When to use a mask
12 Dr. Hiroshi Nishiura is one of the few professionals of mathematical models of infectious diseases in Japan, and it is well known that his ability is outstanding. However, many people don't understand mathematical models themselves (I must confess that I can't say that I understand all of the findings because I'm not a professional of mathematical models either), so his findings and comments are easily deified. Because the contents of the mathematical model are a complete black box to many people, it makes it seem like the oracle is coming out like a shrine's oracle. Much of Japan's infection control policy relies on the Nishiura theory. So there is nothing wrong with that, but one of the problems in Japan is that there is no plan B in case plan A goes bust. Dr. Nishiura is an excellent scholar. It is not God. Hence the need to have that Plan B with the possibility of making a mistake. I am greatly concerned that bureaucrats and politicians who are prone to infallibilism will mistake science for an oracle. It is only when falsifiability is assured that science can continue to be scientific.
Mathematical models are the product of deductive methods. The deductive method is complemented by the inductive or abduction method, which is the basis of scholarship and the common sense of clinical medicine. It's a common occurrence in this industry that no matter how deducibly correct it may seem, it's actually not true. Even a huge intellect like Hegel or Marx can make a mistake by deduction alone.
I'm not saying don't use the model at all. I myself write a paper using a model. However, the model is not infallible, there are assumptions that are assumptions, and the assumptions are often wrong. Making use of Gram's stain means having full knowledge of what Gram's stain cannot do and does not understand, and Gram's stain cannot be used by Gram's stain universalists. It's the same thing. Mathematical models are also utilized in the UK, which is why Brits are very sceptical of their conclusions, and there are always counter-arguments and objections. It is a sound and scientific attitude.
15 Japan's "now" is a well-controlled state of infection, which is much better than Wuhan at its worst, or Italy, Spain, France, England, or New York at the present time. The problem is that it doesn't guarantee that it will "always work".
It is Tokyo that is of concern. The increase in reports of infection is not the only problem. The problem is that more and more infected people are unable to form clusters and cannot be traced. And the number of tests is much lower than that number of positive cases; it's too little that they only tested less than 100 people (the date of testing for the positives is unknown, but it's probably around here) to capture 47 infected people.
Again, it's not necessary to figure out all the infected people. However, it is troubling that the flow of infection, movement and clusters are out of sight. Therefore, the threshold for testing must be lowered in Tokyo. The threshold for testing varies with the circumstances. That's what I explained with the Korean example. Sticking to the Ministry of Health, Labour and Welfare's "standards" will lead to a misunderstanding of the phenomenon itself. Already in the Kansai region, infected people have been found with taste and smell abnormalities, and clusters have been detected from there. I would like to make more use of the athletic sensibilities of these clinicians. I'm not sure "where" in Tokyo is the barrier to lowering the number of inspections, but that barrier needs to be removed immediately.
17 This conceptual diagram that everyone is looking at - lowering the peak of the infection and shifting it to the side. This is all a product of deduction, and I don't know if it's really true. As mentioned above, the UK estimates already suggest that this is not enough. It is possible that the damage that was shifted to the side could simply be "extra-long damage".
And this is the key point: the idea of lowering the peak should not become the notion that the peak must be lowered, or the belief that the peak must be lowered, or the self-implication that the peak is not happening. In a pattern of Japanese failure to stick to Plan A, Diamond Princess allowed no-guard disembarkation by changing "secondary infection should not occur" to "it can't have happened". We need to keep our eyes on reality so that "peak shouldn't happen" doesn't become "I don't want to see a peak. Even if it is an inconvenient truth that we don't want to see.
19 Repeatedly. It's common knowledge in this industry that deductive methods are complemented by inductive methods. Nevertheless, PCR is often false-negative and has little power to determine the status of infection. That's why "testing everything" is so wrong. However, a serum test measuring immunoglobulin IgM and IgG would provide a more accurate picture of the "status of infection in the population. This, however, is not infallible. It is difficult to use for individual cases because it misses early infection, which is why it misses early HIV infection.Whether antibody testing is useful in individual cases remains to be tested, but it is well suited for epidemiological studies on a population basis. Roughly speaking, we can confirm whether the "infection is rampant" in Tokyo right now, or whether it's just an unfounded fear.
As a precedent, serology tests in London showed that the 2009 pandemic flu was 10 times more likely than previously predicted. Antibody testing is often performed after an outbreak, but now is a good time to examine COVID-19, which is becoming a chronic pandemic.
The UK is even more aggressive. The idea is to test for antibodies at home, and if they are found to be infected, they will use it as a basis for self-isolation at home. That strategy is flawed because with the lockdown in place, a negative test does not mean "no self-sequestration". However, the idea is that we want to control the infection as a whole, and I think it is worth considering.
Inductive legal confirmation of how many infections are occurring in Tokyo is necessary and useful. I'm not a prophet, so I don't know what the outcome will be.However, no matter what the outcome, scientists need to accept it and not hesitate to change their thesis and move on to Plan B in some cases. Scientists have to be coherent in their inconsistencies.They may not be coherent in form, but they must be coherent in principles and professionalism. Good faith in the facts.
1 Most of what I'm about to write is no different from what I've said and done in the past. However, I have been asked the same question repeatedly, so I would like to reiterate it. We have received many inquiries from overseas as well, so we should have prepared the same content in English, but due to time constraints, I'm afraid I'll have to skip it. This article is designed to be read without basic knowledge of infectious diseases and jargon, but it is rather difficult to understand. Please forgive me for that.
2 The fact that the number of COVID-19 reports in Japan is very low compared to other countries is attracting attention from home and abroad. Is it true? It has been pointed out that the number of tests is so small that we may be misreading the actual number of infected people.
3 However, this point is wrong at various layers. In the first place, Japan does not aim to capture all the numbers of COVID-19. Whether it's administrative testing or insured care, the state basically has a testing strategy in mind to diagnose, hospitalize, and isolate critically ill patients who need to be hospitalized. It is natural that they "haven't figured it out" and they don't intend to. That's not a bad thing.In fact, the situation is the same in every country, large or small, and no country, whether in the United States, Europe, or Asia, is aiming to "capture the whole number.
The WHO is not asking for such a thing. But instead, Japan gives PCR to asymptomatic returnees and isolates asymptomatic test-positive people in hospital (wasn't it home for people with minor illnesses?). It has not been coherent in its principles. So, people get anxious because "we're not sure what they want to do". It's a failure in the press.
4 The difference between Korea and Japan is the "result" and not the "purpose". In South Korea, where the number of infected people had surged in one place, we had to focus on inspections in and around the area. If such a phenomenon (let's call it an overshoot) occurs in Japan, the number of inspections will increase. When the situation is different, arguing only on the basis of the number of tests without observing the situation is like trying to say, "That team made 50 sliding tackles while this team made only one," without watching a football game. In games where you don't have to slide (e.g., when you're in possession the whole time), even 0 times isn't a "mistake," and of course 50 times isn't a mistake.
There are many diseases for which the total number of patients is not known. In Japan, we do not have a "total" number of influenza cases, but only a fixed-point observation. Because that's enough information, both epidemiologically and in terms of infection control. There is no accurate data on how many cases of the common cold occur each year in Japan. It's also a mistake to say that you can tell by looking at the receipt data, because many cold patients (like me) don't see a doctor and wait until they are cured naturally. Not only in medicine, but also in economics and political science, data are mostly based on sampling to estimate population numbers, and "whole numbers" is an inefficient way of grasping the situation.
6 We have not seen the devastation in Japan as in Italy, Spain or New York City. There is no medical collapse in a critically ill patient, no use of the operating room as an ICU, no piling up of bodies on a skating rink with no place to put them. Even if the "numbers" are not known, it is a fact that the current situation in Japan (including Tokyo) is much better controlled than in other countries.
7 Even so, you may be interested in "Well, what about the actual situation? There are estimates. For example, Dr. Hiroshi Nishiura and his group estimate that the number of mild illnesses in Japan may be twice the reported number. The catch rate is 0.44, with a 95% confidence interval of 0.37-0.50.
8 Although the study was based on data from China, there is no guarantee that the Chinese COVID-19 demographic is the same as the Japanese one. Also, since the original study did not include asymptomatic patients or those with minor illnesses that did not require hospitalization, the number of infected patients estimated on that basis would inevitably be an underestimate. If you are more paranoid, it's not unreasonable to believe that "the Japanese and Chinese viruses are different because of the mutation" (although I don't think so).
9 This does not diminish the value of the paper itself. The model must always use existing parameters, and it is often impossible to prove the external validity of these parameters. If the underlying parameters are not reasonable, the predictions will not be correct. A model assumes a simplified world insofar as it is a model. A model without simplification, which is an adjectival contradiction.
To complain about these "assumptions" of the mathematical model is like complaining, for example, "You can't explain disease B," when a randomized controlled trial is conducted for disease A. This is a meaningless tirade against the honor of the industry.
A mathematical model that assumes a certain hypothesis should have internal academic validity, but it is the responsibility of the reader, as a resident of the real world, to appraise it in the real world.
Just as the RCT findings for disease A should not be used for disease B, it is natural to understand the limitations of the mathematical model and to be careful when applying it to the real world. For example, it would be wrong to read the paper and conclude that the total number of infected people in Tokyo is about 500 as of March 26.
11 People make mistakes. The models are also wrong. Being wrong is not a big deal. The problem is to notice your mistakes and make corrections. Already, a group at Imperial College London has admitted that its original estimate that the peak of the infection should be moderated was "wrong" and has revised its prediction that the ICU will soon fail if it does not fight the virus fairly aggressively.
16 March 2020
If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too. [NOTE: WHO recommends testing contacts of confirmed cases only if they show symptoms of COVID-19]
Washing your hands will help to reduce your risk of infection. But it’s also an act of solidarity because it reduces the risk you will infect others in your community and around the world. Do it for yourself, do it for others.
This afternoon WHO and the International Chamber of Commerce issued a joint call to action to the global business community. The ICC will send regular advice to its network of more than 45 million businesses, to protect their workers, customers and local communities, and to support the production and distribution of essential supplies.
Like me, I’m sure you have been touched by the videos of people applauding health workers from their balconies, or the stories of people offering to do grocery shopping for older people in their community.
This amazing spirit of human solidarity must become even more infectious than the virus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before.
質問: Do you think of the problem that you saw on the ship originated from was it because of the bad examples of a scientific decision making in terms of the crisis management that was happening on the ship?
答え: The simple answer is the lack of CDC as I said before. Why the situation inside that cruise ship had an inadequate infection prevention? I think (this) is because of the lack of principle. The infection prevention is a principle, and the principle will lead to the procedure not the other way around.
The principle will never be given by the bureaucrats, because they never had infection prevention training, they don't have an experience, and they don't have a system. CDC has should have all of these.
答え：For CDC, you need to have a concrete, separate, independent system among experts who can make a dicision in responding to these infectious disease epidemics. This has to be proffesional, they need to have an authority, they need to have an autonomy, and they need to have a clear independence. There should not be any cross-cutting from anybody from the backyard, because I've seen many things that are decided behind the scene.
何度か繰り返していますが治癒証明や退院基準に検査陰性２回のルールは今すぐ改め、退院後の自宅療養期間など時間を根拠にしたほうがいいです。検査はウイルスの非存在を証明しませんし検査キットや人員を枯渇させます。皆の納得安心ではなく論理、合理、科学、そしてサステイナビリティを根拠にすべき— 岩田健太郎 Kentaro Iwata (@georgebest1969) February 21, 2020
消毒スペースがきれいか汚いかの区別がついていないから、防護衣が意味があるのかないのかも分からない。レッドなら意味があり、レッドから防護衣着てグリーンに入ると防護衣が感染を広めてしまう。自衛隊の落ち度ではありません。こういうのはプロが教えてあげないと。 https://t.co/kcO0X7fYCj— 岩田健太郎 Kentaro Iwata (@georgebest1969) February 18, 2020
今日、厚労省のSBさんに言ったこと。「無症候者のPCRは検査の無駄遣いです。すぐに止めるべきです」SBさん「でも、周囲が納得しない」。周囲の納得を科学に優先させるから子宮頸がんも無視状態になったのです。そして誤ったPCR解釈を根拠にCOVID感染は更に広がる。誰も責任を取らない。— 岩田健太郎 Kentaro Iwata (@georgebest1969) February 18, 2020
使い捨てマスクは理論的には1回しか使用できないため、ご家族のために産業用マスク/防毒マスクを準備する必要があります。それは冗談ではありません。中国では、防毒マスクさえ売り切れました。 3M HF-52マスク、3M 6500および7500シリーズのマスクをお勧めします。呼吸器用に十分なn95フィルターを購入することを忘れないでください。 p100フィルターも優れています。 n95マスクが完全に売り切れた後、家族のために4つのマスクを購入しました。
I'm a Chinese. I have been gathering information about the coronavirus from the Chinese internet. Here I share some measures that can protect you from the new coronavirus. It may save your life. I know that many foreigners think the new coronavirus is just some kind of flu. However, it's not the truth. The death rate is much higher than the flu. The death rate outside of HuBei province is low because we have taken extreme and strong measures to cut off the virus spreading. When the infected population rises rapidly, the local medical system will breakdown in a short time. The hospitals will be full of fever patients who have breathing difficulties, and the shortage of medical resources will cause huge casualties. This is what happening in WuHan now. China has sent thousands of doctors to Wuhan and built two new hospitals in just one week, and prepared many quarantine centers. BUT it's still not enough now.
First, personal equipment is extremely important. The n95 masks have been sold out for a long time in China now. Keep in mind that China has the largest surgical mask manufacturing industry. Please buy them as many as possible now, no matter how expensive.
If you can't buy the n95 medical masks, the n95 industry masks can also do the job. If you are in Europe, please buy the FFP2/FFP3 masks, they have the same filtering level. If the n95 masks have a valve, it can still protect you but it can't protect others if you are infected.
The one-time masks can be used only one time theoretically, therefore you need to prepare industry respirators/gas masks for your family. It's not a joke. In China, even the gas masks have been sold out. I recommend the 3M HF-52 respirator, the 3M 6500 and 7500 series respirators. Remember to buy enough n95 filters for your respirators. The p100 filters are also good. I bought four respirators for my family after the n95 masks are completely sold out.
The common surgical masks or medical masks are also important. They can't prevent the coronavirus 100% but they can highly reduce the risks. Please buy them as many as possible. In China, many local governments have announced that it's illegal to use public transmission without a medical mask. The cotton masks are useless, don't buy them.
The eye protectors can help you to prevent being infected through the eye. We have strong evidence that the new coronavirus can spread through the eye-air contact. If you can't buy them, the swimming glass can do the same job (even better).
Considering that you may face masks shortage, the 75% alcohol disinfectant and UV disinfection lamp can disinfect masks for reusing them. Prepare enough alcohol disinfectant and a UV lamp for your family.
When the new coronavirus outbreaks in your city and you have to go to the hospital to treat other diseases, please remember to wear n95 masks, eye protectors and gloves. Many patients and doctors are infected in Chinese hospitals. They weared the common medical masks but they are not 100% effective.
Before the coronavirus outbreak in your city, please prepare a fueled car. Don't trust the government when they say it's under control. Escape your city before things become too bad and lockdown (I don't know if the US government can lockdown a city). The people who escaped WuHan are lucky now. Those people who believed the government and stayed in WuHan is facing a disaster. Many families are infected. First one person has a fever and breathing difficulty, then all the family members are infected one by one. The hospitals are full of patients and hundreds of patients die every day. Nurses and doctors mentally breakdown. It's a nightmare.
When it comes to drugs, I can't recommend anyone since the doctors are still trying. I believe the Remdesivir is effective however it's still in the experiment and you can't buy them from the market. They have tested Remdesivir in WuHan hospital and hopefully the result will come out in 10 days. However, there is one drug that has been proved effective by many Chinese doctors and it has been used for dealing with malaria for a long time. It's Hydroxychloroquine. It's not OTC, therefore, you can't buy it without a prescription. Don't use any drugs before asking your doctor.
If you are living in an apartment in a crowded city like New York, Japan, and Hong Kong, please remember that the new coronavirus can spread in the elevator. The coronavirus can also spread through the sewer and it has been proved by a very famous issue in Hong Kong when SARS outbreaks in a crowded apartment in 2003. Seal your drains in the toilet if anyone has been infected in your apartment and please avoid using elevators.
When you have a fever, please measure the body temperature many times a day. The patients may only have low fever. Some patients (the percentage is still not sure) will have breathing difficulty in about one week. When you feel it's diffcult to breath, please report to your doctor as soon as possible.
"As a specialist provider of offshore savings and wealth management for expatriates, of course we invited our customers to take part. But we also wanted a truly international snapshot of expat life. We contacted online communities and used expat social media sites to ensure as many different international expat groups were included."
"In order for the results and league tables to be statistically significant, we need a minimum sample size of 100 expat respondents from each location. Although we had respondents from over 100 locations this year, 33 met the minimum number of responses required" https://www.expatexplorer.hsbc.com/survey/pages/about
"Welcome to the Land of the Rising Sun" "A global powerhouse of innovation, Japan’s fascinating history, rich traditions and diverse geography create a unique expat experience." https://expatexplorer.hsbc.com/country-guides/japan
twitter.com/mtwestra/status/1164778010534244352 おめーもサマーズもMMTから一つ二つアイディアぱくってて乙 Looks like @LHSummers and yourself picked up an idea or two from MMT. Congratulations on finally catching up with reality!
Umm. I remember when you bashed Stephanie Kelton for saying what you are now saying. Do I need to link to your own words of just a few months ago to spur your memory of your own words of just a few months ago?
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Revert CoreDNS to 1.3.1 in kube-up (and Kubeadm as well):
Absent a migration tool, the project reverted the change. Users of large clusters (5000+ nodes) should still plan on using 1.5.0 via CoreDNS version customization but need to know that upgrading won’t work.
Police arrested Malcolm Davidson, a 27 year old white male, resident of Wimbledon, in a pumpkin patch at 11:38 pm Friday. Davidson will be charged with lewd and lascivious behavior, public indecency, and public intoxication at the County courthouse on Monday.
The suspect allegedly stated that as he was passing a pumpkin patch, he decided to stop. “You know, a pumpkin is soft and squishy inside, and there was no one around here for miles. At least I thought there wasn’t.” He stated in a phone interview from the County courthouse jail.
Davidson went on to state that he pulled over to the side of the road, picked out a pumpkin that he felt was appropriate to his purposes, cut a hole in it, and proceeded to satisfy his alleged “need.”
“I guess I was just really into it, you know?” he commented with evident embarrassment. In the process, Davidson apparently failed to notice the Wimbledon Municipal police car approaching and was unaware of his audience until officer Brenda Taylor approached him.
“It was an unusual situation, that’s for sure.” Said officer Taylor. “I walked up to [Davidson] and he’s … just working away at this pumpkin.” Taylor went on to describe what happened when she approached Davidson.
“I just went up and said, ‘Excuse me sir, but do you realize that you are screwing a pumpkin?’ He got real surprised as you’d expect and then looked me straight in the face and said, ‘A pumpkin? Damn … is it midnight already?'”
And we are here to carry the torch forward.
Because when we talked about racial and economic justice, racial and social justice, we started to really extend those issues to the issues of economic justice, environmental justice, and the intersectionality and interconnectedness of all our fights.
This year we’re gonna organize.
Let us remember that a fight means no person left behind.
that Black women face,
that trans women or immigrant women face,
“I think its totally wrong,” commented Kim. “It’s bordering on child abuse and social services would not be pleased.” The commenter then went on to suggest that the parents could face legal ramifications for having sex in front of their child. “What if they wake up? Revolting and I wouldn’t be able to not say anything. There’s absolutely no need to do it in the same room so the fact they do is just disgusting.”
▼ Is it ever okay to have sex with your child in the room?