% of these deaths were attributed to exposure to excessive natural heat, heat stroke, sun stroke; 63% were attributed to exposure to excessive natural cold, hypothermia, or both.”  Similarly, according to the CDC , from 1979-1999, a total of 8015 deaths in the United States were heat related while 13,970 deaths were attributed to hypothermia. So why aren’t people listening to the science?

Increasing seasonal death rate due to colder temperatures 

Global warming fear is based on speculation regards what could happen in the future if global average temperatures rose 2°F to 4°F. But scary predictions are not scientific fact until their hypotheses are tested and verified. Without time machines we cannot directly test predicted outcomes for the years 2050 or 2100.  But we can observe the effects of a similar temperature change.

In the United States people have steadily migrated away from the cold Northeast to the warmer Southwest. In the Southwest they are exposed to higher average temperatures, temperatures equal to or greater than what global warming predicts they would endure if they remained in the Northeast. The good news, scientists determined that “migration from the Northeast to the Southwest accounts for 4% to 7% of the total gains in life expectancy experienced by the U.S. population over the past thirty years.” We can infer a similar benefit from global warming. A complementary study determined people that migrated to colder climates suffered ‘greater cardiovascular mortality” than people who remained in their native country.

Because the two major U.S. government agencies that track heat and cold deaths - NOAA and the CDC - differ sharply on which is the bigger killer, the public is rightfully confused. In contrast to the CDC results, NOAA argues heat is killing twice as many people as cold, but NOAA’s researchers have also been heavily invested in catastrophic global warming claims. By statistically adjusting the data via “seasonal detrending”, they remove the greater number of winter deaths in their analyses and just focus on extreme temperature deaths. They justify their adjustments arguing factors such as increased winter deaths due to flu season are not directly due to colder temperatures. But that obscures the health effects of temperature.

Colder temperatures reduce the effectiveness of our immune systems, which promotes influenza epidemics that may kill 34,000 to 60,000 people in a year. Because influenza season ends when temperatures warm, scientists are hoping warmer weather will similarly curtail the novel COVID-19 pandemic.

NOAA’s adjusted data focuses on deaths from heat waves and cold snaps. Indeed, there is a greater spike in deaths during heat waves, but research suggests heat waves have a small long‑term effect due to a “harvesting effect”. Us elderly and health compromised people are most vulnerable to extreme weather and epidemics. The “harvesting effect” describes an event during which vulnerable people who would have likely died over the following months instead died “prematurely” during an extreme event. But mortality rates drop in the following months because the most vulnerable have already passed. Researchers have found because mortality rates fall during the months following a heat wave there is no long­‑term population effect. In contrast, cold snaps do have long-term effects as researchers found no such “harvesting effect”.

Although alarming models and media narratives suggest global warming causes more extreme heat waves, scientific data disagrees. As the EPA’s heat wave index illustrates (below), there has been no increase in heat waves as the worse heat waves happened during the 1930s.

Fortunately, heat waves are short‑lived and foreseeable. Weather forecasters detect approaching high-pressure systems that bring cloudless skies that increase solar heating. High pressure systems inhibit rising air currents that normally carry heat away. And high‑pressure systems draw warm tropical air poleward on one flank while blocking cooler air from moving south. By forecasting extreme heat waves, scientists believe we can prevent most heat wave deaths. Urban heat effects are 2°F to 10°F warmer than the countryside, thus urban dwellers should be most careful. And because elderly people who lack air conditioning are most vulnerable and less mobile, we can make sure they are moved out of harm’s way.

Jim Steele is Director emeritus of San Francisco State’s Sierra Nevada Field Campus and authored Landscapes and Cycles: An Environmentalist’s Journey to Climate Skepticism

Tuesday, March 10, 2020

Dissolving Dungeness?

Published in Pacifica Tribune March 8, 2020

What’s Natural

Dissolving Dungeness?

Like New England’s lobsters, savory Dungeness crabs are San Francisco and the northwest’s iconic seafood. While fisheries around the world have declined from overexploitation, Dungeness crabs have been sustainable despite intensive harvesting over the past 40 years.  Their resilience partly relies on mature females producing 1 to 2 million eggs each year. Thus, harvesting females commercially is illegal.

Unfortunately, few eggs survive to adulthood. Besides being preyed upon, early life stages (larvae) must survive being swept out to the open ocean and then return a few months later to shallow near-shore waters. The more larvae that survive that trip, the greater their abundance. But if the winds and currents prevent the larvae’s return, populations could crash as they did in the 1950s.

The successful return of Dungeness larvae largely depends on the strength and timing of upwelling currents. When eggs hatch, larvae rise to the surface and are then blown offshore. If larvae float into the California Current, they’re carried southward and further offshore. But below the California Current is the Undercurrent, transporting warmer waters northward. Northward currents also strengthen during winter.  By migrating daily between contrasting surface and deeper waters, larvae minimize being swept too far away. Then beginning around April, a strengthening California Current creates upwelling currents that carry larvae back towards the coast while larvae remaining in the open ocean die.

Upwelling currents also promote plankton blooms by bringing essential nutrients back into sunlit surface waters. Upwelling enables the entire marine food web to flourish. Larvae that settle in regions bathed by upwelling water, benefit from 10 times more food than elsewhere. Upwelling also increases the abundance of sardines and anchovies, but that causes a problem for crab fishermen.

Humpback whales feeding on anchovies are attracted to Dungeness fishing grounds. Recovering from past exploitation, larger whale populations are more likely to encounter crab trap buoy lines and deadly whale entanglements increased. So commercial crab fishermen agreed to further restrict fishing season to minimize overlap with feeding whales. Promising technological solutions to eliminate buoy lines are a work in progress.

In 2015, beneficial upwelling also enabled a bloom in plankton species producing domoic acid. Passing up the food chain, high doses of domoic acid cause neurological damage to birds and mammals. Detecting high domoic acid levels in crabs, public health agencies shut down the 2015 Dungeness season until the danger passed.  That was economically devastating for fishermen. Hoping to recoup their losses the Pacific Coast Federation of Fishermen’s Associations blamed climate change and sued 30 oil companies. But they are unlikely to win their lawsuit.

Outbreaks of domoic acid poisoning correlate with upwelling and natural ocean oscillations. The northward currents can bring additional domoic-acid-producing species into Dungeness habitat. Then with seasonal upwelling, their numbers explode. In 1961, a similar plankton bloom disoriented seabirds. Monterrey newspapers reported birds flying into buildings and people, inspiring Alfred Hitchcock to produce his iconic horror film “The Birds”.

Unfortunately, bad science also promotes media horror stories such as CNN’s headlines, “The Pacific Ocean is so Acidic that it's Dissolving Dungeness.” But in truth, ocean pH is far above 7.0; oceans are alkaline, not acidic.

Still NOAA’s West Coast Ocean Acidification program seeks worrisome examples of “acidification” and it was their researchers who prompted those horrific headlines. They found Dungeness larvae in off-shore waters (with a slightly higher pH) had smoother inner shells, versus larvae in near-shore waters (with a slightly lower pH) that had shells with patchy dissolution. The dissolution was invisible to the eye. Researchers had to remove the shells’ outer protective layer and examine the inner shell with scanning electron microscopes and various x-ray technologies to find microscopic “changes”. And despite a correlation with lower pH, the measured pH should not have caused any dissolution.

Dungeness larvae reaching near-shore waters are transported by the naturally low-pH upwelling currents. That upwelled water is derived from the Undercurrent, which is fed by waters originating in the deep Pacific Ocean. Those deep waters had not been exposed to our atmosphere for hundreds to thousands of years. Suggesting low-pH upwelled waters are worsened by “atmospheric carbon dioxide” was a false narrative. The lower pH and high nutrients are produced by hundreds of years of decaying organic matter.

When Dungeness larvae return to near-shore waters, they settle to the ocean floor and soon molt into their first juvenile shells. Larvae absorb minerals from their old shell to recycle into their new shell. That causes patches of dissolution. The researchers’ data from one near-shore location was discarded because pre-molt dissolution had clearly started as expected. Still and oddly, researchers blamed that observed pre-molt, but slightly less dissolution, on “ocean acidification” prompting endless media horror stories. What is never told is Dungeness larvae remaining offshore do not molt into juveniles, so would not be undergoing pre-molt dissolution. And despite their smoother shells, larvae remaining in offshore waters die.

Misleading science from researchers who are blinkered by their advocacy for an “ocean acidification crisis” is problematic. We need objective science, not “dissolving Dungeness” fear mongering.

Jim Steele is director emeritus of the Sierra Nevada Field Campus, SFSU and authored Landscapes and Cycles: An Environmentalist’s Journey to Climate Skepticism.