Moon of Alabama Brecht quote
April 25, 2020

On The Coronavirus And Smoking, Infection Fatality Rates And More

On April 3 I had linked the chart below and remarked:

Interestingly smokers seem not to develop a cytokine storms during a Covid infection and are thereby less prone to end up in the ICU.

(A cytokine storm is an inappropriate inflammatory response by the immune system.)

Source - bigger

It was really curious that during a respiratory disease epidemic current and former smokers were less prone to end up in an ICU than people with other preconditions. (It was also a psychological relief for this chain smoking blogger but should be NO reason for anyone to start this otherwise dangerous habit.)

A French study has now confirmed this astonishing phenomenon:

In the study that two of us are reporting [1], the rates of current smoking remain below 5 % even when main confounders for tobacco consumption, i.e. age and sex, in- or outpatient status, were considered. Compared to the French general population, the Covid-19 population exhibited a significantly weaker current daily smoker rate by 80.3 % for outpatients and by 75.4 % for inpatients. Thus, current smoking status appears to be a protective factor against the infection by SARS-CoV-2.

The mechanism does not work through filling the lungs with smoke. Here nicotine works as a nerve agent. It is known to influence the process that regulates the number of ACE2 receptors on the cell surface. Current smokers do have less ACE2 receptors than non smokers. SARS-CoV-2 bonds to that receptor to enter a cell.

The study was led by Professor Jean-Pierre Changeux who is quite famous for his discovery of that general regulation process and other findings. He now plans to use nicotine patches on Covid-19 patients to see if it can help in current cases.


Other medications, especially those that U.S. President Donald Trump publicly pointed to, have proven to be rather worthless:

Financial Times @FinancialTimes - 19:00 UTC · Apr 23, 2020

Exclusive: The antiviral drug remdesivir, which many expected to be a good treatment against coronavirus, has flopped in its first randomised clinical trial, according to draft documents published accidentally by the WHO and seen by the FT

It turns out that study is already a month old and that Gilead, the company that sells remdesivir, had held it back while it continued to promote its useless drug. Someone at the WHO did not like that scheme and 'accidentally' published the results. Gilead's stock then took a 10% dive.

Trump also marketed hydroxychloroquine or chloroquine as helpful against Covid-19. But both can have severe side effects like abnormal heart rhythms and the FDA is now urgently warning against their use:

FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.
Close supervision is strongly recommended

Bret Stephens is one of the super dumb columnists of the New York Times. In today's column he argues for lifting the lockdowns and writes:

Right now, there’s a lot of commentary coming from talking heads (many of them in New York) about the danger of lifting lockdowns in places like Tennessee. Perhaps the commentary needs to move in the opposite direction. Tennesseeans are within their rights to return to a semblance of normal life while demanding longer restrictions on New Yorkers.

I write this from New York, so it’s an argument against my personal interest. But I don’t see why people living in a Nashville suburb should not be allowed to return to their jobs because people like me choose to live, travel and work in urban sardine cans.

Just yesterday the Tennessean reported this:

Nashville saw its highest single-day spike in COVID-19 cases Thursday when the Metro Public Health Department reported 182 new positive test results over the previous 24 hours.
In total, Metro health reported Thursday 2,144 confirmed cases in Davidson County since testing began, up from 1,962 the day before. There were 1,046 active cases Thursday, according to the department.

New York has done some blood testing for antibodies to SARS-CoV-2. These test are new and not yet very reliable:

The tests were particularly variable when looking for a transient antibody that comes up soon after infection, called IgM, and more consistent in identifying a subsequent antibody, called IgG, that may signal longer-term immunity.

Such tests should not be used to write "This person is immune" certificates. But they are good enough for epidemiological research.

The tests have found that some 20% of all people in New York City may already have had Covid-19 and have probably acquired some immunity. Considering the number of Covid-19 death in New York this points to an infection fatality rate (IFR) of ~1%. The infection fatality rate is heavily dependent on population demographics and the health care system.

Christian Drosten, a famous German coronavirus specialist (see his latest interview in German), has estimated the current IFR in Germany to be about 0.53. But the German number is now steadily increasing. The Covid-19 epidemic in Germany first appeared in young to medium age people who were infected during skiing and partying in Austria and Italy. It further developed within that age group and is only now entering assisted living and elderly care centers where it tends to wreak havoc. The IFR will therefore increase and we do yet know where it will end up.

New York City and Germany have well developed health care systems. Countries with less reliable systems are likely to see much higher IFRs of 2-3+%.

For the quite bad flu season of 2017-18 the CDC estimated 45 million infections which in total caused some 61,000 deaths. That gives an IFR of 0.13% for the flu which again proves the point that Covid-19 is not like one. The seasonal flue has an R0 of 1.2. SARS-CoV-2's R0 is 2 to 3. The virus is at least two times more infectious than the flu, only few have immunity against it and even in well developed countries Covid-19 is 4 to 8 times more deadly than the flu. We can thereby expect that the total death rate from Covid-19 will be 10-15 times higher than the number of deaths caused by the seasonal flu during a bad year.

Our health care systems are sized to keep up with a bad flu plus the other usual cases. They are not sized to take ten times the flu cases plus the other ones. It is therefore obvious that social distancing will have to continue.


A non-scientific study by Quillette has looked a super spreading events during which dozens or hundreds were infected at one time in one place. The result in short is that everything that is fun should now be prohibited:

When do COVID-19 SSEs happen? Based on the list I’ve assembled, the short answer is: Wherever and whenever people are up in each other’s faces, laughing, shouting, cheering, sobbing, singing, greeting, and praying.

A Chinese study found that more that 99% of all infections happen indoor:

Home outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport (108; 34.0%; note that many outbreaks involved more than one venue category). Most home outbreaks involved three to five cases. We identified only a single outbreak in an outdoor environment, which involved two cases. Conclusions: All identified outbreaks of three or more cases occurred in an indoor environment, which confirms that sharing indoor space is a major SARS-CoV-2 infection risk.

The results may be skewed a bit as the Wuhan outbreak happened during the cold season in December to February. We can expect a slight relief during summer when more people open windows or are outside. But the next cold season will likely be the most difficult time for everyone.

I had earlier pointed out that the Chinese authorities stopped the home outbreaks by isolating the mildly sick and even people who had only had contact with a Covid-19 patient in special quarantine centers instead of leaving them at home with their families. That I urged to do similar here was the starting point of my conflict with Off-Guardian.

Italy now finds that the Chinese method is the right thing to do:

Italian households represent “the biggest reservoir of infections,” said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases “the possible restarting point of the epidemic in case of a reopening.”

The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. “This is a ticking time bomb,” he said.

The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighborhoods of Rome and Milan.

Letting infected persons stay with their family is a great method to kill whole families and to help the the epidemic continue its course.

A two week quarantine in a hotel or public facility during which one is well provided for should be an acceptable sacrifice when it is know that it helps to save the lifes of others in one's community. It is hard to understand why some people continue to reject this.

Posted by b on April 25, 2020 at 19:00 UTC | Permalink

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"... But public health officials do not have the last word on destroying an economy and the lives, literally and figuratively, of working-class Americans and small-business owners who are the driving force behind job creation." fairleft@190

What you, and the people who DeVos and the Kochs are funding, are talking about are the petit bourgeoisie on the sidelines as the working class has been attacked for generations.
Now it is their turn: they need the help of society in this emergency. And their first moves? To lay off workers most of them at or around minimum wage levels.
The interest of working class Americans is to have a decent social security and unemployment system, a proper welfare safety net, the guaranteed right to organise themselves collectively, a rent and debt collection moratorium, a repatriation of industry and a break up of the land monopolies.
The current crisis benefits workers in the long run by undermining both the theory and practise of capitalism. It puts the onus on them to transform society. But there is nothing new about this- global warming makes it even more imperative that the system be changed.
You are calling for a restoration of a headlong career to imminent disaster and large scale extinction.

Posted by: bevin | Apr 28 2020 18:56 utc | 201

Worthwhile article on Off-Guardian:
"The Seven-Step Path from Pandemic to Totalitarianism. There are just seven steps from pandemic declaration to permanent totalitarianism – and many jurisdictions are about to start Step 5"

One has to be impressed with all the prior work and preparation that clearly has gone into this global project. And there is so much more to look forward to. #StayFrightened, #StayHome!

Posted by: Leser | Apr 29 2020 7:00 utc | 202

A well-reasoned argument comparing the measures and results in various countries. The author's conclusio:

"We don’t need to have a national debate about whether the economic costs of lockdowns outweigh their public health benefits, because lockdowns do not provide public health benefits."

Posted by: Leser | Apr 29 2020 7:45 utc | 203

Much of what is absent in b's perspective on Covid-19 policy and in the discussion here generally is lack of common sense about what is possible in one of the many neoliberal countries that has allowed this very infectious virus -- very deadly only for over-60s and/or over-70s -- to infect 10+% of its population. The correct general response to that is a careful, age-sensitive herd immunity strategy. But tragically, you will be labeled a baby Hitler by both the mainstream and 'left alternative' media if you 'openly' advocate this obviously best policy for countries in the dilemma I've described.

The article below is by far the best summary of this perspective. It lays out, way better than I could, the public health and scientific support for the position and what needs to be done. (But the author is some hack from Harbart Medicine School, which I've never heard of.) I strongly recommend reading the entire article not just the quoted material below.

Delaying herd immunity is costing livesBy Martin Kulldorff, professor of medicine at Harvard Medical School

... "Anti-vaxxers do not suffer the consequences of their beliefs, as they are protected by the herd immunity generated by the rest of us. Neither will the anti-herders, many of whom can afford to isolate themselves from Covid-19 until natural herd immunity is achieved by others. It is older and working-class people that disproportionately suffer from the current approach, becoming infected and thereby indirectly protecting much lower-risk college students and young professionals who are working from home.

"The current one-size-fits-all lockdown approach is leading to unnecessary deaths. Protecting older people and other high-risk groups will be logistically and politically more difficult than isolating the young by closing schools and universities. But we must change course if we want to reduce suffering and save lives."

Posted by: fairleft | Apr 29 2020 13:54 utc | 204

bevin at 203:

You start with a classic 'Trump Derangement Syndrome' move by classifying what I advocate as part of what Trump allies are doing and therefore automatically canceled, unthinkable and bad. But guilt by association is not an argument and I could care less about who shares or hates my position. Your mind and specifically your position on Covid-19 policy may have been subsumed within the deep state 'anti-Trump' hive mind that dominates all of mainstream media except FoxNews, and almost all of 'alternative' media. Not a good place for a real leftist to be.

Specifically, you say, "what you [and scary Trump people] are talking about are the petit bourgeoisie on the sidelines as the working class has been attacked for generations." No, I'm talking about the working class not starving to death under a bridge, under the actual political reality that exists in the US in mid-2020.

"Now it is their turn: they need the help of society in this emergency. And their first moves? To lay off workers most of them at or around minimum wage levels." Yes, that's right. What can we do about that in the actual real political world, so the working class doesn't suffer mass poverty and homelessness over the next 6-9 months of severe economic depression caused by lockdown or near lockdown conditions? I think we should get back to work if that can be done relatively safely.

"The interest of working class Americans is to have a decent social security and unemployment system, a proper welfare safety net, the guaranteed right to organise themselves collectively, a rent and debt collection moratorium, a repatriation of industry and a break up of the land monopolies." Yes, right. But you don't seriously think the working class will achieve that over the next year or so? The US Congress is entirely controlled by neoliberals. The $5-6 trillion giveaway to the oligarchs was unanimously approved.

"The current crisis benefits workers in the long run..." You don't know that! Reality points the opposite direction, and there are horrible consequences for workers if you're wrong. With that one sentence you show yourself to be an irresponsible pie in the sky fantasist who advocates between the lines mass death and poverty and homelessness, in the thin hope that massive socio-economic pain for the bottom half causes a leftist revolution instead of a rightist one. I think that's the wrong approach.

Posted by: fairleft | Apr 29 2020 14:07 utc | 205

fairleft @Apr29 13:54

what is possible in ... neo-liberal countries

You're only talking about neo-liberalism because of my comment @Apr28 15:29.

The correct general response ...

The correct response is OUTRAGE. Which has been noticeably lacking from your evidently fake concerns for the working class.

That link to a Harvard Professor is a joke. Of course he will support the establishment position with absolutely no rebuke. Was no one from a US Army weapons lab or NED-funded NGO available for comment?

And I'm now convinced that 'herd immunity' has been the plan all along. Trump's delay and minimizing of the new virus - with no objection from public health officials(!) - and his buddy BoJo's "take it on the chin" indicate that this is so.

We don't have to stop fighting this new virus that we are still learning about.

We just need a different approach to fighting it. South Korea, New Zealand, Iceland, and others have been effective at fighting the virus with a 'virus suppression' that includes massive testing, early treatment, and contact tracing. These countries never had lock-downs or had a very short lock-down.

IMO The major problem with changing the approach is that Big Pharma's campaign for 'herd immunity'. They could lose billions of dollars of potential profits from treating old people with expensive and/or experimental drugs.

Stocks Surge As Fauci Praises Remdesivir, Talks Down Lancet Findings


Posted by: Jackrabbit | Apr 29 2020 16:12 utc | 206

good post

Posted by: good | May 5 2020 7:41 utc | 207

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