Covid-19 Diary : Monday 23 March 2020

Today’s big news – on a personal level – was WA State Governor Inslee’s “stay at home order” imposed on all Washingtonians, requiring us to stay at home except for getting food, medical visits, essential work, and some exercise.

He pointed out that following his order was mandatory and said that by doing so, we would all be saving lives.  My question to Gov Inslee is simple :  Noting that WA was the first state to suffer a major Covid-19 outbreak, and noting that many other states with much lesser outbreaks have already imposed stay at home type bans (for example, adjacent Oregon, with ten times fewer cases and twenty times fewer deaths) – how many lives could have been saved if you had made this order yesterday, or the day before?  What took you so long?

We’re one week into the 15 day period of the federal government’s strategy to combat the Wuhan virus.  There was an eruption of horror this morning by the “usual suspects” because President Trump had tweeted a concern that the Covid-19 cure shouldn’t be worse than the disease itself.  Surely this is a rational comment, and it leads back to the continual ambiguity I – and many others – feel.  Just exactly how terrible is the coronavirus?  Are we already way past the point where our responses are inflicting massively more harm onto the country than the disease itself threatens?

At the same time, there’s been another tightening up of movement and other restrictions/controls in many countries, including a national lock-down in the UK for three weeks, allowing people only to leave their homes to shop for basic necessities, medical purposes, traveling to and from essential work, and “exercise once a day” (spot the loophole in those provisions).  Additionally, the UK is copying some other countries such as Germany and banning any meetings of more than two people.

Which definitely puts context to Mr Trump’s concern about balancing the problem with the solution.  But what is right and where do we draw the line?  Is this really “the biggest challenge of our lifetime” as Scotland’s First Minister (and many others) assert?

Again, I’m weakly forced to conclude “I really don’t know”.  The only two things I can observe are :

(a)  The exponential rate of growth of this virus makes it impossible for us to make assumptions for the future based on what has happened so far.

For example, here’s an article published two days ago that suggests we’re overreacting, but already, its statistics for the virus spread in the US are totally wrong.  It refers to 276 people having died.  That number, at present, is 553.  The article concedes that maybe, “when all is said and done” there’ll be 1,000-1,200 people who have died from the virus.  A more likely outcome is that we’ll reach that total, not “when all is said and done”, but by the end of this week.

Does the writer’s totally erroneous understating of the death rate invalidate all his other comments?  Quite possibly so.

(b)  There’s a near unanimity among public health professionals that we need to be doing all that we are, and (generally) should be doing very much more.

So do we all passively accept on trust what healthcare professionals tell us?  On the face of it, that seems entirely appropriate (unless you’re an “anti-vaxxer” of course – I wonder how those types of people are viewing this virus?).  But the recommendations of these professionals need to be tempered with one small modifying factor.  These highly qualified healthcare professionals understand a lot about epidemiology and disease transmission and control.  But do they understand much about economies and the other unrelated costs and damages that their recommended measures may cause and create?

My own case, being most central to me, keeps staring me in the face.  My business has been flatlined.  My urgent future business plans have been placed on indefinite hold.  I can’t even take advantage of what remains of the strong housing market and sell my house now that we have the stay-at-home order in WA.  My income is now almost zero each month, while my basic costs of living remain substantial and unchanged or increasing.  I may be homeless and destitute by the time this all gets resolved.

The thought of a possible $1200 or $2400 handout from the government, while appealing, buys me little more than one or two weeks of survival.

I really don’t know how this is going to end.  I’ll accept that doing nothing seems like an awesomely terrible concept, and that we probably need strong rather than weak social controls, but I also am not looking forward to losing my home, my livelihood, and everything else I’ve accumulated in these last 60 years.

Perhaps there is no better way, just a series of tough choices.  Perhaps the light at the end of the tunnel really is an oncoming express train.

Lessons from the Diamond Princess

Here’s another article that seems to be heavily leaning towards the “we are overreacting” side of the spectrum.  It – and many other similar articles – cite the experience of the first of the now many cruise ship outbreaks – that of the Diamond Princess – to support its reasoning.

The Diamond Princess had 2,999 passengers and 1,045 crew, a total of 3,711 people on board.  It was quarantined in Yokohama, Japan, for several weeks, during the course of which an onboard infection of the virus grew to a total of 712 confirmed cases (ie 19.2%).  To date, there are known to be at least 11 deaths (ie 0.3%), and 140 people are believed to still be receiving treatment.  Interestingly, all the known deaths are of passengers, none for the crew.

Some people see this as being a marvelous result.  “Only 0.3% of the total population died” (even though the final count hasn’t yet been reached).  And also, “Only 19.2% of people caught the infection”.

But is this a typical case that can be used to shape our public health policy and general, national response?  We think not.

The two distinguishing things about the Diamond Princess are that it featured a total lockdown of all passengers, plus major restraints on crew movement, and provided intensive testing of anyone suspected of the disease.  It also had no new people potentially bringing new infections with them being introduced into the population, and effectively no limits on available medical resource.

We view the Diamond Princess – something which at the time seemed horrific – as actually being a “best case scenario”.  The way we read the statistics would be “even if you instantly establish a 100% perfect lockdown at the first onset of the virus infection, you may already have almost 20% of the population infected, and even in a case where there are no limits on the testing and healthcare available, you can still expect 0.3% of the population to die.  In the real world, both numbers will necessarily be higher.”

But let’s run with the 0.3% number – the “very best case” outcome.  That would still equate to over 1 million dead in the US, and that assumes we had instituted a total lockdown some time prior to today.  We don’t have anything at all like a total lockdown, even today.

So what we can learn from the Diamond Princess might instead be interpreted as “Because we’ve not yet instituted an effective national total lockdown, it is reasonable to expect that more than 20% of the country will be infected, and therefore, more than 1 million people will die – the actual number depending on when we actually do lock-down to stop the disease’s continuing daily spread”.

So we draw a completely different lesson from the Diamond Princess.  We need more, rather than less, restriction and control.

Statistics

More movements in position among the countries jockeying for places in the top six list.  The new top countries in terms of infection density are

• San Marino/187 cases/the equivalent of 5,511 cases per million people
• Faero Islands/118/2,415
• Iceland/588/1,723
• Andorra/133/1,721
• Luxembourg/875/1,398
• Liechtenstein/51/1,338

The Vatican, with its single case but high rate per head of population due to its tiny population has finally been displaced off this list by Liechtenstein.

Drum-roll please.  Our daily table now has the addition of a “same day last week” column.  What a difference a week makes (the exponential thing).  Look at the explosion in cases, especially here in the US, the highest growth rate of any of the cited examples, below.  In the US at present, in approximate figures, the count of new cases is doubling every two days.

Can you even think back to what life was like, one week ago?  Can you think forward to what life might be like in one more week?

For major countries and/or outbreaks, and in general :

It is interesting to see that while most of the news has been focused on Italy, Switzerland has been catching up to Italy in terms of infection rates over the last week.  Spain is also doing badly, and Austria is racing up the list as well.

For each of the last two days, more people have died in the US from Covid-19 than from car crashes.

China continues to show an encouragingly low rate of new cases, which it claims are almost entirely from people entering China from other countries.

The astonishing success of China is being used as a basis to “prove” all manner of different assertions as to what we should be doing so as to emulate it.  But, as always, I feel very wary at believing a word the Chinese government utters about this virus.  There was an abundance of credible evidence suggesting the government was massively downplaying the extent of the virus infection in its earlier days, which leads to two derivative thoughts.

First, it is all the more remarkable – miraculous – that if infection rates were, as has been suggested, at least ten times higher than officially revealed, that China is now down to low single digits of new infections each day.

Second, if China was blatantly lying and distorting its reality a month ago, why should we believe anything they say now?

Here’s an article that weakly suggests China’s lying and understating of cases is continuing.

Now I do understand that some of you find it hard to accept anything that appears outside of the “newspapers of record” such as the NY Times or the “mainstream media” such as CNN, but please don’t dismiss some of the articles I link to just because they aren’t your favorite news sources.

Look beyond the “messenger” and fairly consider the messages they contain – look beyond the commentary for links to source reporting.  If any article has links to source reports, check those out and validate those, and consider the original article merely a helpful collation of source information and one possible interpretation of the original data.

Who Should Pay?

Denmark has an interesting approach to its Covid-19 problems.  The government has agreed to subsidize the largest part of the would-be wages for everyone who has been laid off, initially for a three month period.  It is providing other support to companies, too.  They are hoping that within three months, the country will return to normal and their subsidies will allow everyone to go straight back to their former jobs, at companies that have been kept on life support during the three months, and the economy will quickly return to normal.

The Danish Parliament has members from ten different political parties in it, but in spite of that (or perhaps because – compromise is not so necessary with two parties, but essential with ten) all parties quickly agreed to the support package.

This article explains more about it.  We hope three months will be long enough, but are perhaps not quite as sanguine as Denmark’s politicians.  The country currently has an infection rate of 250 per million people – a high number, but the daily new cases may have stopped growing in number each day, so perhaps it is reaching the crest of its first wave of infections.

Timings And Numbers

Here’s a terrifying article about coronavirus infections now running through hospital staff in New York.  That makes the claim, within it, that the case peak might be in as soon as 22 – 32 days comparatively good news.

Closings

While we wait for an official announcement from the International Olympic Committee about the continued plans (or otherwise) for the July Olympic Games in Tokyo, it may be that by the time they decide, their decision will be no longer relevant due to the individual countries having already made their own decisions.

Already, both Canada and Australia have announced they won’t be sending teams.  Meanwhile, Japan is starting to murmur gently about the need to delay/defer the games, too.  Details here.

Update – it now seems the IOC are about to announce their plans to delay the Olympics, perhaps to next year.

Germany has announced it will ban meetings of more than two people, except for families.  It still allows people to leave their homes, as long as they keep 1.5 meters (5 ft) apart from each other.  Austria has a limit of five people groups, as does Switzerland, with a distancing requirement of 2 meters ( 6 1/2 ft).  We continue to be bemused how the EU, which demands its member countries march in lockstep with each other, has yet to create any standards regarding a response to the virus.

We wrote yesterday how Emirates announced it was cancelling all its flights, then after government pressure, revised that to say it was cancelling many flights but would still operate some, subject to various conditions which, we noted, seemed to effectively result in 100% cancellations anyway.

Today there’s another reason why Emirates, while allegedly willing to continue flying, won’t and can’t actually keep flying at all.  Its home hub airport in Dubai is closing.  Just about every EK flight either starts or ends in Dubai.

Hawaii is now requiring all arrivals to be quarantined for 14 days.  This seems to be extremely prudent and sensible, and may give the islands a chance of stemming new infection sources.  Of course, it is a much more practical measure for a group of islands, a long way from anywhere else, than it is for our entire country, with thousands of miles of unavoidably porous border on both sides.  Unsurprisingly, its lovely airline, Hawaiian Airlines, is now discontinuing all non-essential flights outside of Hawaii, while keeping its island-hopping flights more or less in place.

Both Airbus and Boeing have now shut their main airplane production lines although we gather Airbus will shortly restart again.

Shortages

I had one worrying thought after going shopping and feeling a wave of appreciation to the shop employees who were soldiering on without complaint, while simultaneously reading about how the GameStop computer game store closed all its stores as a result of employee pressure to do so.

We should all go out of our way to be careful around these people, and to thank them for reporting for work each day.  It was pleasing to read how Walmart and Target are paying bonuses and boosting hourly wages as a very tangible way of thanking their staff – a form of “danger money”, I guess.

Here’s an interesting report of what is in short supply in the Washington DC area.  We expect generally similar situations are reflected elsewhere in the country too.

One of the more alarming categories of shortages is that of medical supplies, and particularly, the “PPE” – personal protective equipment – required to keep hospital workers safe and isolated from infection.  As mentioned before, our healthcare workers are one of our most precious resources at present.  We can make new respirators, hospital beds, even entire hospitals, in a matter of hours/days/whatever.  But a new qualified nurse or doctor?  Four to eight years to get someone freshly graduated, longer to get someone with experience and wisdom.

So protecting our current healthcare workers is, we suggest, even more important that saving patients.  You save a patient, you save one person, once.  You save a healthcare worker, and you might potentially have a downstream saving of ten or one hundred or even one thousand patients.  We’re not doing a good job of protecting healthcare workers at present.

It is therefore very encouraging to see grass-roots approaches to creating new PPE for these people.  A reader sent in an email he’d received from a professional society, asking its members if they had resources that could be applied to this sort of thing.  While federal level administrators argue and, alas, sometimes clearly mismanage even simple things like sourcing supplies (how was it possible that a mask supplier had no orders from hospitals and so was supplying “spare” masks to Target, as reported yesterday), perhaps this growing “volunteer army” of people will triumph.

Here’s a slightly overwrought article about potential shortages of internet and government rationing in the UK.  However, reading through the article suggests there actually are no shortages at all, plenty of capacity in most use-cases, and no government plans to restrict things.

A strange and unnecessarily anxiety-provoking article.  But a terrifying thought, that governments could use the excuse of “not enough internet to go around” as a means to silence some of the public debate and discussion about the virus – even humble diary entries like this one.

Logic?  What Logic?

Those wonderful people at WHO (yes, I’m being sarcastic) have come up with another startling revelation.  They’ve just now discovered a stunning thing.  The rate of new people being infected with the Wuhan virus is accelerating.

For sure, that’s something I’ve been emphasizing, every day, and blindingly obvious to anyone looking at the daily counts of new infections.  And now it is official.

Virus?  What Virus?

I keep getting emails from travel companies encouraging me to travel to countries, this year, that are currently completely closed and not accepting any tourists.  Are you getting the same?

I could understand receiving a postal mailing of something that was planned months ago and in the fulfillment/delivery process for weeks.  But an email that was obviously sent seconds before I received it?

Medical

The Deus ex Machina we are all hoping and desperately waiting for is a vaccine.  We’re told one will be distributed in about 18 months, and we’re told of many companies developing possible vaccines, and even first stage trials with patients of a vaccine in Seattle.

I’ve accepted these statements at face value – so many medical scientists couldn’t be wrong, could they?  But at the same time, I’ve been slightly anxious, because the best known coronavirus of all is the common cold, and no-one has ever succeeded in developing a vaccination for that.

And now, half way through this article is an interesting statement

Winnipeg epidemiologist Dr. Cynthia Carr tells 680 CJOB while any vaccine could still be over a year away, it’s important to remember we might not get one at all, as none of the previous seven strains of the coronavirus has had a vaccine, so developing treatment is equally important.

I think one of the main points of the article is that the “Plan B” – if vaccines can’t be developed – is to develop efficacious treatments – analogous to penicillin as a counter to bacterial infections.  So if we don’t get a vaccine, maybe we’ll still get good treatments for when we do become infected with the virus.  Let’s hope so.

I have linked to a couple of fairly horrific tales from virus sufferers who have described their experiences.  But, to be fair, not all people have such severe encounters.  For many, the experience, while unpleasant, isn’t quite so bad, as this account recounts.

Here’s a fairly dispassionate report on the potential benefits of chloroquine as a treatment for infected patients.  It is important to note the final paragraph comment, although this appears to be based on people deliberately taking ten to thirty times the recommended dose, perhaps as a suicide attempt

The drug is potentially dangerous when used at high doses or for prolonged periods. It can cause permanent blindness and even death.

That’s not a reason to abandon chloroquine, it’s merely a reason to stick to the recommended doses (200 – 600 mgm/day seem to be typical).

We are puzzled that when Elon Musk praised its potential, lots of people eagerly retweeted his praise, but when President Trump echoes cautious approval, he is shouted down by people telling him he doesn’t know what he is talking about.

Here is the full report of the recently published French research.  This is what the CDC has to say on the matter.

Perhaps the most encouraging news is this article from the NY Times which says that, in addition to chloroquine, 69 other existing drugs, also approved for other purposes, seem to have possible beneficial effects when used to treat Covid-19.

If you’re over 60 in Italy, you’re out of luck if you get a severe case of Covid-19.  We’ve been writing about this unavoidable “rationing” of healthcare resources for several days, and the stress needs to be on “unavoidable”.

No-one wants to deny anyone anything, but it is a simple case of how to get the most overall beneficial return on insufficient resources and too many people requiring them.  At this point, I see no reason why we, the community, should seek to overrule the awful life and death decisions doctors are going to have to make at present.  But not everyone shares my perspective, there’s already an anticipatory lawsuit being filed in Washington State about this very matter.

Money

The Dow dropped another 3% today, closing at 18,592.

Rumors

“Above-Top Secret” military plans with code-names like Octagon, Freejack and Zodiac?  Underground laws?  Circumventing the constitution?  This all sounds like a hyper-ventilating conspiracy theorist off their meds.

But it is actually a serious article in Newsweek.  It also seems to confirm the rumors we heard last week about some “prepare to deploy domestically” orders being promulgated.  Details here.

Passenger numbers on US flights are now down 80% from normal.  This may continue to drop further, as states successively bring in lockdown orders.  But flight numbers are only down 40%.  You don’t have to be a high-paid airline executive to realize that is an untenable situation.  But which will happen more – voluntary service cuts down to match the 80% drop in passengers, or a national order freezing air services?

On the face of it, this is something that doesn’t really affect us while we’ve suspended our flying.  But it probably does, for two reasons.  First, the “invisible” passenger on every domestic flight is all the commercial flight that is in the plane’s hold.  If the flight is cancelled, how is that freight going to travel?  And the “freight” we’re talking about might range from essential medical supplies to fresh food to the item we ordered online from Amazon or someone else, to ordinary mail and correspondence.

Secondly, there’s a bit of a game of “chicken” between the airlines and the government.  The airlines may want the govt to order them to stop flying, because if that is done, they then have much stronger reasons to ask for government compensation.

Other

If you find yourself with spare time at home, and particularly if you are a senior with a “super power” (the ability to read cursive), you might find this an interesting way to spend some time each day while contributing to the public good in an unusual way.

And if all of this is starting to really truly depress you, here are some suggestions.

Please stay happy and healthy; all going well, I’ll be back again tomorrow.

Please click here for a listing of all our Covid-19 articles.