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   Technology StocksNew Q write what you like - No boring stuff

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From: SirWalterRalegh11/24/2019 9:08:43 PM
   of 139
Tampons Are Coming to the Men’s Room at Brown University.

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From: SirWalterRalegh12/26/2019 7:33:42 AM
1 Recommendation   of 139
ITEM 17: Ace of Spades HQ reported, "If Donald Trump wants to ensure he recaptures the 2020 electoral votes in the Great Lakes states he won in 2016 -- and possibly add Minnesota, New Hampshire, and Maine -- there is one simple thing he could do that would make him a hero to every snow-blowing American -- issue an executive order to restore functioning gas cans.

"To be clear, this would also make him a hero to tens of millions of other Americans throughout the country who use lawn mowers, power tools, etc around their homes or in their jobs. In 2009 the EPA banned the sale of gas cans that functionally pour gas. To be specific, the scientifically illiterate bureaucrats at the EPA outlawed gas cans with vents, mandating that all new gas cans must have crazy contraptions that require three hands to operate. Unlike the old gas cans, the new ones spill gas all over the user and onto the ground. The result of the EPA’s incompetence is a new gas can that is much worse for the environment than the one it replaced. The incompetent regulators at the EPA are so scientifically illiterate that they honestly believed that the vents on gas cans were there to allow gas fumes to escape, rather than the actual purpose of allowing air to flow in to the can so that gas can be poured out. Having received their science education in Oppression Studies classes at Grievance State University, these morons making rules for how we gas up our power tools have likely never handled a tool more powerful than their own personal groomers.

"The government-mandated non-functioning gas can may be the most unpopular government-imposed regulatory rule since the 55 mile per hour speed limit. If you don’t know someone who mocks and despises these stupid red canisters, then you are living a very sheltered urban or upscale lifestyle. Most all working-class and middle-class Americans deal with these awful containers, and they mock the government for imposing them on us."

I am not going to pretend to know what he is talking about.

But if the federal government did it in 2009 -- the beginning of the Obama Era -- then by all means it was probably the exact opposite if what should have been done, and should be repealed.

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From: waitwatchwander1/16/2020 2:10:51 PM
1 Recommendation   of 139
Oh boy! They're everywhere now ...

Savour Faire:

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From: Jon Koplik2/17/2020 1:31:23 PM
1 Recommendation   of 139
WSJ -- Pinsa Pie Tries to Elbow Into New York’s Crowded Pizza Market ....................

Feb. 17, 2020

The Pinsa Pie Tries to Elbow Into New York’s Crowded Pizza Market

Restaurants are now offering the oval pie that is said to have a lighter texture

Restaurants like Brooklyn’s Bar Camillo are now offering pinsa, an oval, lighter pizza. Above, the pinsa felino and peppers. Photo: Raffaele De Vivo

By Charles Passy

Pizza lovers in and around New York City may have to brace themselves yet again: There is another new pie in town.

A number of restaurants in the city have begun offering a Roman style known as pinsa, an oval-shaped pie that is said to be a lighter take on the favorite foodstuff. This month, Bar Camillo opened in Brooklyn’s Bedford-Stuyvesant neighborhood, heralding pinsa as one of its menu highlights. The dining and drinking spot is an offshoot of Camillo, another Brooklyn establishment that features pinsa.

In mid-2019, pinsa specialist Montesacro Pinseria Romana, a minichain that started in San Francisco, added a Brooklyn location in Williamsburg.

The pinsa at Montesacro Pinseria Romana Photo: Michael Grimm

The pinsa craze is the latest pizza trend in the city. In recent years, New Yorkers have embraced everything from the rectangular-shaped Detroit-style pizza, known for its cheesy edges, to pizza topped with pepperoni “cups.”

Pinsa may have an advantage in that it speaks to New Yorkers’ desire for foods that are healthier or, at the very least, less heavy on the stomach, establishments that offer the style say. Aside from its oval shape, pinsa is often distinguished by the fact it is made with a mix of flours -- not just wheat flour, but also rice and/or soy -- which are said to give it a lighter texture.

As for the name, pinsa derives from the Latin pinsere, which refers to the process of pushing and pulling the dough by hand, pizza professionals said. In pinsa places, no pies are tossed in the air.

The style has become increasingly popular in Rome, professionals added. Camillo and Bar Camillo owner Michele Baldacci said he became familiar with it on a trip a few years ago.

“I was like, ‘Oh, wow, this is different and so good,’” he said. In turn, that led to his offering it in New York City.

Like other pizza styles, pinsa is offered with a variety of toppings. At Montesacro, diners can have a Margherita pinsa with the classic combination of tomatoes, mozzarella and basil. Or they can opt for a vegan-friendly pinsa with leeks, olives and a fava-bean purée.

Bar Camillo’s pinsa napoletana Photo: Raffaele De Vivo

Scott Wiener, a pizza expert who leads tours of pizzerias in the city, said the pinsa trend is an example of something old becoming new again. He noted the style isn’t that much different from the flatbread one, which proved a hit in restaurants about a decade ago.

At the same time, the spread of pinsa raises the question of whether the classic New York pie, itself a variation on the Neapolitan version, could be losing its place in the city’s pizza pantheon, especially when factoring in the other trending styles of late.

Conversely, Alper Uyanik, owner of two pizzerias in the city, Harlem Pizza Co. and Sliced by Harlem Pizza Co., wondered if New Yorkers might eventually suffer from a kind of style overload. His establishments stick closer to the Neapolitan and New York pizza traditions.

“At some point, you’re going to reach the peak of how far you can take it,” he said of the newly introduced pizza versions.

Write to Charles Passy at

Copyright © 2020 Dow Jones & Company, Inc.


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To: Jon Koplik who wrote (4)2/26/2020 12:51:23 AM
From: Maurice Winn
1 Recommendation   of 139
People with boats and people in the oil industry know how impossible it is to protect plastics paint oil etc when sun water heat oxygen and marine life have a free hand.

It's surprising that they are surprised at the missing plastic.

The giant garbage floater "gyres" are not long for this world. Barnacles and all sorts attach and sink floating things. Microbes eat oil. Oxygen and sunlight oxidize crack and polymerase organic molecules.


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From: Jon Koplik2/29/2020 1:21:46 AM
   of 139
WSJ -- Leap-Year Babies Fight a Lonely, Quadrennial Fight for Recognition .................

Feb. 28, 2020

Leap-Year Babies Fight a Lonely, Quadrennial Fight for Recognition

Those born on Feb. 29 just want to be acknowledged by DMVs, retailers and others whose computers don’t recognize their birth date

By Jim Carlton

What Dean Walsmith really wants for his birthday is to have a computer notice him.

Mr. Walsmith, who turns 52 and who celebrates his 13th leap-year birthday on Saturday, launched a petition two years ago to make all computer systems accept February 29 as an option for the end of February, instead of a common setup now of the 28th.

“It’s just annoying,” said Mr. Walsmith, of Post Falls, Idaho, whose petition has garnered more than 1,200 signatures. “Hey, it’s not our fault we were born on the 29th, dang it.”

Leap-year babies are fighting back. They’re tired of being told the date on their IDs is fake. They’re tired of having trouble at the DMV, getting library cards, or missing out on birthday specials that ignore their day.

Raenell Dawn founded a group now called the Honor Society of Leap Year Day Babies, for people born on Feb. 29 to share the joys -- and indignities -- leapers such as herself must endure. Its membership has ballooned to 11,000 from just 21 when she started it in 1988. Among other things, it maintains a list of issues the leapers face.

Karen Korr celebrated her leap-year birthday in 2016. Photo: Karen Korr

Ms. Dawn, of Keizer, Ore., celebrates her 15th birthday Saturday after spending a total of 60 years on the planet. She strives to make life easier on leapers, including getting more states to change their DMV computers to recognize Feb. 29 and pushing restaurants to honor free birthday offers every year rather than every four.

“I’ll tell you who cares, one in 1,461 of us do,” Ms. Dawn says in a video posted on her website, citing the odds of being born on leap day.

Leapers fight back in the ways of any interest group: They write letters, they send emails. And they have seen some change. Some states have rejiggered their computer systems to recognize Feb. 29 on driver’s licenses, said Ms. Dawn.

When Karen Korr turned both 40 and 10 four years ago, she first celebrated with a party with face painters, balloon animals and Barbie cakes. Then, she and her girlfriends jetted off to Las Vegas to see Celine Dion.

“Not having your birthday on the actual calendar means it gets overlooked completely sometimes, but you get to make up for it with a killer celebration every four years,” said Ms. Korr, a legal-marketing strategist from San Diego.

Still, she feels hurt missing out on birthday wishes from her friends on Facebook. “When I don’t get messages on my Facebook wall on February 28, I assume that Facebook will alert my friends on March 1,” she said. “But sometimes Facebook hasn’t alerted friends on either day!”

A Facebook spokesman said it does send birthday reminders to friends of people who are born on Feb 29.

Kelly Rowe delivered triplets on Feb. 29, 2004, and since then she and her husband, Jeff, have had to deal with issues ranging from correcting forms for doctors’ offices to having to convince customs agents on a recent trip to Canada that their children were legit.

Harris, Elizabeth, and Andrew Rowe, in 2004, above, and in 2020 below, were born on Feb. 29. Photo: Kelly Rowe

“Customs were very entertained with their birth certificates we presented and … didn’t believe us because they are all different sizes,” said Ms. Rowe, of Charleston, S.C., whose triplets vary in heights up to 6 feet tall. The family eventually made it through.

One life milestone -- being able to legally buy one’s first drink at 21 -- often becomes a sobering experience. Annabella Gualdoni is still annoyed, 30 years later, about when she went to a bar near her college in Los Angeles to celebrate her 21st birthday and showed her ID for an Alabama Slammer.

“The waiter looked it up and down, scrunched his face, and said, ‘Uh, are you celebrating your 21st birthday tonight?’ ” said Ms. Gualdoni of Newton, Mass. “I said that I was and he said, ‘I’d better check with my boss about this.’ After much deliberation on their part, and a little sweat on mine, they let me have my drinks!”

Rita Sigler recalls that when she moved to Connecticut years ago, DMV officials ended up having to shut down their entire computer system for a half-hour to get it to accept her Feb. 29 birth date. “Needless to say, everyone else waiting was thoroughly annoyed,” said Ms. Sigler, an insurance worker from South Windsor, Conn., who turns 48 and 12 on Saturday. “I tried to act nonchalant so they wouldn’t know I was the troublemaker.”

A spokesman for the state’s DMV said Feb. 29 is now recognized.

Michelle Mohring said when she when she moved to a new town in Michigan in 2009, she was unable to register for a library card online and sought help in person. The clerk, she said, tried but failed to find a way to input Feb. 29 into the library system. She finally got a card when she suggested just changing her birth date on it to Feb. 28.

Annabella Gualdoni celebrates a birthday in 1970. Photo: Annabella Gualdoni

“He informed me I would have this problem for the rest of my life and joked that I should just change my birthday,” said Ms. Mohring, a teacher. “I found that a little condescending. I’m entitled to have a birthday and the correct information without hassle.”

Ms. Mohring said she is looking forward to her birthday on Saturday, when she turns 52, or 13 -- the same age as the middle-schoolers she knows “who get a kick out of knowing we were the same age this year.”

Stacy Keyes, of Compton, Calif., who turns 56 or 14 on Saturday, said her late father warned her life would be like this. They were both born on leap day and among their joint issues: each being questioned throughout their lives if their birth date was real.

“For the mere mortals that don’t understand the leap year, we always get the side eye or ‘Is that really your birthday? How did that happen?’” she said.

Ms. Dawn, of the leap-year baby group, says progress still needs to be made. “We’ve come a long way, but there are still some things that have not been fixed online,” she said. “I’m not going to stop until we are all leapified.”

She said she recently got a coupon in the mail from a department store for leap-year babies to use on their birthday. There’s just one problem: The expiration is Feb. 28.

Write to Jim Carlton at

Copyright © 2020 Dow Jones & Company, Inc.


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From: Jon Koplik3/11/2020 11:04:26 PM
   of 139
Bloomberg -- safety of bills (cash) / microbes persisting on surfaces ..............................

March 11, 2020

Fear of Virus-Tainted Dollars Opens New Front in War on Cash

By Jennifer Surane, Olivia Rockeman, and Robert Schmidt

Some banks urge Fed and Treasury to vouch for safety of bills

Yet payments firms could benefit if cash is labeled a threat

The signs began appearing around Seattle in the windows of Dick’s Drive-In, the city’s iconic burger chain: “In an abundance of caution, we ask you to please pay with credit or debit card if possible rather than cash.”

Fear of dollars is now palpable in the U.S. epicenter of the coronavirus.

And across the financial industry, a rigorous debate is brewing over how to address the public’s mounting concern that greenbacks might transmit Covid-19. Studies show it’s at least theoretically possible for other coronaviruses to survive on the dollar’s cotton-and-linen weave, though there’s little agreement on the actual risk of contagion.

Behind the scenes, some industry groups and banks have been urging the Federal Reserve and Treasury Department to issue a statement assuring Americans that there’s minimal risk for using cash, according to people with knowledge of the discussions. The Fed, in turn, says it’s waiting for advice from the Centers for Disease Control and Prevention, which so far has said the virus spreads primarily through person-to-person contact. In the meantime, the Fed has been putting notes repatriated from Asia in quarantine for up to 10 days to ensure it’s safe.

The stakes are high for banks and companies handling electronic payments: Billions of dollars in profits hinge on whatever statement or policy authorities ultimately issue.

On one side, small and mid-size banks are working to keep branches open so they can keep serving legions of business customers that refill their cash registers daily. Representatives from some lenders think it’s important for regulators to offer guidance on handling money, noting the risk of using currency is low -- comparing it, say, to pushing an elevator button or grasping a handrail.

‘Hygienic’ Payments

If, on the other hand, authorities take steps that discourage the use of dollar bills, it will buttress the credit card industry’s long-running “war on cash,” sending more transactions through their networks and to payment apps that collect fees. That could even boost interest-bearing credit card balances.

Firms such as Visa Inc., Mastercard Inc., American Express Co., PayPal Holdings Inc. and a slew of large card-issuing banks would be among the top beneficiaries.

The virus may end up serving as a “trigger event” for wider acceptance of cards long term, either persuading retailers to start taking them or prompting the government to force them, said Lisa Ellis, an analyst independent research boutique MoffettNathanson. The shift would be especially dramatic in regions of the world where card use is still relatively uncommon, she said.

“Digital payments are already viewed as good for society by governments because they help with financial inclusion, they drive tax revenue and eliminate corruption,” she said. “This is another reason: ‘Oh, and it’s hygienic too.’”

Fighting for Poor

And on another side are millions of Americans who lack access to bank accounts, as well as poor and rural communities with few if any branches serving residents and local businesses. Many of them rely on cash for commerce. Repeatedly in recent years, consumer advocates have fought stores and restaurants that try to simplify checkout by going “cashless.” Cities such as New York, Philadelphia and San Francisco passed laws requiring dollars be accepted.

Some of those groups worry they’re about to face a national battle to allow cashless commerce in response to the coronavirus.

“Going cashless is definitely not something that we particularly support,” said Eric Espinoza, an associate director at Neighborhood Trust Financial Partners, which helps provide financial services to low-income communities. “We certainly wouldn’t support it under a hasty decision-making environment in which you’re extremely reactive and potentially not as thoughtful about the repercussions.”

Despite the increased popularity of credit and debit cards in recent years, cash still remains one of the most popular ways to pay for things in the U.S., accounting for 26% of all payments by consumers last year, according to data compiled by the Fed. Spare change and dollar bills are still overwhelmingly favored for small purchases, accounting for about 50% of payments under $10.

Roughly 25% of Americans are either unbanked or underbanked -- with black and Hispanic households making up the largest percentage of those lacking accounts, according to a study by the Federal Deposit Insurance Corp. More than half of unbanked households in the U.S. say they lack the funds to keep an account open.

“If you want to go that direction, it’s going to take really thoughtful planning in order to deal with the questions of inclusivity,” John Thompson, chief program officer for the Financial Health Network. “There’s still really important, substantively sized sectors of the country that are operating outside of the mainstream financial system.”

Paper currency in the U.S. is made from 75% cotton and 25% linen, according to the Treasury. That makes the surface of bills coarse and fibrous, allowing germs to adhere more easily and survive longer than they can on smooth objects. One study in 2013 showed the dollar has the ability to show “significant and prolonged carriage” of the dreaded Methicillin-resistant Staphylococcus aureus bacteria known as MSRA.

A 2020 study of coronaviruses, which included SARS and MERS, showed the microbes can persist on surfaces for as long as nine days. That can be reduced significantly using ethanol-based disinfectant, according to the study, but cleaning a paper bill proves more difficult than a plastic surface like a desk.

Confronted with Covid-19, the People’s Bank of China began using ultraviolet light and high-temperature ovens to disinfect cash coming in. It has also replaced old notes with newly minted bills.

The Fed is staying in contact with the CDC to make sure it’s aware of the agency’s latest thinking on how the virus spreads, a spokeswoman for the central bank said.

So far during the current outbreak, the Fed hasn’t widely enacted its longstanding protocol for banks handling bills suspected of being dangerous: First stacking them in “straps” of 100, then bundling those into larger bricks and packaging them in plastic bags with the word “CONTAMINATED” scribbled in permanent ink.

Even if the virus compels more people to use cards, the world’s largest payments network will still be battling the broader slowdown in spending, especially in the travel sector.

“In the near term, at this point, coronavirus is a clear negative because of disproportionate impact on international travel and consumer discretionary spend,” Sanford C. Bernstein & Co. analyst Harshita Rawat said in an interview. “People are just not traveling internationally and this is one of the most profitable businesses that these companies have.”

-- With assistance by Dan Reichl

© 2020 Bloomberg L.P.


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From: Jon Koplik3/16/2020 11:00:38 PM
   of 139
WSJ -- Relax, America: The U.S. Has Plenty of Toilet Paper ................................................

March 16, 2020

Relax, America: The U.S. Has Plenty of Toilet Paper

Factories are flush with bathroom tissue, but large manufacturers say the problem is getting it to stores

By Sharon Terlep

America can spare a square.

Jittery shoppers across the country are clearing shelves of bathroom tissue as coronavirus keeps people home and threatens to force more Americans into quarantine. But toilet paper­ -- unlike some other high-demand items such as hand sanitizer and face masks -- ­remains plentiful, according to the two biggest manufacturers.

Charmin maker Procter & Gamble Co. and Cottonelle maker Kimberly-Clark Corp. say they have ramped up toilet-paper production and are able to make enough to meet demand. Kimberly-Clark has started posting pictures of warehouses full of toilet paper in some markets. The problem, the manufacturers say, is getting the product shipped to warehouses and retailers, and then onto store shelves, quickly enough to keep up with sales.

The shopping frenzy stirs memories for some of the global financial crisis, which disrupted the market for, among other things, short-term corporate debt.

“This is literally 2008 played out over toilet paper and not commercial paper,” said Justin Wolfers, a University of Michigan professor of economics and public policy. “As long as I believe you are going to run to Costco and buy toilet paper, I’m going to run. And as long as you believe that I am going to run, you are going to run. Both are rational.”

People are buying extra toilet paper as a safeguard and not using a dramatically larger amount, which distinguishes bathroom tissue from face masks, sanitizer and other cleaners that are being consumed in far greater quantities.

U.S. toilet-paper sales were up 60% for the week ended March 7, compared with the same period a year ago, according to Nielsen. It is a significant jump, but not close to the sales increases for hand sanitizer or aerosol disinfectants, up 470% and 313%, respectively, for that period.

Restocking inventory can take several hours or days as goods work their way from the factory to the warehouse to shelves. The consumer-products industry, including suppliers, manufacturers and retailers, have overhauled supply chains over the past two decades to be more profitable and flexible by keeping limited inventory on hand as opposed to stocked up in warehouses. The more cost-effective system means that when demand spikes unexpectedly, supplies run short.

Toilet paper is relatively easy to make. It is produced in the U.S., involves few materials and doesn’t require parts imported for packaging. U.S. industry sales were roughly $9 billion last year, according to Nielsen.

Kimberly-Clark said it has plans in place to meet increased demand for its products, including faster production and “reallocating inventory.”

A P&G spokesman said toilet-paper shortages are sporadic and generally temporary. He noted that on any given day in P&G’s hometown of Cincinnati, there are stores with plenty of toilet paper and stores completely sold out.

“We have seen some temporary out-of-stocks at some retailers given rapid consumer purchases,” he said. “However we continue to manufacture and ship products to retailers nationwide.”

Sales of toilet paper and other non-perishable, non-consumable goods will likely slow down considerably for a while after the coronavirus situation stabilizes, said Bill Simon, former CEO of Walmart U.S. The purchase frequency for items such as toilet paper is consistent and predictable, he said.

“You don’t use more toilet paper because you have it,” he said. “If you bought three bags of Doritos, you’ll eat them.”

-- Sarah Nassauer contributed to this article.

Write to Sharon Terlep at

Copyright © 2020 Dow Jones & Company, Inc.


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From: Jon Koplik3/20/2020 2:11:16 AM
   of 139
WSJ -- The Unsung Pioneer of Handwashing .................................................................................

March 19, 2020

The Unsung Pioneer of Handwashing

In 19th-century Vienna, Ignaz Semmelweis fought to convince his fellow doctors that washing their hands could save patients’ lives.

By Lindsey Fitzharris

It’s difficult to feel any sense of optimism during the Covid-19 pandemic, but one source of encouragement is that simple soap and water can be a powerful defense. The coronavirus that causes the disease is enveloped in fatty layers that are easily dissolved by detergents, exposing the core of the virus and causing it to perish. That’s why public health authorities keep stressing the importance of washing our hands.

Handwashing to kill germs might seem like basic hygiene today, but it is a relatively recent discovery in the history of medicine. In the early 19th century, even hospitals had no inkling of the importance of cleanliness. They were breeding grounds for infection, often referred to as “houses of death.” Hospitals provided only the most primitive facilities for the sick and dying, many of whom were housed on wards with little ventilation or access to clean water. In 1825, visitors to St. George’s Hospital in London discovered mushrooms and maggots thriving in the damp, dirty sheets of a patient recovering from a compound fracture. Mortality rates for hospital patients were three to five times higher than for people treated in domestic settings.

The first doctor to understand the importance of hygiene in stopping the spread of infectious disease was Ignaz Semmelweis, a Hungarian physician, who in the 1840s was working in the maternity department of Vienna’s General Hospital. At the time, the idea that the squalid conditions in hospitals played a role in spreading infection didn’t cross many doctors’ minds. Among those most at risk were pregnant women. When they suffered vaginal tears during delivery, the wounds provided openings for the bacteria that doctors and surgeons carried on them wherever they went.

Semmelweis, then in his late 20s, noticed an interesting discrepancy between the hospital’s two obstetric wards. One was attended by male medical students, while the other was under the care of female midwives. Although each ward provided identical facilities for its patients, the one overseen by the medical students had a mortality rate that was three times higher. Those at the hospital who noticed the imbalance attributed it to the idea that male students handled patients more roughly than female midwives did, thus making the new mothers more susceptible to developing puerperal fever, a dangerous postpartum infection.

Semmelweis wasn’t convinced. In 1847, he had a breakthrough when one of his colleagues became ill after cutting his hand during a postmortem examination. Semmelweis noticed that the man’s symptoms were remarkably similar to those of women suffering from puerperal fever. What if doctors working in the dissection room were carrying “cadaverous particles” with them onto the wards when they assisted in the delivery of babies?

At the time, doctors didn’t wear protective gear such as gloves when dissecting the dead, or take care to wash their hands afterward. Perhaps the big difference between the students’ ward and the midwives’ ward was that the students were the ones performing autopsies.

Believing that puerperal fever was caused by “infective material” from dead bodies, Semmelweis set up a basin filled with chlorinated lime solution in the hospital and required all doctors to wash their hands in it before attending to patients. In April 1847, the mortality rate for new mothers on the students’ ward was 18.3%. After handwashing was instituted in May, it fell to just over 2%

Semmelweis’s results were compelling, and no doubt he saved the lives of many mothers during that period. However, he was not able to convince his colleagues that puerperal fever was caused by contamination through contact with dead bodies. Even doctors willing to carry out trials of his methods often did so inadequately, producing discouraging results. And Semmelweis himself could never completely eliminate cases of puerperal fever, even when his protocols were strictly enforced. After a number of negative reviews of a book he published on the subject, in 1861, Semmelweis lashed out at his critics, going so far as to call doctors who didn’t wash their hands “murderers.”

Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital.

In time his behavior became erratic, an embarrassment to the hospital. Later historians have suggested he may have been suffering from the effects of Alzheimer’s disease or syphilis. On July 30, 1865, one of Semmelweis’s colleagues lured him to a Viennese insane asylum, under the pretense that he would be visiting a new medical institute. When Semmelweis surmised what was happening and tried to leave, he was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Two weeks later, he died of a wound on his right hand that had become gangrenous.

Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital. It wasn’t until the 1880s that pioneers of germ theory such as Louis Pasteur, Joseph Lister and Robert Koch proved to the world that disease really could be transmitted by microscopic particles, leading to a revolution in sanitary practices. Only then was the crucial importance of handwashing widely accepted and Semmelweis’s contribution acknowledged.

Today, the term “Semmelweis reflex” is used to refer to the knee-jerk tendency to reject new evidence because it contradicts established norms.

As a new pandemic tests the world’s medical systems and its ability to mount a coordinated response, our minds need to remain open to creative solutions that don’t necessarily fit accepted methodologies. Even in 2020, it remains a challenge to convince people that washing their hands is one of the most effective ways to combat Covid-19. If any positive change comes from the pandemic, it may be that hand-washing will at last become as universal as Semmelweis hoped.

-- Dr. Fitzharris is a historian of medicine and the author of “The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.”

Copyright © 2020 Dow Jones & Company, Inc.


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From: Jon Koplik3/25/2020 11:37:51 AM
   of 139
WSJ -- Is the Coronavirus as Deadly as They Say ? ..................................


March 24, 2020
6:21 pm ET

Is the Coronavirus as Deadly as They Say?

Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.

By Eran Bendavid and Jay Bhattacharya

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise -- ­and projections of the death toll could plausibly be orders of magnitude too high.

Fear of Covid-19 is based on its high estimated case fatality rate -- ­2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases­ -- orders of magnitude larger -- ­then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.

Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.

The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

This does not make Covid-19 a non-issue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lock-downs.

Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.

Copyright © 2020 Dow Jones & Company, Inc.


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