I don't follow the deliberate release into their own population to somehow make it spread to other places and then the US. WHy not just release it here if that's the case?

MORE INFORMATION ON ALCOHOL FOR DISINFECTING HANDS
 

DEF: Isopropyl alcohol (IUPAC name propan-2-ol; commonly called isopropanol or 2-propanol)

I'm still tracking the trail of primary reference sources. But I now think that the advice to use 60% alcohol became separated from the requirement to apply it for 3 minutes, and the requirement to use 1 Propanol. This is from a European standard for a surgeon to wash his hands. If he does not have soap & water, then use a specified type of alcohol & % -- but whether soap or alcohol, SCRUB FOR THREE MINUTES.

Then WHO created a paper teaching local/regional government how to produce alternative "hand rub formulations". They had "formulation I" and "formulation II" - one for 80% v/v Ethanol, the other for 75% v/v 2 Propanol aka Isopropanol. Note that they differ by 5%.

Then someone tested them, and found they did not meet the Euro standard, which is 1-Propanol 60%. They failed the 3-hours-later part of the standard.

So they suggested, and eventually WHO concurred, on a Modified formula. The difference is using w/v instead of v/v, but the confusing thing is it adds up to the same "percentage" number. And to extend the wet contact scrubbing from 3 to 5 minutes. And to omit or reduce the glycerol (glycerin).

There is another issue I am tracking down, related to exactly what was being tested. The early or original tests did not include SARS or MERS (done prior to those outbreaks). I have a paper mentioning that but have not digested it yet.

Also note that the study below shows Log10 reductions only on the order of 2 or 3. I'd like to see 4 or 5.

BOTTOM LINE: I have not yet found any primary reference that says 60% alcohol of any kind for a few seconds - ie Purel etc - is effective on SARS-CoV-2 (unofficially, HCoV-19). Especially since these "gel" formulations contain huge amounts "gunk" of various kinds as emoluents. Even 1.45% glycerin made the WHO formula fail.

https://www.researchgate.net/publica...d_Preparations

Modified World Health Organization Hand Rub Formulations Comply with European Efficacy Requirements for Preoperative Surgical Hand Preparations
Article (PDF Available) in Infection Control and Hospital Epidemiology 34(3):245-50
March 2013 
DOI: 10.1086/669528
Source: PubMed

Miranda Suchomel primary author

Abstract
Background. The World Health Organization (WHO) has published "Guidelines on Hand Hygiene in Health Care" recommending 2 hand rub formulations based on 80% vol/vol ethanol or 75% vol/vol isopropanol for local production in healthcare settings where commercial products are not available or are too expensive.

Previous investigations have shown that neither formulation meets the efficacy requirements of European norm (EN) 12791, which is the most stringent available norm for surgical hand rub preparations.

Even when modified with approximately 5% higher alcohol content, the formulations proved to be inferior to the reference of the norm when measured after 3 hours.

Objective.
Because the high glycerol content of the formulations was suspected to negatively influence their efficacy, additional investigations were performed with varying glycerol content.

Methods.
Modified formulations with higher alcohol concentration (mass instead of volume percentage) and lower glycerol concentration (0.725% instead of 1.45%) or without the addition of glycerol were evaluated for their conformity with the efficacy requirements of EN 12791, which demands noninferiority in comparison with a reference hand antisepsis procedure immediately and 3 hours after treatment on volunteers' hands.

Design.
Randomized Latin-square design.
Setting.
Microbiology laboratory of the Medical University of Vienna, Vienna, Austria.
Participants.
Twenty-five healthy volunteers.

Results.
Reducing the concentration of glycerol or omitting it completely rendered both WHO formulations noninferior to the reference, both immediately and 3 hours after surgical hand antisepsis.

Conclusions. Both WHO-recommended formulations meet the efficacy requirements of EN 12791 by increasing their alcohol concentrations by 5%, prolonging their application to 5 minutes and reducing the glycerol concentration to 0.725%.

So now I need the math to turn 75% v/v 2 Propanol aka Isopropanol, into 75% w/v.

What is 75% w/v expressed as % v/v, since weighing the liquid would be very tedious & most do not have an accurate enough scale?

humor
 

Q: Why is there a shortage of toilet paper?

A: Because every time one person sneezes, 50 people sh*t their pants.

A: Bear's are waking up from hybridization and we all know what they do in the woods.

One plausible line of thought... they didn't intend to target the world; just their own folks. But they simply fucked up and vastly under-estimated the potential for global contagion.

As late as early February 2020, China was still racked by "viral" anti-government protests. Of the like not seen since the days of the Cultural Revolution. The lion's share of media coverage focused on events in Hong Kong, but the movement had spread to something like 20 other major cities. So you had a regime in desperate straights vis-a-vis its perceived legitimacy with the citizenry, combined with unfavorable world news coverage, international opprobrium for its handling of dissenters, and (oh yeah) a burgeoning Islamic minority movement about to jump on the same protest bandwagon. The current Emperor & Mandarins were shitting themselves about four months ago. Worried about personal survival in the event of a likely near term Populist revolution (sometime later in 2020).

That worry (and it's previously round the clock world news cycle coverage) has abated. Nobody is paying any attention to it. It's done.

Some bright and nefarious actors might have looked for a solution to decisively end such a problem on the streets of China. One that didn't involve a hard military application of violence nationwide. One that could plausibly quash massed gatherings... and even make the government look good as it "responded". An ability to "disappear" certain targets during the widespread "natural" lethality may have just looked like icing on the cake. Bonus points. A solution to their problem that would appear to be natural in origin and (hopefully) disappear after the advent of spring/summer and warmer weather.

Enter an engineered bug that seemed to fit the bill and probably briefed well on Power Point. Probably sounded brilliant to some select and tiny group of Deciders desperately looking for a cure for their regime security woes.

What previously dire political protest movement is apparently not happening in China today? Rhetorical question.

Since the critter got released into the wild, everything else is just collateral damage. Including a self-inflicted major hit to China's economy and subsequent world-wide pandemic. The not-too-bright, but ruthless fuckers that would kill a percentage of their own population without a second's hesitation, probably didn't anticipate all the branches and sequels. But they were likely more concerned, back during the November/December time frame, with being eventually hung from lamp posts (Mussolini style).

As far as they are concerned, the positive outcomes for executing such a plot readily outweigh the bad:

1. Nationwide anti-regime protest growth stopped dead in its tracks.

2. Increased population control measures implemented/enforced without much bad press or incitement to open revolt. For as long as they deem necessary.

3. A winnowing of population that they can afford to lose (elderly, dissidents, Uighurs, etc.).

4. The means of delivery is operationally friendly to a clandestine release with little danger of ever being politically/legally/technically traceable. Very few witting participants in the actual physical part of the release (and those few loose ends easy to dispose of). No major logistical hurdles that couldn't be handled. The entire operation would theoretically need involve only a handful of people, at least one of whom had security access to a vial from a major bio lab... like the one in Wuhan. Plausible Deniability. No living witnesses to the deed. :rolleyes:

5. A major electoral torpedo delivered to the Trump Administration in the form of a Black Swan social/economic crisis event. Something that might fortuitously dispose of their least favorite geo-political nemesis. Probably not anticipated, but nevertheless advantageous.

6. Opportunity to extort certain nations (in terms of strategic deliveries of crucial exports like pharmaceutical precursors, rare earths, just-in-time finished medical export products, etc.). Quid Pro Quo concessions.

7. Opportunity to exploit economic/political fissures between other global alliances. Or to opportunistically destabilize certain regimes worldwide (from Africa to the EU). Never allow a good crisis to go to waste.

Numbers 1-4 would represent the Main Effort (regime survival), while numbers 5-7 would emerge as 2nd or 3rd order effects, predictable or not.

In aggregate, one way to look at possible origins for this bug, based upon a Cui Bono examination of events & outcomes.

-------------

Alternatively, the virus could have developed out of natural mutations (IMHO highly unlikely). The Wet Meat Market Theory. The whole world's salad getting tossed by a bowl of bat soup in Wuhan.

Or it could have escaped from a lab setting through simple human carelessness (or financial greed). Lazy lab protocols, careless employees, or just someone selling leftover lab animal carcasses at the market across the river. For a few extra Yuan to augment their paycheck. Never attribute to Malice that which can be readily explained by Human Stupidity. Maybe as likely as a nefarious plan. But after flipping a quarter between unintentional lab escape... or deliberate release...


I'm going with Chinese Regime Hail Mary Pass for $200 Alex.

ABC123

Russian, China, and Iran in less than a week present a direct threat, arguably coordinated, while also holding a duplicity of deniability. Two of the actions include the acceptance for the loss of life. Those incidents where loss of life is recorded occur in china as a deniable byproduct of zoonotic transfer in an outdoor market, covering the actual intent of releasing a 2nd novel virus with pandemic potential.

The 2nd virus corrected the deficiencies that the 1st SARS virus lacked. Released in Wuhan, layers the plausible denial for China’s leaders to argue, and later to lay elsewhere. The concept of state sponsored genocide is unthinkable for the West, but not for China. The strategy embraces the risk of unimageable loss of life, the goal to humble and hallow out America’s ability to defend/react, while China holds hostage the entire American/world financial system, offering the opportunity to complete China’s long term goal of reincorporating its ancestral rouge territories: Hong Kong Taiwan; consolidate influence and expansion in SEA locally and the whole of the Pacific generally.

Russia has similar interest looking west, where Russia goal is to control all of western & Central Europe via energy. While Iran plays the linchpin where Russia, China and Iran engage America in a war of attrition in the unresolvable ME, impacting the political situation in America’s primary Presidential election year.

Maximum pressure campaign by three ideologically aligned state actors. All possess mutual interest and seek Regional hegemony.

Their actions taken separately and together, painted with a broad-brush stroke, engage the Trump Administration by capitalizing on and encouraging through surrogates, the continued domestic political discord.

This is not a product of happenstance or coincidence. It is not by chance that Russia decides to up the ante to gauge response by flying a routine mission into AM/CA airspace, while the Administration is confronting pandemic hysteria and the accusation by China that America is responsible for the virus, mixed that opaque color with the MSM Propaganda charging incompetence and uncertainty, while Iran reenters the mix by attacking and killing Americans, a Red line crossed, confirming Iran also is willingly prepared for the loss of life in pursuit of its Regional ambition, is not accidentals.

Imo, this is not by chance, but by mutual interest that China, Russia, and Iran act, if not by formal verbal mutual consent and agreement, (Obama/Putin) but by understanding political opportunity, these three have capitalized with the understand that the enemy of my enemy is my friend philosophy.

Further, I suspect and have no faith that Kerry on his trip to Iran, acted in America’s best interest. Possibly encouraging these events, by explaining the possible outcome that would be mutually beneficial if Trump was not reelected in 2020.

Astronomy, I missed that, great assessment, thank you for the insightful lesson.

Edit to add: Thinking about this further, you are stating intent combined with unforeseen consequences. So the release was intentional and the release of the virus was a domestic solution that unraveled adversely.

If I missed someone else already mentioning this, I'll go ahead and apologize ahead of time. These articles provide a little insight as to how the Wu Flu showed up in Italy. The timeline for the Wu Flu emergence in Europe can be traced to the Chinese workforce returning from the home country after the lunar new year.

https://www.businessinsider.com/chin...s-2013-12?op=1
https://www.ecnmy.org/engage/prato-c...f-look-around/
https://www.nytimes.com/2019/12/05/b...far-right.html
https://fashionista.com/2013/02/as-m...in-italy-label https://www.bloomberg.com/news/artic...inese-illegals
https://www.english-online.at/news-a...e-in-italy.htm

Working nights so far this weekend has been, well, interesting. Now we have the ability to test but it's a 3 day turn around through LabCorp. Our facility is now taking it seriously. We're allowing only one visitor per patient and our director has purchased disposable Ventilators. I think we have 15 on hand now in addition to our current fleet with possibly more on order. Our department is responsible for all our PAPRs and we're in the process of obtaining more. They seem to be more effective than N95s. MAXAIR-systems are the ones we're using. All I can say is in three days we'll know what we're up against. Flatten the curve!

I see that disposable ventilators seem to be for short term use. Is there a strategy for choosing these or are they the only kind available? My very short reading about ARDS has me believing that patients are on them for a long time. The article talked about optimizing the ventilator settings -- not too deep a breath so you don't tear the tissue, etc.

Tyvek suits now a restricted item
 

My order with Graingers, made some time ago, was cancelled today for that reason.

My wife is upset that the things I have been talking about have happened.

Clinicians' Biosecurity News 3/13/20
 

The following is linked to in the 13MAR20 daily situation report from Johns Hopkins:
http://www.centerforhealthsecurity.o...rces/COVID-19/


Clinicians' Biosecurity News 3/13/20
http://www.centerforhealthsecurity.o...-03132020.html

Get Ready for a 1918-like Scenario

Eric Toner, MD | March 13, 2020

My colleagues and I just submitted to medRxiv a paper on what a Wuhan-like epidemic would do to US ICUs.

https://medrxiv.org/cgi/content/shor....09.20033241v1

The bottom line is that demand would far exceed capacity, and some people in need of critical care would not be able to get it. But it is not just Wuhan; Italy is currently in the midst of a similar outbreak, and critical care services are overwhelmed there, too.

The encouraging news, however, is that it seems that community mitigation strategies—such as isolating the sick, home quarantining the exposed, canceling mass gatherings, and social distancing—have worked to tamp down the height of the epidemic wave and therefore have kept the healthcare systems functional in other parts of China, Hong Kong, Singapore, South Korea, and Japan. But to be effective, these measures need to be vigorously implemented several weeks before hospitals become overwhelmed.

Applying Wuhan data to the average US city

SNIP

EDIT: FROM THE PREPRINT ITSELF:

...secondary transmission in the community continued as patients and their household contacts
moved between hospitals seeking care.

Exceeding healthcare capacity may also lead to decreased quality of care, such as not being
able to get access to a ventilator, which would lead to an increased case fatality ratio. By the
end of February, Wuhan’s case fatality ratio was 4.5%, 3.2% for the rest of Hubei province, and
for the rest of China, where healthcare capacity was not exceeded due to strong social
distancing and contact quarantine measures in the early phase of the epidemic (such as
Guangzhou), 0.8%.

In both Wuhan and Guangzhou, the lockdowns did not lead to immediate downturns in the
demand for hospitalization or the number of serious cases; rather, the peak in these measures
occurred approximately a month after the lockdown in Wuhan, and two weeks after the
lockdown in Guangzhou. This delay reflects the potentially long time from infection to severe
and critical conditions as many COVID-19 patients who eventually require ICU care present
initially as having only mild symptoms,14 and even longer time to discharge or death,15 resulting
in the accumulation of hospitalized cases long after the downturns in the community spread. In
Wuhan, the longer delay may also reflect the ongoing transmission after the lockdown described
above, which itself resulted from the overloading of the healthcare system.

It's my understanding that fortunately ventilation (co2) isn't the issue, it's just profound hypoxemic respiratory failure. The ones who require ventilatory support are on for at least 20-30 days. At ~100 bucks a pop and readily available, it's a simple procedure to take the patient off the vent and bag them with a peep valve while changing out the disposable vent. Shouldn't be an issue. If you happen to have access to a Facebook account, below is a link to a Doctor in Italy who is sharing the strategies that seem to be working for Ventilator patients. It appears proning seems to work well. His page is public.


Edited to add:

According to the Doc in Italy, the lung compliance never really gets that bad as it does with typical ARDS. That's a good thing because it won't take too high a pressure (if using pressure control ventilation) or too high a volume (SIMV or volume modes) to ventilate a patient. The lower the pressure, or volume, the less tissue damage.

https://m.facebook.com/story.php?sto...&ref=bookmarks

All you need is the density of IPA. If density is 1.0 g/ml then 75% IPA (v/v) is 75% w/v. If the density is 0.8g/ml then 75% IPA (v/v) is 60% IPA (w/v) and is the recommended concentration for use as a disinfectant. I guessed the density of IPA is 0.8 g/ml, but you can look that up to be exact. :p