Romania: the terminally ill recorded as dying from coronavirus?

A young woman from Ialomita reports her grandfather died with a broken hip bone and a lung tumor at the age of 77. He was reported as dying from coronavirus, which she vehemently denies. He has bedridden since February and the coronavirus cannot be the cause of death in this case and likely in many other of the reported cases. She questions what's gained from counting so many terminally ill patients as coronavirus cases. Like her grandfather, she suspects many have not even been tested. 

Romania's dead from/with COVID-19: aquiring the virus in the hospital?

A Romanian newspaper has published a list of all the people who died of coronavirus along with a brief description of their pre-existing conditions.

https://www.gandul.ro/stiri/coronavirus-13-noi-decese-provocate-de-coronavirus-au-fost-confirmate-bilantul-a-ajuns-la-65-in-romania-val-de-decese-in-spitalul-groazei-din-suceava-19413463

As expected from other sources, and seen in other countries, we see that most patients had serious pre-existing conditions that would have placed serious limitations on their life expectancy. The average age of the coronavirus deaths isn't vastly below Romanian life expectancy, but, surely, average life expectancy is based on the general population who has fewer health ailments. 

The virus is now spreading through hospitals. Many of the people who died acquired the infection in hospital. We have a cluster of 13 deaths in the Suceava hospital, perhaps along with a few thousand infections. Ironically, one of the dead patients appears to have been hospitalized for plastic surgery. 

The situation clearly calls into question the role of hospitals, doctors and the entire health care system throughout this pandemic. 

On one hand, doctors save lives. There is no doubt about it. Most severely ill patients have a higher chance to live in the hospital than at home. 

In a situation like this, however, when more and more hospitals are going to be full of coronavirus, the positive impact of medicine has to be carefully weighted against the negative impact of hospital-caused infection. Today, that's coronavirus infection, but in general, hospitals are dangerous places. 

Even for coronavirus patients with mild symptoms, going to a hospital is likely to reduce life expectancy through stress and hospital-acquired infections, other than coronavirus. 

It seems like only the really bad cases benefit from medical intervention. 

We must also not forget that really sick patients, with limited life expectancy otherwise, will not be treated. In the patients where treatment is refused, the hospital again has a negative impact on life expectancy, as such a refusal can be stressful and psychologically difficult for the patient. 

World War III: Aftermath

While the current pandemic event is not unprecedented, the political reaction to it is extraordinary. At no other time in history have we seen so many countries in such a short time switch from civilian to military rule and take drastic action. At no other time, since World War II have we had so many countries under military command. It is true that viruses pose extraordinary threat to mankind. The Spanish Flu pandemic from 1918 killed more people than the First World War that was raging at the time. And this wasn’t the only one. We have had less deadly pandemics since and even more deadly ones prior.  

Even though this virus is not deadly enough to justify this kind of action, it is a reasonable military exercise to see if we can stop it. The answer is clear. We can’t. Even Boris Johnson can’t protect himself from the virus. The Royal Family isn’t safe either. The transmission rate is too fast. A lot of tests come back positive all over the world. The virus has a good hold of humanity and is here to stay.

Now, we’ve mobilized the armies, we’ve seen we can’t do much … what next? Will it end? How? When? 

In the meantime, we lose life in several ways
   1. When closing borders and important sectors like agriculture in the spring and summer in a over a quarter of the world, the impact will go beyond financial loss and loss of quality of life. There will be lives lost due to the measures. But it's beyond my ability to compute this kind of death rate. So, I will continue by discussing the more obvious loss of life.

  2. People who die either because of the virus or because they cannot receive proper treatment since the medical system is overwhelmed. In Italy, the average death of COVID-19 victims is close to 80.  Average life expectancy is 82. Thus, the average victim loses, perhaps 2 years. Perhaps less since the people with pre-existing conditions and lower life expectancy are more likely to die. Also, note that all victims who die with COVID-19 in their system are labeled as COVID-19 victims, whether the virus was the actual cause of death or not. Since hospitals are infected, and cannot be effectively cleaned or closed at this time, people who go to the hospital are likely to get  COVID-19 if they do not already have immunity to it and those with pre-existent conditions are more likely to die.

   3. The quarantine is life lost one day at a time. If we keep 1000 people locked up for a bit over one month, we have lost 100 years. If one in 1000 people die, and that life is cut short by only 2 years, the quarantine is the main cost. Donald Trump seems to understand this. The rest of the world does not.

But can we predict some of the aftermath beyond obvious life loss?

— There is unemployment and there will be more. The recession has already begun.
— Governments are printing more and more money without connecting the money to action. They cannot take action because everything is in lockdown. So, there will be devaluation, which means everyone will pay for the lockdown by losing their savings and it will go beyond that. There is no easy way out. Germany's finance minister committed suicide when trying to cope with the economic fallout of the coronavirus. The situation is serious, and will go beyond financial loss. 

— In this period, it is much easier than normal to escalate to a classic military conflict, using guns. 

— The travel restrictions and other acts appear to be more politically motivated than to do with the virus. The world seems to be turning into a second China. This is worrisome to say the least.

— The United States will probably try to keep the quarantine short and get America back to work. This will minimize both financial damage and overall loss of life. US states refused to impose full lock-down measures and New York city refused to enter full lock-down.

-- Sweden has gone back on its quarantine measures while training people who lost their jobs to become hospital workers.  IF they succeed in standing up to the rest of the world, these countries will fare better in the end.

-- In Europe, I hope the borders won’t last long and we’ll soon be free to travel again. A lot of the freedom that we gained with the EU has disappeared overnight. It is very important to regain this freedom. Travel restrictions between EU countries with similar levels of infection don’t make any sense. Yet, they are in place. 

-- Eastern Europe is doing the quarantine in a way that’s too expensive: too few lives saved for too much trouble. All work contracts have ended. In Romania, everybody is unemployed, locked up in their own homes, and paid by the state at 75% of their pay-check. They have closed every sector including agriculture, while explaining how nothing will come in, and local farms will support people.  Borders are closing completely as of this week. They may end up having no quarantine at the peak of the epidemic, when it would truly help OR they may end up being too expensive to be kept in Europe after the mess is over -- if there will be an European Union when this is over.

Some civil liberties are probably lost forever. Governments will have more easy access to persona data, travel patterns, etc. This is a serious limitation to personal freedom. It an be used in both good ways and bad ways. 

Some bubbles burst. Real estate, stock markets, etc. When a commodity is priced in a way not backed by reality, it might come back to its real value. Or, frequently, to less. 

We will shop more online. Some stores will close forever. We’ll learn online and do bureaucracy online. This digital transition is permanent. 

Some Airlines failed. There will be higher cost for air travel if things return to normal.

Real Estate markets will change worldwide. Prime London Property that comes with very little space and a near certainty to achieve early exposure to COVID-19 may lose some value. Countryside land and homes that offer more space might increase in value. Who wants to be stuck again in a very small flat? This is probably going to happen worldwide. 

Past wars have been followed by baby booms. In World War II, we’ve had more additional lives that started due to the war than lives that ended in the war. Yes, World War II produced more lives than it ended. The population increased faster than before — both during and after he war. 

Given that birth rates throughout most of the world are below replacement level, a baby boom would be a very welcomed thing. Since in most of Europe, population halves every two generations or faster, a baby boom would be most welcomed. There’s no better thing than children to replace the old dead. Let’s hope Italians understand. 

From Russia With Love, the military has come to the rescue in Italy. It’s a beautiful gesture. The Russians are sending doctors and equipment to Italy, when, in a very short time, their own medical system will collapse and they will need this stuff. They are doing it at the expense of their own people, but, haven’t they always done that? Politically, it’s a great move. And, perhaps, by the time the peak of the epidemic arrives in Russia, the Russians doctors would have been infected with COVID-19 in Italy and recovered already. Thus, they’d be immune and able to do away with the need for some of the protection equipment in Russia. 

-- China has developed tools and technology to fight this virus at home. They’ve scaled up production capabilities and they will come to the rescue of the rest of the world. Sure, it will come at a price. Some will be paid now and some later by recognizing China’s place in the world in a different way than before. Let's hope this recognition will not come at the price of turning the rest of the world or parts of it into a second China like the quarantine measures are doing and keeping it so.

— In the United States, the virus made the press stop writing about the impeachment of Donald Trump. His chances to get reelected are much higher than in times of peace. It would be amazing to see military hospitals from China, Russia and Cuba come to the rescue when the American medical system collapses. 

— Russia might increase its influence in the world. Moldova, Ukraine may drift further away from Europe and the annexation of Crimea will no longer be discussed. As Europe loses power, they might annex other countries as well including parts of Eastern Europe.

— The developing world will likely not be very much affected by the virus, but they will be affected by the lock-down measures and these will cost lives. India and Africa are used to disease — many diseases more deadly than COVID-19. An illness that only kills the old and frail will be easily dealt with.  Most people will die at home, without respirators and tests. 

Lessons from the past and thoughts on the future

My great-grandmother from my father's side, Smaranda, was a survivor of the Spanish flu from the Focsani area. Mandita, as everyone called her, was 22 at the time. She was among the oldest children in her family and remembered it well. The pandemic had a death rate of about 3%. Almost every household had their dead.  Both her parents died of the Spanish Flu -- a few days apart from each other -- leaving behind 11 children. The youngest was a baby -- her name was Emma.

A lot of soldiers died in that pandemic. She blamed it partly on the war and the co-morbid conditions it left behind. Yes, they were young, but many had lived for years in conditions worse than the world's homeless have today. They had suffered from hunger, cold and thirst. They lived in trenches soaked up to their knees in water and sewage together with the rats and lice. Many had survived typhoid fever and various other diseases, which left imprints even on those who had the strongest constitutions. The older people were home, and had a higher chance of surviving the flu than the young soldiers -- all clumped together and all recovering from war. Her parents were not part of the survivors -- perhaps the strain of having 11 children and of working hard to raise them healthy at the expense of their own health played a role. These were times when there, often, was not enough for everyone.

After their parents died, the siblings moved to Galati to start over and took everyone along. They built a bar/shop there, which helped them all survive the aftermath of the pandemic. They lived because the economy moved on. Emma grew up and married a colonel in the Romanian army, who was later discriminated against by the communists. Then, she and her husband moved back with Mandita, who, throughout her life, continued to help the siblings in need. I was born towards the end of Mandita's life, and her last words were that she was glad her mother's name was passed on to me. Her name had been Ruxandra.

The flu did not stop the war -- the war stopped when the Xis and Putins and other leaders of the time agreed on new borders. Even during the pandemic, people continued to fight for freedom and dreamed of a time when their opinions mattered -- when there will be democracy.  In 1918, my great-grandfather from my mother's side was in prison. They first imprisoned my great-grandmother, Ana. Every day they would kill somebody from her village in front of her and let their blood run at her feet. Then they'd ask Ana "Tell us where he is!", and she'd answer "How, should I, a poor woman, know. He never tells me where he goes". He had been in a hidden attic of their home were she was taking him food. But once she was returned home, he gave himself up because he could not suffer the thought of having others die because of him. He was then imprisoned for more than a year in the cold together with other educated minds of the time who had favored the creation of Romania on a ship on the Danube river, and every day one of them would be shot in front of the others as they were told "another one of you will follow the next day, until you all perish". He did not die from the flu, and was eventually released -- many months after Romania formed. However, on that ship, he developed tuberculosis, which takes longer to kill. He returned home, and lived till 1928. This extra time allowed him to send his boys to school. My grandfather went to Berlin to study engineering -- he and his brothers left home in the years that followed to study in various corners of the world:  Teodor studied law in Paris, Ghedeon started by studying marine engineering in Livorno, and later switched to law and joined Teodor in Paris, and Mircea studied religion in Monaco. I still have some of the books they used to study from -- most of them, once the communism came, were used to light various fires by uneducated minds who hated education and all that it stood for. I also have some of my great-grandfather's notes from that time, but they were written in Hungarian and, unfortunately, I cannot read the language well enough to understand their meaning. His wife, Ana lived to 94 -- through both world wars and most of communism -- she frequently talked about their fight for freedom (first with her husband, and later with her children), decried communism, and hoped and prayed that future generations will be free. 

Today, we have given up the freedom that so many generations had fought for in over a quarter of the world in the name of a virus. This is the most documented pandemic the world has ever known. Yet, these decisions of giving up all freedom everywhere are unprecedented. They are, supposedly, based on apparent mortality rates, which are known to be wrong and on the idea that this halt will stop the virus from spreading, when it has already been shown it has a good grip on the population based on the large number of positive tests everywhere. We also know that, so far, the average age of those who died is within a few years of the life-expectancy of the countries they lived in. In spite of all this, all leaders from around the world have been given absolute power over their country and over their people in the hope that they will stop this pandemic without, of course, proving they had a plan -- other than stating that these measures will continue and become stricter "as needed" -- they first mentioned a few weeks, and now it might be a few months or longer. The stricter the measures, the more we vehemently applaud. In the same time, we acknowledge that, in times of peace, we would not have voted for most of these people to continue on. Nevertheless, we all wholeheartedly believe that all these leaders will give up this new-found power as soon as they are told to by scientists whom they have never listened to before -- in times of peace or war. Why have they never listened? because of their thirst for power, which they now have.

I am not a politician, and not even a "true" scientists any more. I am a woman and mother of three boys, who tell me Snow White is stupid -- how could she have not seen through the disguises of her step-mother? and not, once, but three times. They don't believe the latest version of the story where Snow lives happily ever after with the prince. They think 'in real life' she must have died and she deserved to do so for being so obviously wrong. Indeed, if one looks at versions of this story (and of most other bedtime stories), the earlier versions, do not have the happy ending. We fervently believe in happy endings today.

In the past, those who enforced measures who directly led to widespread death and destruction were part of "the ax" and those who applauded these measures were called "coada de topor" ("the tail of the ax";  those of you who have split wood know that an  ax cannot function well without a fairly long tail). Today, I cannot help, but wonder, are most people in the world part of such an ax tail? driven on by the media? I do not know the answer to these questions. Most of my educated friends think I am insane for being worried and faithfully believe everything will return to normal, and will be over soon -- yet, I am worried. Economies from over a quarter of the world  ground to a halt in exchange for promises of success in halting the pandemic. The various leaders have absolute power and no plan beyond stricter and stricter measures.  I see unprecedented loss of freedom, and predictions of hunger, theft and unprecedented problems from those who lived through life. So, yes, I worry that I am right and that they are right, and that this is the beginning of a tragedy that knows no bounds.

I have visions of my children and all my nieces and nephews and their children -- those who make it through this and some will because they are many and they are all over the world -- blaming me and telling me "how could you have had everything and given it all up? how could you be this stupid to give up our future for a bunch of lies? we thought nobody could be worse than Snow White, until we were old enough to understand what you and your generation did, how could you?" In the position I am in, all I can do is stay home, take care of my children, and my father, and write on my blog when they sleep -- and they slept late today. So, I am doing this, and then I will get up, and dress, and with help from my mother get through another day of caring for the children, their pets and for my father. She got up at five, went to bed past midnight, and is way ahead of me at doing real work. I simply wanted to explain my reasoning to my applauding friends who worry less and believe more.

Loss of life vs lives lost

In our society, one way in which we often go wrong is that we assign too much weight and importance to feelings and care too little about facts. This becomes obvious in how we handle the topic of death. We, as a society, think that the act of death is extremely important, but we care less about the life that’s lost through death.

Life is an exercise of changing the world. One day at a time, we exchange our lives for what we do. This is the value of life. What we do with every day we live. The books we write, the things that we discover, the lives we start, and the lives we change. For a scientist, like me, the value of life is changing the world through mathematics. For a writer, it is through the books they write.

In Italy, in the COVID-19 pandemic, the average age at death is close to 80 for coronavirus victims and 82 for the general population. Thus, on average, each victim loses perhaps two or three years of remaining life. Potentially, it’s even less, as, in each age group, the people with several pre-existing conditions have a lower life expectancy than average. Thus, the average 80 year old that dies today of the coronavirus would, most likely, have lived less than the country’s life expectancy of 82 years.

If one in 1000 people die, and the average age of death is 80, each person who dies loses years — typically the 81st and 82nd years of their lives. If in order to save those two years, we keep 1000 people in quarantine for a little over one month, we will be wasting 100 years worth of freedom for people of all ages for the sake of the two years, a good portion of which is end-of-life care. Is this the right thing to do? Would the grandparents choose to have this extra year of life in isolation? End in a plastic bag? No family? No children nearby? Does that time make such a difference? 

If life was thought to be truly valuable, shouldn't we be allowed to go on living our lives instead of being prisoners in our own homes at the whim of politicians who have suddenly found new power in becoming dictators?

Do we trust them to give us back our freedom, the freedom that generations fought so hard to achieve over hundreds of years and we just relinquished so willingly over a period few days? Do we trust them now when we did not trust them before this pandemic and would not have re-elected them?

Is it just a drill? Is this why we plunged the world in war?

Are we mad?

Do we just want war for other reasons?

Is this some brilliant plot that will result in splitting the world up, yet again at the whim of a few dictators and in the destruction of democracy?

What remains to be done

Each life lost has value and I am not trying to say otherwise. However, in these extreme circumstances, it might makes sense to have a fact-based assessment of life, its loss, the impact of the measures taken, and I (and the brilliant women who have helped me write these posts much better than I would have otherwise) believe in speaking up against public panic fostered by most of the mass media at the moment.

A lot of work still remains to be done for the scientific community. Once the epidemic is over and the dead can be counted, we will have to assess the true meaning of the virus for our societies. 

Many questions remain. Will my proposed 0.2% hypothesis be confirmed? Will the wheel of restricting everybody's lives be turned back? Will we be allowed and enabled to change the world again, each of us in one's very individual way? Once absolute power is given and dictatorships established, will it be relinquished? will this world ever look the same again?

Each of us is longing for the day when we can leave the house again without communicating to the government where we'll go and how long we'll be out. We all long for the day when we can use our passports, spread our wings and fly to change the world again.

From China with Love

Respiratory infections like colds and flus are caused by vast numbers of viruses. As viruses infect us all, they cause herd immunity and stop propagating. Usually, they do not completely disappear, but come back in new waves causing small number of infections. We have learned to live with colds and flus, albeit they are an important contributor to life lost to illness (sick leave, etc). 

When a new virus appears, nobody is immune. Thus, the virus is free to infect the entire population in a relatively short time. Even for a virus that is mild and causes serious illness only in very rare cases, infecting a vast number of people all at once will result in a spike in deaths and seriously ill patients. 

Every time a virus replicates, it can change its genetic code a little bit. Some of these random changes will give the virus interesting and useful abilities, like, for example, to infect a new species. If the new species is in close contact with the old host when the mutation occurs, the virus has the chance to jump. This is how the epidemic starts. 

For reasons I do not fully understand, China and South-East Asia seem to be a prolific ground for such jumps. Several new viruses have been tracked to this area and, most likely, many of the epidemics of the past also originated there. China and nearby nations have played no politically motivated role in this natural phenomena. 

It may well be that some cultural habits do play a role. For example, Chinese are more adventurous with their food. They are more likely to eat undercooked bat lungs, frog intestines or other delicacies. They are also more likely than many other nations to  cook and process these animals with bare hands and neglect scratches and bruises on the skin when doing so. On farms, people and animals often live together, with caregivers walking barefoot in excrement, blood, etc. While, for the individuals such habits can actually be healthy (fewer allergies, asthma or autoimmune disorders), the lifestyle may offer viruses an opportunity to adapt to humans. 

In the West, we eat factory farmed stuff. While not quite there yet, in principle, we tend towards a world where our food is formed of sterile clones of the same thing. All pigs are clones of the same pigs, all cows clones of the same cow, all chicken are clones of the same chicken and so on. In Romania, for example, the European Union has recently made it illegal for pigs to reproduce naturally. All porcine reproduction is to take place in EU standardized farms. In the past, when a farmer wanted piglets, he would call on a friend who owned a male pig and introduce him to his sow. The male would be walked through the village to the house of the female, where reproduction takes place or if the male was more valuable, the female would go to the house of the male and there was a price to be paid for the service to the owner of the male pig. This is now illegal. I do feel sorry for the pigs who have to reproduce through artificial insemination and for the farmers who have to pay, sometimes more than the cost of a pig for the insemination procedure. 

For viruses though, the disappearance of privately owned pet pigs that are occasionally eaten, might not be not great news. If the pig and the man do not stay nose - to snout, when the pig has a cold, he cannot pass it to the man. Most viruses cannot mutate from one species to another — but a few do. Recently, we have seen the avian flu (mutated from birds), the swine flu (mutated from pigs) and now the coronavirus. 

Modern pig farms where animals of nearly identical genetics are catered to by machines and very few people offer less opportunity for viruses to change species. If this is, overall, a good or a bad thing for humanity and nature, it is still to be debated. 

Anyway, the conclusion is that viruses change species. This often happens in China and they go on to spread around the world. 

== This isn’t the first time == 

Humanity has seen countless pandemics. The coronavirus pandemic is not the first pandemic and it will not be the last. This is, however, the most deadly pandemic since the Spanish Flu of 1918, and the best monitored. Due to recent advances in PCR (polymerase chain reaction), it has been more closely monitored. 

What is unusual, is that it appears we have understood this virus so well that we even know the market where it adapted to infect our species. The market in itself is not unusual for Asia. Animals are sold -- some dead, some alive in a mix of blood, sweat and excrement. People — salesmen and customers -- are in close contact with each other and the animals. The animals, in a state of stress and near death have weakened immune systems. This makes them more susceptible to human viruses. Perhaps, when human and animal viruses meet in the same organism, they can exchange some genes which can help them adapt to infect humans. This is a natural phenomena. 

The flu tends to cause multiple well observed epidemics. Coronaviruses, generally, gave 10-15% of colds. They were not well tracked before because the colds were not severe enough to warrant attention. The exceptions to the rule are MERS and SARS who are rather deadly and have been successfully stopped. 

The most famous flu epidemic is known as the Spanish Flu of 1918. It consisted of three different waves. This flu ended more lives than the first world war. This is what we are afraid of. Today’s coronavirus has a similar ability to spread, but it kills fewer people, and the average age of the dead in each country is so far within a few years of the life expectancy.

The Spanish flu was different. It killed mainly young adults. Pregnant women were particularly vulnerable, with some authors citing a mortality of about 70% among pregnant women, with a good fraction of survivors losing the baby.

Today, we have a flu vaccine. We did not have that in 1918. Various treatments have been tried, but it appears nothing worked. We were in a similar situation to what we seen now with COVID-19. We don’t have a cure. 

In 1918, the one thing that appeared to work was blood transfusions. Transfusing the blood of people who had recovered from the flu into newly infected patients would pass on to the recipient the antibodies of the donors, resulting in milder infection and better change of recovery. 

It is amazing that we are considering such barbaric treatment methods today. 

== To kill or not to kill? This is the question of viral evolution == 

Cold and flu viruses had been able to conquer the world long before planes and trains would help them travel fast. They’d go from house to house, from village to village, at the speed of a donkey or slower than a snail. Yet, sooner or later, the often end up taking over the world -- the whole world. 

Once a virus becomes adapted to humans, it continues to evolve. The virus “wants” to live and spread. It wants to colonize new hosts. For this, the old host has to be able to carry the virus to the new one. Thus, a virus who kills the host will not be very successful. The virus will go in the grave with its dead host and spread no further. However, a virus that causes mild illness allows its sick host to party and dance, to meet people and kiss friends and infects a lot more people. Thus, a less deadly virus will be more successful. 

If a mutation appears, making the virus less deadly, but not sufficiently different to be immune to the antibodies of the main viral population, the less deadly virus will spread more than the deadly version of the virus. Eventually, the deadly version will die out and the more mild one will take over the world — unless, maybe, an ever milder evolves. This is why, cold viruses that have infected humans for a long time don’t cause very serious illness. 

Evolution in the opposite direction is also possible, but not likely. It isn’t always easy for a virus not to kill. The natural thing for a virus to do is to multiply — an exponential process that can easily grow out of control, until all cells of the host have been killed. The host will die when only a relatively small fraction of its cells no longer work. Thus, the virus has to be very careful to not kill us. Usually, they do a pretty good job of being careful. 

== The role of globalization == 

In the past, at the start of an epidemic, the new virus would progress with relatively low speed. He’d move from house to house and from village to village, at most at the speed of a donkey. Usually, it might have been more like the speed of a snail, with many stops and breaks. This way, it would take a long time and many cycles of viral replication to go around the world. Along the way, the virus would learn to be gentle with its hosts, causing milder and milder illness as it went along. 

This gradual transition towards a more mild illness was seen in the Spanish Flu of 1918. People infected later fared better. 

We have seen a similar effect in Wuhan in 2020. In Wuhan, however, the more mild illness happened when the quarantine was imposed. It is thus possible that they were not caused by a viral mutation, but by the quarantine itself. People who go to work through wind and snow often develop more severe forms of the cold when infected. We have seen this in World War II. Adenoviruses, that usually cause nothing but mild colds, were responsible for many cases of pneumonia among young and healthy soldiers who were forces to live in cold and damp trenches for a long time. 

In the same way, overworked doctors are seen to have more severe forms of COVID-19 and have higher mortality rates. It is thus possible that Dr Li Wenliang who first discovered COVID-19 was not even killed on purpose by the Chinese police. He was only jailed — certainly a stressful experience. Just like soldiers in trench warfare who develop deadly pneumonia from a mild adenovirus, Dr Li Wenliang would be expected to develop a more severe form of pneumonia after a stint in jail than after a sunny holiday. Furthermore, upon release, the government issued the doctor with an apology and he was sent back to work, not on holiday. Most free men would not willingly work for a government that put them in jail for fake reasons. Statistically, these aspects would have certainly contributed to Dr Li Wenliang’s death even if he was not actively killed. 

The quarantine should help by making people stay home, thus decreasing the severity of the illness. It may be beneficial even if we don’t consider the effects on contagion. Considering that hospital care is very expensive, especially if it comes to using one of the respirators on very short supply, the productivity lost in the quarantine could be less than the cost of the hospital care that is saved as long as the quarantine period stops before the supply chains break in an irretrievable fashion.

Romania's 15th, 16th, 17th and 18th coronavirus deaths

-- 63 year old man from Neamt who died in the hospital in Iasi.

-- 70 year old woman from Suceava.

-- another 70 year old woman from Suceava.

-- 76 year old woman from Huedin who died in Cluj. 

All were suffering from co-morbid conditions that typically included both arterial hypertension and diabetes. 

Romanian's experts predict two peaks of the pandemic -- one before Easter towards the middle of April and one after Easter. The number of confirmed cases are around 1000, but those simply depend on the number of tests performed. They expect about 10, 000 cases by the end of the pandemic. They note that all the dead had co-morbid conditions that significantly increased the probability of pulmonary infection and ultimately death.

With Mihai's 0.2% estimate, if herd immunity is achieved when half of the population is infected, we should expect about 20 000 deaths. Since about 800 Romanians die from natural causes every day, some additional deaths spread over a period of two months might not be easily noticeable. Quarantine did start early, and the country is in complete lock-down. So, the numbers could be less. Up to now it seems that many hospitals are infected, which makes treating patients difficult because often doctors and nurses are placed in quarantine. It also makes patients with low immunity and co-morbid conditions more likely to get the diseases when going for their regular treatment.

A glimmer of truth from Russia

Never thought I'd live to see this, but Russia tells the truth as it is.

Their first patient with a positive coronavirus test died, but not because of the coronavirus. The cause of death was a blood clot. 

Congratulations, Russia! Tell it like it is. In the interest of humanity, dare to make the whole diagnostic public. 

In Romania, we didn't dare to go that far. Our first coronavirus death was announced a few days before the patient passed away. He was expected to die of metastatic cancer, and this was openly said, but he was falsely recorded as a coronavirus death.

It is one thing to die with coronavirus in the system and a very different thing to die because of the coronavirus.

Romania's 9th, 10th, 11th, 12th, 13th and 14th coronavirus deaths

-- 64 year old woman from Suceava died on Tuesday. She suffered from a number of pre-existent conditions including arterial hypertension, ischemic cardiopathy, and arterial fibrillation. She traveled in between 13th and 29th of February to the Mauritius Islands, Seychelles, and Dubai.

-- 74 year old man from Ialomita who died at the hospital in Bacau. He suffered from pre-existent conditions including obesity, arterial hypertension and chronic renal insufficiency.

-- 59 year old man from Suceava. Like all the other patients who died so far, he suffered from pre-existent conditions including cardiovascular diseases and diabetes. No known history of travel or of meeting known positive cases. 

-- 80 year old woman from Suceava.  Again, she was known to suffer from pre-existent conditions including cardiovascular diseases and diabetes. She is believed to be an internal case who did not travel. The hospital will be disinfected due to the large number of coronavirus cases including those among medical personnel.

-- 72 year old woman from Caras-Severin. She died at Hospital for Infectious Diseases in Timisoara after being transferred from the County Hospital in Resita. She had traveled to Spain (Madrid). She suffered from diabetes, atrial fibrillation and ischemic cardiomyopathy.
-- 52 year old man from Suceava. He suffered from obesity and is the youngest reported victim to date. The hospital is now closed because of the high number of infections among staff. The media reports that 52 of the medical personnel have now been confirmed positive to the coronavirus test. Some patients will be sent home to be supervised by family physicians for 14 days and the more severe cases will go to other hospitals.

ALL the 14 patients who died to date due to the coronavirus were known to have pre-existent conditions.

Starting today Romania enters total lock-down, which means people can only travel for work and to go shopping for food or medicine. People over the age of 65 can only go out of their homes between the hours 11:00 and 13:00. The army will supplement gendarmery and police force to enforce these measures. The Romanian army has about 70,000 active personnel, while the police only about 45,000 employes. The fines are between 100 and 5000 lei.

I wonder how many of the police, army or gendarmery will suffer from coronavirus and have more lethal infections because they are forced to work long hours. A lot of them are older, obese and have pre-existent conditions, too. The weather is not great either. It snowed today, but that should improve.

Italy slows down. Quarantine works.

The pandemic seems to be slowing down in Italy. It started to slow down some two weeks ago moving away from exponential increase. The numbers reported for coronavirus daily deaths have stayed below 800 for the past few days. 

Coronavirus Tests in Italy

Like WHO and, my former colleague, Werner Benger, who should write something for this blog, correctly point out, testing is crucial to understanding the pandemic and to having functional quarantine. In Lombardy, they started in February by doing 200 - 300 tests for every death. As the epidemic progressed and the system got overwhelmed, they could only test 20 people alive for every coffin. By this loose testing policy, Lombardy let many people free to spread the illness. And spread it did. By March 23, Lombardy lost 3776 people to COVID-19. Given Lombardy's population of 10 000 000, it means 0.038% of the citizens of the province lost their lives  to COVID-19. The apparent mortality rate, if we only consider the people tested, was a staggering 13%. The reported number of deaths is still below my death rate estimate of 0.2%. However, it is known that the number of deaths is under-reported. 

When quarantine worked

At the opposite end, is the city of Vo, where everyone was tested. There were positives before the very first clinical illness. No one died. 

Veneto had a more German approach. They tested vastly more. Compared to Lombardy, Veneto started doing 3 times more tests per capita when Veneto had one dead and Lombardy had 6. About a week later, Veneto had 2 deaths and Lombardy 55. On March 23, Lombardy reached 3776 deaths while Veneto only had 192.  Overall, Veneto used 70% more tests per capita and lost 40 times fewer people to COVID-19. 

In Lombardy today, nearly 60% of the tests are positive. In Veneto, only 11%, with an apparent mortality rate of 3.5%. A negative test can mean that
-- the patient has never been exposed to COVID-19
-- the patient has had the illness and is now healthy. People test negative when they leave the hospital.
-- there was an error with the swab.
We can distinguish between a person who has never been exposed to COVID-19 and one who has antibodies that protect them against this virus only when antibody tests become available. We will then be able to tell how many of us have had COVID-19, compute a true death-rate and determine whether quarantine is still needed.

Meanwhile, the discrepancy between Veneto and Lombardy showed that widespread and early detection surely makes a difference. If we fight something -- anything -- it sure helps to find the thing. That's what tests do.  If there is a silver lining, with nearly 60% of tests returning a positive, Lombardy should be done with COVID-19. Herd immunity should have been achieved and a second wave of COVID-19 is not expected (by me). Veneto and Vo, on the other hand, were able to contain the virus spread. So, as soon as the quarantine ends, the virus should come back. Unless they did some magic... 

In both Veneto and Lombardy, the deaths slow down. They still increase by about 10% each day -- but this is slow compared to the 30% a day increase that seems to be the norm in this epidemic. Thus, the peak should be near. 

Lombardy should expect a sharp drop in deaths after the peak is reached, whereas in Veneto it should continue burning slowly and coming back in new waves.

A note on Germany

A private clinic today offering tests to the general public for 150 Euro per test and reported that about 4-9% of the tests are positive. They test people who would not qualify for testing under the more strict criteria of state sponsored free tests. However, the down side is that some private tests may be more experimental and thus are less accurate than those approved by the government. 

If the numbers are correct, here too, the peak shouldn't be too far away. We should all be exposed and get over it. And then, we'll be finally free. Free to fly like a few weeks ago. 

Germany has also been seen a reduction in fatalities, which appeared too soon to be a result of the reduction in COVID-19 infections associated with the quarantine. 

Thus, it must be due to the fact that people in quarantine are less likely to die. Like with most illnesses, it is important that each person takes care of themselves. When they are home, they are less likely to be overworked and tired or to go out in the cold. Staying home in the first days of the illness before the symptoms appear seems to be associated with better outcome for COVID-19 and with a lower chance of complications and hospital admission.

World War III

A few months ago, the world was a conglomerate of passive states run by incompetent parliaments who were slow in taking any lasting decision, argued forever, and struggled to stay awake during meetings. Yet, this did not seem to matter to the average individual. Until a few days ago when all this changed, people were free to move, to work and to fly. They could be in any part of the world they wished to go. I loved that freedom. I had countless days where I'd wake up in the morning not knowing where I'd end up that very evening: Malta? London? Paris? Berlin? Vienna? Leipzig? Aarhus? They were all a few hours away. I could reach any of them in most days with just 100 Euro, if I'd wake up early in the morning to book my flight. 

I'd hear people complain that the middle seat in Ryanair wasn't comfortable enough or be annoyed when trains were late or the airport was a few hours away from the desired destination. But we all had that freedom to be anywhere, do anything, be anything. We had the freedom to be wherever we wanted to be -- to cross borders in the name of love, work, fun and life. 

In the name of the coronavirus, a cold that sometimes leads to viral pneumonia and becomes deadly, in the space of a few weeks, the free world has slipped into strict military rule. One by one, hours apart, countries did away with democracy and brought in military rule. New laws were passed overnight, and, in a few days, we, people who used to be free, find ourselves jailed in our own houses -- like common criminals.

The phone that makes me feel at home in London, Tel Aviv or Abu Dhabi -- the phone I used to beat the locals with in finding food or getting rides on uber is now about to be used to jail me. Like the rest of my family and all my friends, I am under house arrest, as if I had committed a crime. There is a two week jail sentence for crossing borders that I'd normally cross many times a week. 

Under wartime legislation, the governments have found new power -- the power to be heroes and save keep the people too busy with their own lives to hold them responsible for setting and not achieving impossible targets as Greta Thunberg put it, "fairy tales of eternal economic growth". 

The military rule is in. The dictators may find it hard to relinquish their newfound power and go back to inefficient decision making algorithms. Trump may not like to go back to not being impeached. Putin will never want to step down. Xi might want to take over the world. The war is raging and the gun have not yet been brought out. Will there be guns? Will they be brought out? While I hope a war where the world is split on a piece of napkin yet again like it was in the 1940s is still unlikely, I fear this more than any virus. 

Will there be a way out? will we be/are we too weak and to scared for any form of defence? We are all locked-in after all.

A group of people want to establish in the court of law that China is responsible for this pandemic. That China should pay. It is conceivable that a judge might rule against China and the newly found war powers brought in to make America Great and extend wartime dictatorship beyond this epidemic. 

America is no longer the world's strongest and largest economy. They do, however, have the largest and strongest guns. In the current state of emergency, the guns are easier to fire.  If the guns are brought in the game, there's nothing to challenge American supremacy. War would be a way to keep America Great. For a short while, as empires fall only from within. 

Without military escalation, America could look quite bad. They managed the pandemic way worse than China. In front of the virus, their democracy is inferior to China's dictatorship. The Chinese claim to have stopped it and are free, while the Americans may fail -- e.g., if the virus is kept back by quarantine and, as soon as quarantine is lifted, it comes back, keeping us forever prisoners into our own homes. 

When the French revolution came about, people could go to England and find shelter. After the iron curtain split Europe, people would find ways to go past it and be free. Now, it's unclear where freedom is. Before the escape route was clear if challenging to get to.

Sure, a brief quarantine will lower death rates and help medical systems cope. But will it end? and what will happen next?

I am scared and these are scary times. 

Romania's 4th, 5th, 6th, 7th and 8th Coronavirus Deaths

Romania's fourth and fifth coronavirus casualties were a woman (age 72) and a man (age 71) from Suceava. Both died at the county hospital in Suceava, and had pre-existent conditions: cardiovascular disease and diabetes. Neither traveled elsewhere or were known to meet people confirmed to be positive to the coronavirus test. It is possible that the two patients met while in the hospital. When the medical personnel was tested, 18 doctors and 9 nurses tested positive to the coronavirus. It was suggested that other hospitals routinely test their medical personnel because in some cases it may that the hospital staff and the hospitals are the ones infecting patients who come to receive treatment for chronic conditions, e.g., like dialysis.

The 6th person to die was a man of 64 years of age from Arad. He was a penticostal preacher who had be unwell for some time. His illness made him unable to preach or travel and so it is believed the coronavirus infection was local. It was reported that he had enough pre-existent conditions to make it difficult to tell that he had coronavirus until the day he died when the test came back positive.

The 7th person to due was a 65 year old man with kidney failure from Bucharest. He was in contact with another person confirmed positive to coronavirus and also suffering from kidney failure and in need of dialysis . 


The 8th person to die was a 70 year old man who died at the county hospital in Craiova. He was reported to be obese (second degree) and insulin dependent.  He had returned to Italy together with his daughter on March 7th. The daughter is still quarantine.


In the meantime, in Romania, pharmacies report running out of medication needed for chronically ill patients including diabetes and problems with the thyroid gland. Problems with obtaining medication have been predicted since the beginning of March since many of the substances come from abroad and some of the supply chains are broken. Over-shopping is also to blame for the depleting of the exiting stock. If the shortage continues, people will die from lack of treatment as consequence to the coronavirus outbreak and of the measures taken to stop it.

A cold or not a cold? What is a cold?

In humans, contagious viral upper respiratory tract infections are classed in two broad categories: the cold and the flu. 

The flu or Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 290,000 to 650,000 deaths. About 20% of unvaccinated children and 10% of unvaccinated adults are infected each year.^[14] In the northern and southern parts of the world, outbreaks occur mainly in the winter, while around the equator, outbreaks may occur at any time of the year.^[1] Death occurs mostly in high risk groups—the young, the old, and those with other health problems.

Each virus type is different. You don't get the same virus twice because of antibodies. At times, the flu can be deadly. The example most widely known is the Spanish Flu from 1918, which killed more people than the first world war. 

For Flu, we have vaccines -- each year a different one, as the viruses change. We also have some dedicated antiviral drugs like Tamiflu, etc. 

Common Colds are cased by hundreds of different viruses of several different types such as rhinoviruses, coronaviruses, adenoviruses,  human respiratory syncytial virus (HSV) and others. Colds are usually mild, but, on occasions, they can cause complications. The most common complication is a lower respiratory tract infection like bronchitis, bronchiolitis and pneumonia. Some cold viruses also play a surprising and interesting role in obesity.  There is no specific treatment and no vaccine. Therapy is usually just supportive -- keep the patient alive while the immune system solves the problem.

HSV causes pneumonia in children. It used to be a significant contributor to childhood mortality in the past. In western countries, high risk children are periodically injected with an antibody against HSV like palivizumab.

Adenoviruses cause about 5% of colds and may play a role in causing obesity after the cold has healed [2,3, 4]. 

Coronaviruses used to cause 10-15% of colds. It will be more this year, as COVID-19 joined the party and will probably infect a significant portion of the world population. 

There are 7 coronaviruses that infect humans:

1. Human coronavirus OC43 (HCoV-OC43)

2. Human coronavirus HKU1

3. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus)

4. Human coronavirus 229E (HCoV-229E)

– and three with symptoms that are potentially severe:

5. Middle East respiratory syndrome-related coronavirus (MERS-CoV), previously known as novel coronavirus 2012 and HCoV-EMC

6. Severe acute respiratory syndrome coronavirus (SARS-CoV or "SARS-classic")

7. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV or "novel coronavirus 2019". It is the cause of the  current COVID-19 pandemic. The virus is classed as potentially severe, albeit it is now clear that it is a lot less deadly than the other two. 

I thus rest my case. COVID-19 is a cold, just like the Spanish Flu was a flu. 

I have shown COVID-19 classifies as a cold, but this does not mean it's not deadly. However, if the mortality rate is of the order of 0.2% as I guess/estimate, it is not as bad as WHO fears. More tests have to be done to ascertain the mortality rate. Testing symptomatic people gives an apparent mortality that is much higher than the true mortality where all the asymptomatic cases are included.