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COVID-19 and “super-spreaders”

Evidence is emerging suggesting that COVID-19 does not spread equally. A minority of infected individuals seem to spread the virus easily to many people, while most infected individuals spread it to few others or no one at all, likely through a combination of circumstance, environment, and possibly biology. Why is this, and what does it mean for coronavirus containment strategies?

SARS-CoV-2, the coronavirus that causes the disease known as COVID-19, is a novel virus. It is undeniably true that science has made many discoveries about the virus and disease in record time (remember, the first cases were only reported only late last year in China), including isolating the offending coronavirus and sequencing its genome in record time, developing tests for it, and even finding potential treatments that appear to decrease mortality, such as dexamethasone and remdesivir. However, even with the rapid pace of discovery, some of it based on what we know about other coronaviruses, including SARS and MERS, and at times showing science at its messiest, thus leaving the door open to grifters and conspiracy theorists, there still remain many mysteries about COVID-19, how it is spread, how its spread can be prevented and slowed, and why a minority of people become ill with life-threatening disease while the majority do not, with a third or more having no symptoms at all, or symptoms so mild that they don’t think much of them. Enter the question of “super-spreaders.”

We’ve written before about the recent controversy over whether COVID-19 can spread through aerosols (answer: probably, but it’s complicated) and whether masks work to slow the infection (answer: yes, contrary to the misinformation being spread about masks). These are not just academic questions. Given how COVID-19 is spreading rapidly in many parts of the US, perhaps the most urgent question remains, amazingly enough; How does COVID-19 most efficiently spread? If we can target how COVID-19 spreads, we have the best chance of having the most impact in slowing down its spread. This brings us to the topic of so-called “super-spreaders” and “super-spreading events”. It’s a great example of how confusing science at the “bleeding edge” can be and, more importantly, how hard it is to make decisions based on science when the science is still uncertain and in flux.

An article yesterday in the Washington Post by Ariana Eunjung Cha, unfortunately, starts with just such an event in my state:

It wasn’t until Day 7 of her team’s coronavirus investigation when it dawned on Linda Vail, the health officer for Michigan’s Ingham County, that this was going to be a big one. It had started with just two infections at the college bar on June 18, not long after the state began reopening. But the numbers quickly jumped to 12, then 18, then 34.

As of Friday, she was staring at a spreadsheet with 187 infected at Harper’s Restaurant and Brew Pub.

“The tables were six feet apart, but no one stayed there,” she said. “The DJ was playing music so people were shouting, the dance floor started to get crowded. We had flattened the curve and then boom.”

The East Lansing case is what’s known as a super-spreading event — possibly the largest so far in the United States among the general public. Many scientists say such infection bursts — probably sparked by a single, highly infectious individual who may show no signs of illness and unwittingly shares an enclosed space with many others — are driving the pandemic. They worry these cases, rather than routine transmission between one infected person and, say, two or three close contacts, are propelling case counts out of control.

More than 1,000 suspected clusters — ranging from the single digits to thousands — have been logged in a database compiled by a coder in the Netherlands. A megachurch in South Korea. A political rally in Madrid. An engagement party in Rio de Janeiro. Nearly all took place indoors, or in indoor-outdoor spaces.

These “super-spreader” events all share certain characteristics. Specifically, nearly all of them took place indoors or in indoor-outdoor spaces. Unfortunately, although so-called “COVID parties“, parties in which people intentionally try to be infected with COVID-19, are probably far more urban legend than reality, there are lots of events still occurring in which people don’t wear masks, don’t social distance, and are in general very cavalier and careless about the possibility of contracting COVID-19, such as underground parties being held in New York City.

While we know that COVID-19 is mostly spread by larger respiratory droplets, there’s emerging evidence that it can also be spread by aerosols, smaller respiratory droplets that can hang in the air a lot longer. (Again, I discussed this issue in detail a couple of weeks ago.) Now, here’s the strange part:

Why, for instance, didn’t the earliest infections in the United States, or the infamous Lake of the Ozarks party, spur lots of cases, while a much smaller gathering at a Michigan bar produced nearly 200? Why out of countless large gatherings held — church services, soccer games, choir rehearsals, and Zumba classes — did only a fraction ignite significant infections?

Part of the uneven spread of the coronavirus — and the phenomenon of superspreading — can be explained by extreme individual variation in infectivity, researchers say.

Some people will not transmit the virus to anyone, contact tracing has shown, while others appear to spread the virus with great efficiency. Overall, researchers have estimated in recent studies that some 10 to 20 percent of the infected may be responsible for 80 percent of all cases.

Scientists are only starting to understand the different factors — physiological, behavioral, environmental — that play a role in amplifying transmission.

There’s a term used by infectious disease experts known as R0 (pronounced “R-not”), which is an estimate of the average number of people a single individual with an infectious disease will infect. Measles, a disease we used to discuss a lot in the context of the antivaccine movement’s depressing vaccination coverage with the MMR vaccine and the measles outbreaks that have resulted, is highly transmissible, with an R0 of around 12-18, while Ebola, which I’ve also discussed before in the context of comparing its transmissibility with measles, has an R0 of around 2, but that number is an uncertain estimate because it depends on a lot of factors.

As Carl Zimmer put it:

The new coronavirus turned out to have a reproductive number somewhere between two and three. It’s impossible to pin down an exact figure, since people’s behavior can make it easier or harder for the virus to spread. By going into lockdown, for instance, Massachusetts drove its reproductive number down from 2.2 at the beginning of March to 1 by the end of the month; it’s now at .74.

This averaged figure can also be misleading because it masks the variability of spread from one person to the next. If nine out of 10 people don’t pass on a virus at all, while the 10th passes it to 20 people, the average would still be two.

One critical factor is that COVID-19 can spread from people who are either presymptomatic (they don’t have symptoms yet but go on to develop symptoms) or asymptomatic (they never go on to develop symptoms), meaning that people who can transmit the disease often interact with people while releasing the virus. One prominent common trope spread by COVID-19 conspiracy theorists and deniers of the severity of the pandemic is that asymptomatic COVID-19 patients do not spread the virus, but the evidence for asymptomatic spread has become much stronger over the last couple of months, along with the evidence that facemasks work to slow the spread of coronavirus.

There also appear to be large differences in how effectively a given infected person spreads COVID-19. For example, in a recent study out of Hong Kong that is currently available as a preprint—as always, remember that this means it hasn’t undergone peer review yet—researchers investigated several COVID-19 clusters and looked at the results of contact tracing to determine the chain of transmission. What they found in these “super-spreading events” is that about 20% of those infected were responsible for about 80% of viral transmission. Another group, consisting of around 10% of the total, infected one or two others, consistent with an R0 of around 1.5, while the remaining 70% didn’t infect anyone at all. The reasons for this difference were not entirely clear:

Superspreading is considered a function of both variations in individual transmissibility and individual susceptibility or exposure. Our results show that the number of individual secondary cases was significantly higher within social settings such as bars and restaurants compared to family or work exposures (p<0.001). This is certainly due to the greater numbers of contacts expected in such settings. Social exposures are therefore at an increased risk for SARS-CoV-2 transmission and likely constitute the core behavioural risk factor for SSEs. Targeted interventions should therefore focus on reducing extreme numbers of social contacts at high-risk venues such as bars, nightclubs and restaurants, which also appear at increased risk of SSE (22), either via closures or physical distancing policies, both of which currently remain implemented in Hong Kong (17).

There are other studies that come to similar conclusions. For example, in this one from Israel, currently in preprint, investigators sequenced 212 SARS-CoV-2 nucleotide sequences and used the information to perform a comprehensive analysis to trace the origins and spread of the virus, estimating an R0 of around 2.0 to 2.6 and noting large differences in transmission of SARS-CoV-2, with around 1-10% of infected individuals resulting in 80% of secondary infections. Another study, this one from Georgia and also in preprint, estimates that 2% of individuals seeded 20% of cases. There’s also another parameter, the k-value, which estimates how much viral infections tend to cluster, which has been estimated to be around 0.1, indicating that 10% of infected people might be responsible for 80% of secondary spread.

These observations have significant implications, if they are borne out in further research. As noted in May in Science:

That could explain some puzzling aspects of this pandemic, including why the virus did not take off around the world sooner after it emerged in China, and why some very early cases elsewhere—such as one in France in late December 2019, reported on 3 May—apparently failed to ignite a wider outbreak. If k is really 0.1, then most chains of infection die out by themselves and SARS-CoV-2 needs to be introduced undetected into a new country at least four times to have an even chance of establishing itself, Kucharski says. If the Chinese epidemic was a big fire that sent sparks flying around the world, most of the sparks simply fizzled out.

Especially compared with other viruses:

The lower k is, the more transmission comes from a small number of people. In a seminal 2005 Nature paper, Lloyd-Smith and co-authors estimated that SARS—in which superspreading played a major role—had a k of 0.16. The estimated k for MERS, which emerged in 2012, is about 0.25. In the flu pandemic of 1918, in contrast, the value was about one, indicating that clusters played less of a role.

Nature

So we know that COVID-19 tends to spread in clusters. What could be the factors that determine who is and is not a “super-spreader”? We already know that enclosed indoor spaces are conducive to the spread of coronavirus. It’s been speculated that the situation matters more than the person infected. Yes, there could be biological differences among people regarding how much coronavirus reproduces and how much virus is in their respiratory droplets, but scientists suspect it’s the situation that matters more:

Some people also have more opportunity to get sick, and to then make other people sick. A bus driver or a nursing home worker may sit at a hub in the social network, while most people are less likely to come into contact with others — especially in a lockdown.

Dr. Nelson suspects the biological differences between people are less significant. “I think the circumstances are a lot more important,” she said. Dr. Lloyd-Smith agreed. “I think it’s more centered on the events.” A lot of transmission seems to happen in a narrow window of time starting a couple days after infection, even before symptoms emerge. If people aren’t around a lot of people during that window, they can’t pass it along.

And certain places seem to lend themselves to superspreading. A busy bar, for example, is full of people talking loudly. Any one of them could spew out viruses without ever coughing. And without good ventilation, the viruses can linger in the air for hours.

Still, scientists don’t discount the possibility of biological differences as a cause for “super-spreading”:

While it’s often impossible to identify the person who triggered an outbreak, there have been some commonalities among those who have been pinpointed as the likely source in studies. They tend to be young. Asymptomatic. Social.

Scientists suspect these “super-emitters” may have much higher levels of the virus in their bodies than others, or may release them by talking, shouting or singing in a different way from most people. Research based on the flu, which involved college students blowing into a tube, showed that a small percentage tended to emit smaller particles known as aerosols more than others. These particles tend to hang or float, and move with the flow of air — and therefore can go much farther and last longer than larger droplets.

In a study published in Emerging Infectious Diseases by Japan’s Hitoshi Oshitani at Tohoku University of 22 superspreading individuals with the coronavirus, about half were under the age of 40, and 41 percent were experiencing no symptoms.

Emerging Infectious Diseases

This is mainly speculation, though. There is a paucity of evidence supporting even the existence of especially infectious people with COVID-19.

Personally, I’m more on the side of concluding that it’s more the situation, than the biology of the infected, that determines who can be a “super-spreader”. However, I also did several PubMed searches, and I must admit that the literature on this phenomenon is very confusing right now. It also doesn’t help that “super-spreader” doesn’t have a very clear epidemiological definition, as discussed in depth in this article by Emma Cave. She notes that this is not a new term and is defined (usually in retrospect) as an individual who has a greater than average propensity to infect a larger number of people. (Perhaps the most famous example of a “super-spreader” was Typhoid Mary.)

However, the terms “super-spreader” and “super-spreading” are problematic for a number of reasons, as Cave argues. Again, its precise meaning in epidemiology remains rather vaguely defined. More importantly, though, it is a term that can easily take on a moral judgment and be used to blame certain individuals:

The term is particularly problematic when applied to individual ‘super-spreaders’, as it can mean different things to different groups. Media interest in super-spreaders focuses on the early stages of the epidemic when efforts are being made to contain, trace and delay. Used in this way, a ‘super-spreader’ will generally have interacted with a larger than average number of people, making tracing difficult or impossible. At the other end of the spectrum, scientific interest can focus on the heterogeneity of populations in the transmission of infectious disease. Used in this sense, ‘super-spreading’ is connected to the scientific nature of the virus and the way it manifests in some humans. There is speculation that some people with COVID-19 are especially infectious (Boseley and Belam 2020).

Super-spreading is therefore a product of biological, behavioural and environmental factors. It can be used to describe decisions, policies, events, settings and individuals—in fact, anything that contributes to increased rates of infection can be seen (by some groups) as super-spreading. The wide and varied use of the term ‘super-spreader’ is problematic for two reasons considered in subsequent sections: it can lead to apportionment of moral blame to alleged super-spreaders and it could detract from scientific investigation into heterogeneity of COVID-19 if misunderstanding leads to diminished public support and trust.

Cave concludes by proposing that a different, more neutral term be used. She makes a good argument.

The COVID-19 pandemic has, unfortunately, provided a perfect storm of information mixed with misinformation and rapidly changing science that confuses not just the general public but the public policy response. The entire issue of “super-spreading” is one such issue. On the other hand, if “super-spreading events” really are the main driver of the COVID-19 pandemic, it could be possible to tailor a public health response that isn’t so blunt, that doesn’t limit so much of what we can do. For example, in Japan health officials have noted that “many COVID-19 clusters were associated with heavy breathing in close proximity, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gymnasiums”, and Japan’s Prime Minister’s Office and the Ministry of Health, Labor and Welfare announced three situations that could increase the risk for COVID-19 cases and advised the population to avoid the “Three Cs”: closed spaces with poor ventilation, crowded places, and close-contact settings.

And wear a mask!

I’ll conclude by warning that the tsunami of misinformation mixed with rapidly evolving science is likely to continue to get worse before it gets better. There’s an election coming up, and it’s likely that science will be politicized even more than it’s been thus far, particularly as various candidates for vaccines go into clinical trials and preliminary results are breathlessly reported to the press. That, however, is a topic for another day.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

58 replies on “COVID-19 and “super-spreaders””

I have my Masters in nursing and I studied medical industry conflict of interest for years.

“Even Mr. Chamberlain himself takes pride in England’s honorable uniform, and makes the army down there wear an ugly and odious and appropriate disguise, of yellow stuff such as quarantine flags are made of, and which are hoisted to warn the healthy away from unclean disease and repulsive death. This cloth is called khaki.”

As for Pattimmy, it’s your choice whether to make people wonder where, in general, you’ve been.

@ Princess Diana

“I have my Masters in nursing”

Congratulations!

“and I studied medical industry conflict of interest for years.”

Any publications?

“The author of this article is spewing ignorance, hate and lies”

Evidence-based ignorance. Moreover, he explicitly warned against making moral judgements against super-spreaders. And you have given zero evidence of lies from Orac.

“and is doing a lot of damage.”

Yeah. Right. Quacks hate him. May he keep the damage business up and running, and be as frightening to them as Freddy Krueger

“He is not for health and wellness.”

Right. He’s for death and pain… obviously… since you say so.

“Here is the truth about him.”

This Bolen Report article was hilarious. Thanks for the laugh.

This Bolen Report article was hilarious.

Oh, L-rd, the well is practically bottomless. Did you know that he lives in a postal box while not hiding in the woods like a bunny rabbit?

This fits with my (admittedly casual and unscientific) obserrvation that every time states open bars, hot spots soon occur. But I lived in Milwaukee for many years, so maybe I’m more sensitive to this situation.

Indeed it does depend on accent: in Received Pronunciation (RP) – the standard pronunciation of middle-class speakers of southern British English – the vowel in ‘not’ is short, whereas the vowel in ‘nought’ is long; but many other speakers of British English would not distinguish them.

Perhaps English needs spelling reform or something more drastic

Ah, Colonel McCormick. Am I the only one who just says “R zero”? I’m utterly baffled how the news media seems to have risen as a single man to provide pronunciation advice for a lone symbol.

As re-openings here near [Redacted] ** proceeded, indoor restaurant seatings were scheduled for late June but then counter-indicated as the Rt wobbled around 1- the governor watches the numbers like hawk similarly, “next door”, bars and restaurants remain sidewalk style only. California re-opened briefly and later closed indoor dining ( as I observed, although it was heavily controlled with social distancing, low occupancy, nearly contact free), It is rather hilarious to view how local restaurants are coping by setting up outdoor tables and chairs with umbrellas or tents in parking lots*** or sidewalks of small cities and suburbs but I think that it may save many small businesses. But what will they do in November? Heating fans with tents?

Because many mysteries about Covid-19 remain, the topic is fertile ground for woo-meisters and anti-vaxxers to confabulate cures and conspiracies. Mega vitamins and organic produce will prevent or cure infection and being vaccinated ( in any manner) makes a person more vulnerable to infection and serious sequelae: the internet is rife with these stylings. ( see PRN, AoA, NaturalNews, The High Wire, Children’s Health Defense, etc).

** redacted because trolls . Minions are smart enough to figure it out
*** on Saturday, I ate at a table with an umbrella on a small strip of grass in a parking lot.

What always surprise me that the people in my country, who are protesting against social distancing and other things to prevent the spread of Covid-19, are also against vaccines.

CBC Radio is reporting that that we have a bunch of anti-maskers who seem to be using the antivaxer playbook of lies, fake news and mad conspiracy theories. There are some of these idiots demonstrating at Queen’s Park, (Ontario Provincial Parliament Buildings in Toronto), every weekend.

Around here we appear to be having fairly good compliance. Certainly, I notice that people seem to be really trying to give other pedestrians 2 metres on the sidewalk and in my local grocery stores. Stores have hand sanitizer available at the entrance (and often people to politely yell at you if needed).

People definitely give me lots of space especially since I have adopted the Aryurved prophylactic of fresh cow dung and crushed raw garlic applied externally. Say what you want about quack medicine, this works!

@Deni¢e writes, “It is rather hilarious to view how local restaurants are coping by setting up outdoor tables and chairs with umbrellas or tents in parking lots*** or sidewalks of small cities and suburbs but I think that it may save many small businesses. But what will they do in November? Heating fans with tents?”

Rather hilarious small business owners are trying to survive? Doing what they can to make a living? Wow. Duhnice, even if you feel that way, best to keep it to yourself. If the cooks and waiters only knew how you truly feel about their welfare, you’d have some special sauce in your sandwich. LOL!

There are so many other things you could mock…like, perhaps all the false positive Covid tests. https://www.beckershospitalreview.com/healthcare-information-technology/testing-glitch-leads-to-90-false-positive-covid-19-tests-in-connecticut-5-details.html

Lots more stories on the interwebs as “proof”. I’m sure you’re capable of finding them.

Oh, btw, does anyone know if the Covid positive antibody tests are still being lumped to the positive infection rates? This would also artificially increase the case number. https://www.livescience.com/cdc-combined-covid-19-diagnostic-and-antibody-tests.html

Good day.

You can’t read well enough to understand meaning, can you?-
they are hilarious looking.

I am one of the many people who has, since March, gone out of my way, SEVERAL TIMES A WEEK, to support small businesses like those who offer take-out, delivery or now, outdoor dining.
We pick places which we already know and new ones who seem to be trying hard to stay afloat – most of them are run by immigrants from Asia, Europe or the Middle East; we deliberately avoid large corporate chains and places in high rent areas who appear to be doing just fine. We spend a lot of money doing this, more than before the crisis on purpose

The self-righteous slant of your disdain for me blinds you.

Bottom line is try to avoid places where superspreading can occur, because while you should avoid individuals who are superspreaders, you can’t tell who they are. You can tell you’re about to walk into a bar or a church full of people,

The church issue is especially interesting because of questions around first amendment. At this point we have two Supreme Court cases upholding restrictions on churches – one arguably trickier than the other – but without reasoned opinion by the majority, since it’s an interim decision.

@ Orac

“More importantly, though, it is a term that can easily take on a moral judgment and be used to blame certain individuals.”

Thank you for having a moral compass.

“The wide and varied use of the term ‘super-spreader’ is problematic for two reasons considered in subsequent sections: it can lead to apportionment of moral blame to alleged super-spreaders”.

Agreed, but perhaps this isn’t a problem if the term is applied to Trump, Bolsonaro, Johnson and other public figures whose dismal leadership has been responsible for many unavoidable deaths from COVD-19.

“Yes, there could be biological differences among people regarding how much coronavirus reproduces and how much virus is in their respiratory droplets”

“While we know that COVID-19 is mostly spread by larger respiratory droplets”

“there have been some commonalities among those who have been pinpointed as the likely source in studies. They tend to be young. Asymptomatic. Social.”

That continuum of droplet sizes though. If only it could be pinned down if greater numbers of smaller droplets (with less virus/drop) that ‘hang around’ longer is just as effective at causing infection as standing 5.9 feet away and getting sneezed on. Size of droplets upon emission, timing of evaporation thus getting smaller, penetrability.. what could be the ‘sweet spot’?

Children:

The emitters of very young human children are typically at a lower elevation than the collectors of their adult counterparts. Perhaps many of the droplets make a hard landing before having time to lighten up. Late tweens-mid/late teens were the most infectious (where did I see this?). I note that these are the years when the voice is changing, cracking.

I would not be a bit surprized to hear that vocal cords flapping around at various frequencies or quality (raspy v. swave) were generating that ‘sweet spot’ more efficiently — not to stigmatize anyone with “shut your covid-hole, ya optimal SPAT sprayer!”

Circumstance, as noted, is the biggie. Sing in the shower, choir persons — not in those escalating seats that finally cascade all of it onto the minister.

“The emitters of very young human children are typically at a lower elevation than the collectors of their adult counterparts. ”
Except for the children who are so small that they are held, putting their faces not only in immediate proximity to the holder’s face, but also in much closer proximity to the faces of other adults.

Also, very small children have yet to be trained to not sneeze or cough directly in other people’s faces.

Over here there are two main hotspots.
First of all, coal mines, which seems pretty obvious, all those people stuck in tight elevators leading underground or in even smaller rail cars (don’t know how to call it in English, there are those little railways in the mines, delivering the miners to ther workplaces). But for various reasons, mostly political (miners are very vocal and famous for coming into the capital in force and burning tyres in front of government buildings), the government did not order the mines to close, choosing to do extensive testing instead. You can guess the results – on some days more than a third of new cases are miners and their families. According to the government data, most of them are asymptomatic.
And the other ones? Weddings. Yes, that’s right. Beginning in June, the government has allowed weddings with less then 150 guests who can remain unmasked, as long as they sit at their tables with their families and keep social distancing. You can guess how well it’s been going.

It’s called a mine railway or pit railway ( or mine or pit railROAD) .
I had to look it up myself ( Wikipedia)

Your English is excellent -btw-

I had to look it up myself

The exhibition at the Museum of Science and Industry in Chicago was pretty cool when I was a kid.

And I’ll bet my bottom dollar that there was a statue of Lassie in the center of the final chamber when my parents took us to Meramec Caverns as a kid.

Orac writes;

“Enter the question of “super-spreaders.”

MJD explains,

Alcohol consumption likely affects the surface tension of saliva, and the particle size distribution of SARS-CoV-2. A higher particle size distribution increases SARS-CoV-2 agglomeration stability, survival, and its spread by aerosols.

@ Denice Walter,

Please limit drinking copious amounts of alcohol in an effort to avoid becoming a “super-spreader.” Thx.

@ MJD:

AS usual, you have no idea what you’re talking about:
my annual alcohol consumption could easily fit in a Starbucks large plastic glass.

My semi-feral black cat could generate more interesting comments on a blog.

“my annual alcohol consumption could easily fit in a Starbucks large plastic glass”

I’ve seen those…

But, hurray! Fret not, the first step to recovery is admitting you have a problem.

“plastic glass”

See what we mean??

Oh, Timmeh!

I forgot which one was Venti and which Grande.Both less than a litre anyway..

Plastic glass is much more accurate than plastic cup or container because readers can easily imagine what it looks like and thus, what I mean. What Starbucks gives you ( very mediocre) Iced tea in.

Plastic glass is much more accurate than plastic cup or container because readers can easily imagine what it looks like and thus, what I mean.

Ahem.

For those who may not have got my jib, aphantasia is a thing.

Someone mentioned The Good Doctor awhile back. When I started watching that it was like o.k. this damaged, handi-capable genious would never have been allowed into such a position — But he has a superpower! He can visualize all his medical readings and research.

Shortly after, I came across an r/TIFU where a girl friend was trying to explain her synesthesia to SO and they came to realize that he was “mind’s eye blind”. — in fMRI, there is no visual cortex activity when asked to ‘imagine’ or ‘picture this’

What? How can it be a super power if I’m the only one without this? That explains alot; no ‘daydreaming’, no ‘picture this’, no ‘counting sheep’ and no understanding “He’s totally let himself go. This is a real mission impossible for his stylist.” from only radio, and so on.

Then, I came across this:

“What is going through your mind all day, if not sights and sounds?”; answer — “All narration, all the time.”

https://www.theverge.com/2016/4/25/11501230/blake-ross-cant-visualize-things

@ Tim:

People vary widely in their ability for experiencing images/ transforming images in their minds’ eyes.

re Starbuck’s :
just google/ bing :” images of Starbuck’s drinks”. It’s the clear one.

re synasthesia:
I have a VERY limited form wherein I automatically imagine** revolving patterns of light when particular repetitive musical passages occur ( a la Phillip Glass, esp)
BUT only that.

** without drugs

Natural News is now offering a “Colloidal Silver Skin Soother” for dogs.

Now every breed can be a blue heeler.

a “Colloidal Silver Skin Soother” for dogs.

Err… For external application, or for mixing in Lassie’s bowl food? Given the claims of effect, it’s unclear.
If the former, a cheaper version must already exist, CS creams for topical application are a legit thing. Well, as a skin antiseptic. As for soothing the skin…
If the later, or if the dog just keeps licking the ointment off its skin…

Trump and Co. have gotten all riled up over masks, shutdowns, and HCQ after Limb…ehem…someone went on a frothing rant yesterday.

Oh, the tweets! the tweets! the sweet, sweet tweets!!
Oh the bans! the bans! the bad, bad bans!!

Re-tweet about the bans, retweet this person:
https://www.thedailybeast.com/stella-immanuel-trumps-new-covid-doctor-believes-in-alien-dna-demon-sperm-and-hydroxychloroquine

and this video:
https://youtu.be/Aa5isvrSqvo?t=1

FFS, it appears at this point that the only way HCQ might possibly work (in the lungs, at least) at high enough levels to stop replication without messing with the heart might be to just smoke it. Grow your own, stupid MAGAs — I hear Kalonji seeds do the trick.

Trump just devoted a lengthy response in his afternoon press conference to extolling hydroxychloroquine and defending/promoting the video from the so-called “America’s Frontline Doctors” that was taken down by Twitter, Facebook and Youtube as “misleading and false claims about the coronavirus pandemic”, after going more-viral-even-than-Plandemic; that after having been Tweeted by Don Jr. and shared by Breitbart and the Tea Party Patriots YT channel.

Trump went on and on about how hydroxy was being endorsed by “frontline doctors” as if the phrase referenced a general category description rather than a astro-turf group created a couple weeks ago by a few of his donors. And he focused on the “very respected doctor” featured in the video and how she was getting “very impressive” results curing thousands and thousands with hydroxy. He framed all of this under the rubric of him being widely read and more knowledgeable than just about anyone on hydroxy, and repeating his earlier claims that the drug is absolutely safe…

At which point a reporter who knew the skinny on Dr (?) Stella Emmanual started to ask him about her numerous outre views: “that doctors make medicine using DNA from aliens and that they’re trying to make a vaccine to make you immune from becoming religious…” At which point Trump cut the reporter off – no doubt keeping the even wackier claims noted in The Daily Beast from being being exposed to the national TV audience – re-iterated that Emmanual was “very impressive” and mumbled something about other doctors being in the video as he abruptly left the press room.

You can’t make this stuff up…

It’s something like quite a read.

“It — it’s safe. It doesn’t cause problems. I had no problem. I had absolutely no problem, felt no different. Didn’t feel good, bad, or indifferent. I — and I tested, as you know. It didn’t — it didn’t get me, and it’s not going to hopefully hurt anybody.”

Antecedents, whatever.

I hear Kalonji seeds do the trick.

The Deuce you say.

(Pardon me: It is not “black cumin.” I don’t care how much you want to put up Y—be videos about “harvesting your own,” because that is insanely stupid anywhere that somebody can see the freaking video. G-d, do hing or something.

Now, the hair angle is 100% a new one on me. I’m too tired to look up the fatty acid profile.

Just when you thought you were out… some of these kalonji hair ads have pretty much the same picture of sliced red onion, which, I suppose, could be smashed up too if one were kalonji, but something tells me that this would be quite the production line.

In any event, I don’t know how the Indian export ban has been fairing. (Vide hing for the Vaishnavas, etc.)

Now that the story of the little packets of mystery seeds that has been mailed to people all over the country and apparently hails from China has hit the networks, what about that?

Media keeps posting ‘UPDATED’ and the gamut has ranged from a vegan biological attack to “brushing” (mailing some product to your address and then using your stolen info to leave a good review for themselves).

All the articles warn DO NOT PLANT, DO NOT PUT IN TRASH and the new ones say they are being investigated.

This has apparently been happening for quite some time — How are these seeds not identified?? What are they trying to hide?? Fred the lobbying farmer at USDA, FDA, DEA, NCIS, and $(state) Department of Environmental Management is pretty handi-uncabable, after all?

I hope I get a pack so I can plant the fk out of them (in pots, of course)… could be a nice buzz.

@Tim

I would be careful if someone sent you “mystery” seeds…..

Could be Tumbleweeds, those nasty thorn-filled wind monsters.

Beware the tumbling Tumbleweeds!!!-!!!

Sombody call911, Narad hads had a stroke, or just as alcohol poisoned as myself. After $37.08, the best it came up with is that kalonji is not the most efficient use of growing yourube videos without getting fat.

Oh, pipe down. I hardly got any sleep last night, as an unholy result of anxiety meeting indigestion.

Baking soda (sodium bicarbonate). Ignore the instructions. Don’t dissolve it. It won’t eat out your esophagous. Just put a quarter teaspoon of powder in your mouth and swig it down with water straight from a running tap. Works every time.

{I don’t think this works by ‘neutralizing acid’ but by some effect on the esophagous that makes the feeling go away — for me, the effect is instantaneous though I may be singular here as I usually do it after accidentally swallowing dip.}

@Deni¢e writes, “The self-righteous slant of your disdain for me blinds you.” Woo Hoo! Now this is hilarious. Duhnice, I have no disdain for you, that takes too much energy…mocking is much more fun. You’re a fraud like Joel. I don’t miss him or his diatribes AT ALL. Good riddance.

You stated, verbatim, ” It is rather hilarious to view”. Sounds callous and uncaring to me. Hilarious means very funny. Then your snarky, “But what will they do in November? Heating fans with tents?” No, Duhnice, if this madness continues, those restaurants will be closing and replaced with more crappy franchise restaurants.

Good day.

“if this madness continues, those restaurants will be closing and replaced with more crappy franchise restaurants.”

That may be true but I’m working on a system that will deliver your order ballistically. I don’t give a shit if it arrives ‘intact’.

https://youtu.be/wW-4LU79qbU?t=1

I know my views aren’t popular, but I’ve never courted popularity.

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