Covid-19 Diary : Monday 30 March 2020

My dog was outside and started barking furiously this morning.  A quick glance at the security cameras showed an Amazon delivery driver at the far end of the long driveway and not wanting to approach any closer to where the dog was safely confined.  Can’t say I blame the driver for his caution!

Usually, if a driver’s arrival coincides with the dog being out, they come down the driveway a safe distance and leave their package on the side of the driveway, but this guy was just standing motionless at the end of the driveway.  So I went outside and walked down the drive.

I realized, when I reached the end and accepted the package from the guy that I felt a frisson of annoyance he didn’t just “safely” drop the package on the ground and keep his distance from me.  All the stories of Amazon’s problems with infected workers started rushing to the front of my mind, and I gingerly carried the package back with as little body contact with it as possible, left it outside to disinfect, and urgently did the handwashing ritual inside.

It is amazing how something as commonplace as accepting a package from a delivery man has gone from being a fun happy making event to now feeling threatening and unwelcome.

I watched the entirety of President Trump’s Sunday briefing.  His “threat/plan” (if you believe the left wing media) to open the country up (whatever that means, 99% of the controls in place are at state or county/city levels) in time for Easter has now been updated.

As you may recall, he originally announced federal social-distancing guidelines in mid March, for 15 days, expiring at the end of this month.  While he, for sure, along with every one of us would love to see all restrictions removed, as soon as possible, Easter or not, there’s no way he’ll do that if it isn’t prudent to do so.  And it is not prudent.

Rather than announcing an extension of the distancing guidelines for another half month, he has announced an extension for all of April, and went as far as to say that the new numbers and projections they are getting (alas, from not altogether persuasive models, in my opinion) is that daily death numbers will peak in two weeks, which would be Easter Sunday, and while he is extending whatever the federal policy is through the end of April, he went on to say that he didn’t expect us to reach “the bottom of the hill” (after scaling the peak around Easter) until the beginning of June.

If we have a truly effective lockdown, I think we’ll see new infections drop to a very low level within the next few weeks, although the count of new cases will be boosted as more and more people get tested.  But note not just the qualifier at the end of that sentence, but also the seven words at the start of it.  “If we have a truly effective lockdown”.

We don’t yet have that.  We have a moderately effective lockdown, and that will likely be sufficient to slow the growth in new cases and perhaps even to cause them to gradually decline, but our lockdown is full of exceptions, and also is often totally not complied with.  An example?  How about the crowds who surged to see the hospital ship, USNS Comfort, arrive in New York earlier today, while the police passively watched and did nothing until someone complained to the authorities and the police finally started to request “social distancing”.  We talk more about this in a few paragraphs’ time.

Also in the briefing yesterday, Dr Fauci said they are hoping to keep deaths to the lower end of the estimate (100,000-200,000) in their currently preferred model, and again acknowledged that all the models are only as good as the assumptions that go into them.  So if we continue with “more of the same” we might end with a total of around 100,000 deaths, while also being asked to believe the unverifiable fact that if we’d done nothing, we might have ended up with around 2.2 million deaths.

There’s a reason people love this nonsense number – it helps to justify the money now being spent.  To be fair, spending $2.2 trillion to save 2.1 million lives is actually a fair price to pay.  Except that, the true cost is some multiple of $2.2 trillion (and the true worst-case loss of life scenario probably much lower).  The $2.2 trillion is merely the amount of the cost being shouldered by the government in its one spending bill.  My guess is the real total cost is some multiple of $2.2 trillion, and of course, there’s every probability that the government is going to continue throwing money, in multiples of trillions of dollars, at the problem through the end of April and possibly even beyond.

We were also told there were 894,000 tests done as of the end of Saturday, and that part of the reason we have so many cases is that we’re now doing more testing than any other country, so we’re uncovering more cases.  There is some truth in that, but we don’t think that to be a complete truth.  We can contrast our clear highest score for cases (we have more than any other country) with our lower score for deaths (we’re fourth for deaths) to see the partial truth, but the death count is still significantly higher than in many other countries (but perhaps they will catch us up in time).

If interested, you can see the entire briefing here.

There is to be a major new policy statement from the administration on Tuesday afternoon/evening.

I’d like to come back to the social distancing topic.  The thing is we don’t actually need a “zero tolerance” policy that rigidly enforces a no-exception 100% ban on any possible close interaction between people.  This is because not all people are equal.  Wait – don’t start screaming “racist!” at me.  🙂  I mean some people have many more social interactions than other people, and some situations and activities involve many more higher risk social interactions than others.

There’s one other thing to consider.  We don’t need to 100% prevent the spread of the disease.  To effectively manage/control it, all we need to do is bring the number of new cases that each infected person creates down below 1.0.  A rate of, for example, 2.5 means that each newly infected person then infects 2.5 more people.  Then they each infect 2.5 more (ie 6.25 more), and so on.  Some studies suggest the Covid-19 virus has an infectious spread rate around about this number.

But if we can bring the rate below 1.0, this means that say, for example, with a rate of 0.75; 100 infected people (to avoid fractions) will infect 75 more people.  Those 75 people will infect 56 people.  Those 56 people will infect 42.  And so on.

Wouldn’t it be better to selectively allow some low-risk activities, while focusing on more effectively controlling the high-risk activities?  Especially if the actual mortality rate of the virus is low – could it even be as low as 0.1% (we don’t know yet), there’s not a lot of “cost” associated with an infection rate appreciably less than one, but still more than zero.   And to selectively allow some low-risk individuals, while focusing on the “super-spreaders”?  For example, a person who has had the virus and recovered and is now immune, they can now move freely anywhere and everywhere and interact with anyone.  They’ll no longer get the disease themselves, and they’ll no longer spread it to other people, either.

In terms of restricting activities, we get that some activities – sports games in arenas, for example – are high risk.  But we don’t think that walking in a park is very risky (as long as the people in the park can keep apart from each other).  Can we allow some of these “quality of life” activities rather than shutting everything down across the board as if they are all equally risky?

The concept is to “work smarter, not harder”, now in the context of our social distancing implementation.  Yes, it will probably require a high level of monitoring and privacy compromises, but if it means we can start to revive some of the shuttered businesses, and start to staunch the staggering cost of all our measures, is that not a great concept?

Here’s an article that explains the concept clearly and completely.  This is the type of intelligent “added value” approach to controlling the virus outbreak that we need to be adopting.

Here’s another take on the error-prone nature of the Covid-19 topic.  Instead of criticising the statistical analyses and projections, it points out that many of the seemingly scholarly research papers and their findings are being accepted and published at lightning speed, way before any of the normal review and editing process that is typical.  This gives some of the research findings an apparent authority they do not deserve, with mistakes already resulting in some papers being withdrawn.  Alas, the withdrawals are not always publicized, either, and then are used by the statisticians to build their models.

Current Numbers

Iceland moved up one rating, pushing Luxembourg down one.  The seven states of any size with the highest infection rates are :

• Vatican City/6 cases/7,491 cases per million (unchanged)
• San Marino/230 cases/the equivalent of 6,778 cases per million people
• Andorra/370/4,789
• Faero Islands/168/3,438
• Iceland/1,086/3,181
• Luxembourg/1,988/3,176
• Gibraltar/69/2,048

Here are the top six major countries, showing death rates per million of population in the country.  There have been no changes in rankings today :

• Italy/11,591 deaths/192 deaths per million
• Spain/7,716/165
• Netherlands/864/50
• France/3,024/46
• Belgium/513/44
• Switzerland/359/41

To put those numbers into context, the death rates per million in US/UK/Canada are 10/21/2.

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

As I mentioned yesterday, the new case growth rate in the US has now shown four days of subdued growth rates.  Yes, new cases are still growing each day, but no longer at an increasing rate each day.  There’s a temptation to say this means that we’re starting to reach the “peak”, all the more so because our testing rate is increasing.

All we can really do is observe and mention the four “better than feared” days and hope this continues.  We do expect that abundant testing may bring about what seems like a fearful ballooning of new cases.  The thing is that the “definition” of what causes a new case to be registered is changing every day, making it a terribly imprecise number to use for any sort of future predicting.  But the other obvious number, the daily death rate, has such a lengthy lag between changes in “real” new cases and subsequent deaths as to make it harder to try and correlate actions and outcomes.

The new case rate is like looking out of the front of your car while driving on a foggy freeway; the death rate is like driving with your eyes shut and having someone tell you what they saw – a minute ago.

Talking about death (as we seem to do a great deal of at present!) I added another country to the cumulative death chart matching up the growth in deaths of different countries.  The new country is Germany – there have been articles observing Germany’s very low death rate as a percentage of cases, and ascribing various meanings to that.  Better testing?  Better healthcare?  Different demographic groups affected?  Who knows what the answer may be.

We noticed an interesting thing when we added Germany to the chart.  Germany’s daily growth in deaths almost exactly matches that of the Netherlands, a country with a 4 1/2 times smaller population.  But – and here’s the unknown – at what point will the numbers stop growing in each country?  Is Germany merely several days behind the numbers in the Netherlands and will it eventually catch up and overtake it?  This is another case where we shouldn’t rush to any type of judgment just yet, much as we all desperately wish there to be “signs” and “lessons” for us to get comfort from and respond to.

This is a fascinating chart.  It compares the daily count of passengers being screened at US airports by the TSA with the same day last year, adjusted so that the day last year is the closest day with the same day of week, so we’re always comparing Mondays with Mondays and so on.

The chart speaks for itself.  It seems traffic is more or less leveling out at about 7.5% of last year, which contrasts with what we would have expected if all was normal, about 105% of last year due to projected and actual growth prior to the start of the virus impacts.

Yes, it is stunning to see the rapid collapse in air travel.  But we also find ourselves a bit surprised that there are still “so many” people traveling, and it could be said this is an interesting clue as to the overall effectiveness of the various social distancing and lockdown measures.

But – and here’s the good news, relating back to the article I linked to in my introductory comments about working smarter rather than harder at social distancing.  A 14-fold reduction in travel will get us a very long way to dropping the reproductive index (the number of new infections each infected person creates) down below the critical 1.0 point.

As passenger numbers drop, so too, but more slowly, are the number of flights being operated by US airlines.  And that is creating one of these fascinating derivative type issues/problems – things that are very hard to foresee, but directly related to the coronavirus.  Did you know that many planes send weather reports to the national weather services, giving up to date and exact information about temperatures, pressures, and winds at various altitudes as they fly over the country.  That information has helped our weather forecasting to be much more accurate than it apparently otherwise would be, and now we’re going to have to start accepting slightly less perfect weather forecasting due to less airplane received data.

Who Should Pay?

Timings And Numbers

We’d like to warmly welcome Botswana, which became the 200th “country or territory” now included in the country count methodology being used by Worldometers.  This is the first new country to be added in five days, with the slowdown in new country growth being simply due to there being fewer and fewer countries left uninfected.

How many countries remain uninfected?  Well, that depends.  As you are hopefully starting to realize from my daily dissertations, just about every number that we consider to be a “fact” is actually imprecise rather than precise, ambiguous rather than unambiguous.  Depending on the definition used, you can get anywhere from about 195 to almost as many as 300 different “countries”.  There are, for example, 193 UN members, plus two observers (Palestine and The Vatican) and two others (Taiwan and Kosovo).  The International Olympic Committee recognizes 206 countries.  The “Travelers’ Century Club” lists 327 locations that it considers as countries for the purpose of allowing people to boast they’ve been to at least 100 countries.  This includes counting Alaska and Hawaii separately from the mainland US, and Tasmania separately from the rest of Australia, or Siberia separately from Russia.

So we’ll simply say it appears that essentially the entire world is now infected.

Where and when did the coronavirus first appear?  We know that China is desperate to say “it wasn’t us”, and they’ve suggested the US actually brought the virus to China – a claim we find impossibly difficult to accept (the same as most else that China says about its virus experiences – please have a look in the rumors section below for more).

But we have seen, locally in the Seattle area, credible reports that maybe some of the old folks homes were suffering from the virus earlier than realized.  This is because no-one really seemed to be too alarmed when old people died of what seemed like the ‘flu.  But, in hindsight, it is now being realized there were higher than would be expected rates of deaths before the coronavirus was fully recognized as a potential problem.

Here’s another article about the possible earlier appearance of the virus in Italy, too.  We’ve reported on this already, and it is interesting to see it starting to get more exposure.  Yes, definitely, if necessary, exhumations would be helpful to understand and give the world peace and certainty in terms of how/where/when the virus originated.

On the other hand, confirming earlier virus-related deaths in Italy (or in Seattle) doesn’t mean the virus originated either in Italy or Seattle.  Both places have substantial numbers of people traveling to/from China; and as we’ve said, we have no way of truly knowing when the virus first appeared in China.

There have also been suggestions that Iran had the virus long before it was officially admitted.

Here are two interesting animated charts showing the global growth of the virus.

And here’s another article on the curious way in which Sweden is doing its own thing with a much more permissive approach to social distancing.  We’ll have another look at the numbers between Norway and Sweden in a few more days.

Closings

The southern part of Florida, plus all of MD and VA have now been issued with stay-at-home orders.

Shortages

Several people have asked me where I got my numbers about how many ventilators are currently in the US.  I’ve used another of sources – second hand sources such as this article, and what seems like the ultimate authoritative source as well.

By the way, do have a look at the authoritative source.  Dated 14 February 2020, this document, put out by perhaps the most reputable medical institution in the country (Johns Hopkins’ Bloomberg School of Public Health) starts off by adding a comment that no sustained human-to-human transmission of the virus had been observed in the US.

Can we blame that terribly wrong statement on President Trump?  Probably not, he had already started restricting travel from China two weeks before (31 January) and had constituted a special task force to respond to the virus threat the day before (on 30 January).  And can we cut him some slack for his early downplaying the danger of the disease when independent and ultra-credible sources like this are telling him not to worry?

There’s one other interesting point on this document, and in line with my comments, they briefly note that the potential limit on ventilator deployment is not the number of ventilators, but the number of respiratory therapists who can use them.  Surely that’s the constraint that headline seeking claims by politicians demanding more ventilators should be focusing on – getting the necessary trained staff to operate the new ventilators they are receiving.

There’s an interesting point in this article – the article itself might feel a bit uncomfortably laudatory, but the suggestion within it – use ventilators sourced from vet surgeries if there’s an unsolvable human ventilator shortage – seems interesting and sensible.

One shortage that is most definitely not yet an issue.  Gasoline.  With oil consumption having dropped 25% or more in the last few weeks, and over-production world-wide, gas prices continue to drop.

Logic?  What Logic?

We’re still a long way from rioting in the streets, and we hope that never happens, indeed, we’re reasonably comfortable that it won’t.  But, yes, we were pleased to see the federal government affirm that gun stores are an essential service that does not need to be closed at present.

Small little local challenges may arise.  Like for example, this very regrettable and totally erroneous action by some locals in Maine, objecting to people who moved there a month ago to live in their second home.

Here’s an article that was sent to us by an outraged (and, alas, now former) reader.  But we feel there is way too much outrage in the world these days, and not enough pausing for careful consideration.  The article talks about the CEO and one other senior executive of the Mount Sinai hospital in New York being now located in Florida and working from there, rather than in the hospital itself.

Does one really need to be “in the office” to lead?  With probably half the contacts these two gents make being with people outside the physical hospital itself, and at least half of the other half being contacts they’d have with people within the hospital but by phone or chat program or email, is their physical presence essential?

As for the remaining in-person interactions, now that we’ve started to have some Zoom video teleconferences ourselves (as well as using Skype too), we agree with the observation that others have made that the teleconferencing sometimes seems to be more business focused, with less trivial “stuff” interfering, and we like the teleconference experience.

We do agree though it is a bad “optic” to have the senior leadership keeping a safe distance from the hospital itself.  On the other hand, they’re practicing what everyone in the nation is preaching – older people (these two are each 72) need to be more aggressive at distancing.  One could even say that by keeping themselves safe, they’re not only ensuring they’re able to continue to lead and direct the hospital, but they’re keeping two beds in the hospital free for regular patients.

Virus?  What Virus?

There’s an interesting disconnect between the lack of any social distancing in Belarus and the increasingly strict approach in Russia.  Belarus already has a very slight lead over Russia in terms of cases per million (16 compared to 13 in Russia) even though the virus was first reported in Belarus almost a month after it appeared in Russia.

The two countries are about as close as two independent countries ever are, but (just like the EU and just like Norway and Sweden) there is again no coordination of virus response.  It will be interesting to see the numbers for Belarus evolve.

We’re uncomfortable with the growing intrusions into our constitutional rights – indeed, and it is relevant to this item, the Constitution merely records rights that are not granted to us by man but which are innately ours as a gift from God and so, therefore – at least in theory – rights we can never lose.  We also have never been comfortable with the justification “yes, of course there is free speech, but that doesn’t mean you can shout “fire” in a crowded theater”, because that analogy is invariably used to then justify a much more egregious constraint on whichever right it is that is being encroached upon.

But we do accept the common sense essential nature of us all acting in a manner during this crisis to preserve our lives and lifestyles, and the same for those around us.  If we fail to observe the current restrictions, we harm not just ourselves but other people too.

And so, never mind about separation of church and state, religious freedom, or the right to peaceably assemble.  This pastor was clearly and totally wrong, and his parishioners only slightly less so.  He (and perhaps they too) deserve to now suffer the full consequences of the law.  The pastor, in particular, is clearly a potential “super-spreader”.

Lastly in this section, here’s an interesting bit of miscellanea – submariners who have been on patrol since before the Covid-19 outbreak, and who won’t know about it until returning back to base.

Medical

In the “very important if true and common” category is this report that some patients can remain infectious after their coronavirus symptoms have disappeared.  Proper testing would mean a better evaluation of when a patient is truly free of the infection, but until that point, we have more people out there who may be infectious for longer than earlier thought.

Also in the “very important if true” category are more reports giving upchecks on the use of various forms of chloroquine by itself or with other drugs at the same time.

The FDA has now followed France’s lead and authorized the use of these drugs, and allowed the adding of 31 million doses donated by pharmaceutical companies to the Strategic National Stockpile.

While President Trump never unilaterally endorsed hydroxychloroquine as a treatment for Covid-19, many media outlets claimed he did.  While those outlets now say “It seems President Trump was correct”?

We agree that the science and proof underlying the benefits of hydroxychloroquine treatment remain uncertain, but here is another encouraging datapoint – a NY state doctor who says he has treated 699 coronavirus affected patients with 100% success.  Mind you, the doctor’s definition of success is fairly broad “Didn’t die in a week and aren’t in critical care”.

This doctor is using a three drug cocktail of hydroxychloroquine, Azithromycin, and Zinc Sulfate.  This article by him explains a little more about it and shows his dosing – note in the first article and its featured video interview, he ponders the benefit of upping the hydroxychloroquine dose, particularly on the first day, and says he thinks he might double the first day dose (as has been done in other trials) for more severely affected and more at-risk patients.

I’ve now added Zinc Sulfate to my list of emergency home remedy medicines.  It is, ahem, a growing list.

Money

The Dow rose by 3.2% on Monday, closing at 22,327.

Rumors

Here’s an interesting article about how China is attempting to rewrite the history of the coronavirus outbreak.

Whether you accept this article or any of many others, using different perspectives, one of the truisms of this outbreak is that China is being economical with the truth of its own experience with the virus.  There have always been stark conflicts between observed realities and claimed numbers.  We’ve seen video of dead bodies piled high at a time when China was claiming only small numbers of casualties each day, and more recently have seen hundreds of caskets being processed while China is now admitting to fewer than 10 deaths a day.

It total, China says there have been 3,305 deaths from the Covid-19 virus.

But, here’s an interesting thing.  The number of cell phone subscribers in China has dropped by about 20 million over the last couple of months.  Bloomberg reports a reduction of 21 million users.

An official explanation is that with the travel ban, people have not needed to have so many cell phone subscriptions.

If that is so (and we’re a bit unconvinced), how can China also explain a reduction of 840,000 landlines in use between 18 December and 19 March?  Details here and many other places.

Some observers have suggested the “official” death count of 3,305 might be understated by a factor of ten or even as high as one hundred.  But these phone subscriber counts might point to even greater mortality.

Other

We are being encouraged to practice social distancing.  But sometimes it is hard to do so.

Many thanks to reader Bill W, a gentleman who has traveled to Scotland with me in the past, for this suggestion as how best to guarantee that no-one will want to get close to you.

You know the frequent references to being as smart as a rocket scientist?  Well, apparently not all rocket scientists (to be exact, astrophysicist) are extraordinarily smart, leastways, not in Australia.

When you’ve finished laughing, here’s a nice uplifting video showing how one can have a socially distanced choir.

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.