Covid-19 Diary : Tuesday 31 March 2020

Some days, it is really hard to be positive when assailed with the ongoing flood of bad news, or when something that one had dared to hope was the start of a positive trend turns out merely to have been a random aberration.

I sense that many of us are feeling the same way, and the fear of things that are almost too dreadful to be spoken out loud has put many of us on edge.  While there are heartwarming stories of communities coming together, uniting against a common foe; there are also alarming stories of xenophobic reactions by towns seeking to keep “outsiders” away.  In my own little world, I sense an underlying edge of tension in many of my interactions, a tension that sometimes fights its way to the surface and causes unfortunate outcomes.

I started this diary so as to record for myself and to share with you my evolving perceptions as to what was happening and – most of all – what might happen; to separate the truth from the spin, and to better understand the overall issue.  With knowledge comes acceptance and calm, or so I hoped.

As for improving my understanding, the more I look, the less I see.  Every black and white issue collapses into a confusing rainbow of greys, and I am now very suspicious of anyone who assertively claims their opinions are gospel facts.  There are no such things – as you’ll see below, even counts of Covid-19 deaths are very subjective.

As for separating truth from spin, I’ve lost some good friends and long-time loyal and generous readers because I refuse to allow everything that is happening to be seen from the perspective of “how can we lie and twist this story to make it seem like Trump is bad/wrong/stupid”.  If he is, I’ll have no hesitation in making that observation.  But if he isn’t, I’m not going to distort our understanding of an issue so we can pretend he is.

When Britain in particular was locked in life and death struggles in the two World Wars, it had coalition governments and a united sense of purpose – we were all in it together, all to win or all to lose.  It is the same now, in the sense that what is good for one is good for all, and vice versa.  We shouldn’t be trying to score political points, and we shouldn’t be trying to distort the narrative and confuse ourselves with mixed and varying messages.  We also shouldn’t be constraining our leaders from being able to directly “tell it like it is” and instead always be worrying how their words can be twisted.

For example, I saw an account earlier today jeering about the President holding “long and rambling press conferences going over 90 minutes”.  What the story did not tell us was that the reason for the length of the press conferences was because he kept accepting more and more and more questions from the press.  The formal part of, eg, today’s conference probably lasted under 30 minutes, being presented in part by the President, VP, and Doctors Fauci and Birx.  The hour or more of additional meeting time were the people up front answering questions from the press.

How ridiculous is it to fault the President and his senior advisors for standing up and fearlessly answering questions for over an hour?

Even Death Counts are Deceptive

Britain revised its Covid-19 death counts today by changing the definition of what should be registered as a Covid-19 death – it now includes what are believed to be Covid-19 deaths outside of hospitals as well as inside hospitals (we’d noticed this anomaly last week).

I’ve often bemoaned the inaccuracy of counting Covid-19 “cases”, but have felt that at least deaths are an unambiguous measure.  A person is either alive or dead.  So it seemed death counts would be more accurate.

But, as the British revision today indicated, there can be subtle issues that cause death count numbers to vary as well.  Perhaps the biggest variable is how the cause of death is attributed.  What happens if a person dies, for example, not of cancer but of complications from depressed immune system responses as a result of the cancer and treatment for it – is that a cancer death or an immune system death, or what?  Can you give percentages – “this death was 65% caused by this factor, but that was influenced by a 25% contributing factor and another 10% general risk factor.

Another example.  A person swerves to avoid a drunk driver coming towards them.  Their car crashes through the guard rail, falls down a cliff, and the driver gets several broken limbs because he didn’t have his safety belt on.  While in hospital, he acquires an antibiotic-resistant super-bug and dies of that.  What is the cause of death?   The drunken driver?  Losing control of the vehicle?  An inadequate safety rail?  Not having a safety belt on?  Or the drug-resistant super-bug?

So, while death is an absolute, the cause of death is more complicated.  Which brings me to another ambiguity.

A 100 yr old person is in stage four cancer, and is expected to have no more than a month left to live.  They acquire Covid-19, and die.  How can that death be compared and measured alongside the perfectly healthy 25 yr old who also acquired the virus and also died?  With all respect to the 100 yr old with terminal cancer, it just takes a very small nudge to speed their journey on to the after-life.  But something that can fell a 25 yr old in the prime of good health is a massive threat to everyone.

Similar to the 100 yr old, we know there are various risk factors that can impact on a person’s susceptibility to the Covid-19 infection.  Age.  Respiratory problems.  Smoking (or am I repeating myself).  High blood pressure.  Obesity.  And assorted other things, too.  If a person scoring high on all these other issues gets and dies of Covid-19, should that be ranked the same as the healthy 25 yr old?

Should we be categorizing deaths into different categories?  How can we better track the number of deaths directly caused by Covid-19 and the amount of “influence” the virus had on other deaths?

Here is an article that talks more about the complicated issues surrounding what seemingly is a simple thing (counting deaths), and suggests that the Covid-19 death figures being cited are as much as three times higher than they should be.

The writer distinguishes between people who die “of the virus” and people who die “with the virus”.  That’s an important distinction, and in Britain at present, if you have the virus, that is cited on the death certificate, even if not the leading/proximate cause.

A second article from the same author looks at the issue from a slightly different perspective.

Our point isn’t to suggest the virus is more or less dangerous, killing more or fewer people.  It is clearly a bad thing.  We merely wish to point out that even death counts are subjective and can be interpreted different ways – not only can be, but almost certainly are being interpreted in different ways, in different jurisdictions.

So with that as preamble, should we now have our daily look at what are increasingly seen to be very flawed numbers?  Yes, we should, and in particular, while the numbers might have major issues, as long as the numbers are obtained consistently, at least we can see trends, no matter what the actual numbers should be.

But, uh oh, changes in methodology like just happened in Britain, and changing sampling rates sadly mean that the numbers are not even consistently flawed, they are inconsistently flawed, because they are changing every which way, every which day.

Current Numbers

Two big changes today.  Luxembourg moved up two places, and Spain appeared on the list for the first time, displacing its neighbor, Gibraltar (which had no new cases today), off the list.  The seven states of any size with the highest infection rates are :

• Vatican City/6 cases/7,491 cases per million (unchanged)
• San Marino/236 cases/the equivalent of 6,955 cases per million people
• Andorra/376/4,866
• Luxembourg/2,178/3,479
• Faero Islands/169/3,459
• Iceland/1,135/3,326
• Spain/95,923/2,052

I was criticized yesterday for providing the above set of data.  “No-one even knows where the Faero Islands are” was part of the comments made.

The reason for this information is to set the “worst case” limits.  I find it interesting and helpful to see what the worst case infection levels are.  If we continue to see there are no statistically significant cases of countries with over, say 10,000 cases per million, and significant slowing of new case rates way below that number, I find that extraordinarily interesting (and encouraging).  Why has nowhere gone over a 1% case rate?  How can we bridge the gap between “nowhere over a 1% case rate” and claims that 50% – 70% of the entire population may become infected?

Here are the top six major countries, showing death rates per million of population in the country.  Today saw Belgium move up two places.  It remains interesting to see the enormous three-fold gap between the top two and all the others :

• Italy/12,428 deaths/206 deaths per million
• Spain/8,464/181
• Belgium/705/61
• Netherlands/1,039/61
• France/3,523/54
• Switzerland/433/50

To put those numbers into context, the death rates per million in US/UK/Canada are 12/26/3.

There’s been a lot of anger in the press at present, seeking out someone to blame for the US having “one death every two minutes” yesterday.  But imagine if our death rate was akin to that of Spain or Italy – 15 or 16 times more than what we’re already suffering.

I know that’s precious little comfort for any of us, and also there’s an overtone of concern, because clearly our death rate has a lot of room to get worse.  But the key point to consider is that if you’re able to stay at home and never interact with anyone outside your home, directly, then you’re almost surely not going to become one of those statistics.  Most of the deaths we’re recording at present are from people who were unlucky and acquired the infection prior to broad acceptance of the social distancing guidelines, or who ignored them subsequently.  If you follow those guidelines, you’re almost certain to be just fine.

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

Here’s a screen grab taken from the Presidential Daily Briefing today.  It shows a rather optimistically shaped curve atop the daily new cases being reported in Italy.  My own “line of best fit” wouldn’t be quite so encouraging, but however you draw it, for some days now, Italy is no longer suffering skyrocketing new daily case counts.

Has Italy reached its peak for new daily cases?  The largest daily count was actually all the way back on March 21, with 6,557 new cases.  The last two days have seen right around 4,000 new cases reported each day.  Maybe, yes, Italy has peaked; although even “only” 4,000 new cases a day is an unacceptable number.  We hope that the drop in new cases will continue, and at a reasonably significant rate.

The clear implication is that if Italy can do this, then we can too.  But not yet.  Today seems likely to end up with about 25,000 cases, way up on yesterday with 20,297.

But maybe this is due to the accelerating number of tests we are now processing – the last few days have seen an average of 100,000 tests done each day.  So perhaps no cause for alarm.

I Am Not a Doctor, But….

I mentioned yesterday the doctor in New York who was treating patients with a three-drug combination, including zinc, with the zinc being in the form of zinc sulphate.

Reader Paul sent in a useful article pointing out six reasons not to take zinc for a cold, with the subheading being “This supplement isn’t worth the money or the risk of side effects”.

I totally agree, when we’re talking about colds.  But we’re not talking about colds.  We’re talking about Covid-19, something that can be deadly.  I’d certainly accept some of the occasional side effects of zinc – vomiting, stomach cramps, diarrhea, and a foul taste in my mouth if it meant I was spared from the worst of Covid-19 – a couple of weeks of intubation leading to death.

The interaction with other drugs needs to be considered, as of course do all the other points.  I also note that the NIH says that unless you’re taking zinc for medical reasons under the care of a doctor, the maximum daily limit should be 40 mg.  The dosage the NY doctor has been prescribing is 46 mg (200 mg of Zinc Sulphate, in either of its two hydrous forms, equates to about 46 mg of Zn itself).

Most of the thrust of the linked article is for people casually taking zinc, including but not mentioned, people who take it as a preventive measure during the cold season.  In general, all the zinc you need can be obtained through a regular multi-vitamin tablet (the Costco/Kirkland tablets I now have show they have exactly the 100% recommended daily amount).

I’d also caution against the “logic” of “If one tablet a day is good, surely two is better”.  That is often not the case – studies have shown that taking too much of many vitamin supplements can stress your liver and kidneys and cause much more harm than good.

Timings And Numbers

I mentioned yesterday that Worldometers reported, by its definition, the 200th country in the world has now reported a virus infection.  I thought that would probably be about all, but today, Worldometers reported another two, bringing the total to 202.  Here’s an article listing some of the other countries that seem to have been spared.

Here’s a story that isn’t a surprise – the US is finding it very hard to verify the reality of case and death counts in countries like China, Russia and North Korea.

I’ve often expressed concern about the accuracy of both the Chinese and Iranian numbers.  Here’s an article that claims Iran has had almost 15,000 deaths rather than the 2,900 officially reported.

Here’s a great map – alas, five days out of date – which shows US virus numbers in terms of percentage infection rates rather than simple numbers.  While absolute numbers are also important, from a point of view of understanding the prevalence of the virus, it is essential to see numbers as percentages.

When we see the percentages, we see a totally different picture.  We see that some of the “virus epicenter” claims are really not much more than “of course there are lots of virus cases there, because there are lots of people there” whereas some small areas have astonishingly high rates of viral exposure – look at the clusters in ID, UT and CO, for example.  Those are the places of greatest concern and also greatest interest right now – how did these small areas get such high infection rates?  What can we learn from these outbreaks in terms of how to improve our social distancing models?

Closings

This article tells us that half the world’s airline capacity has been suspended.  That’s “good”, but still not enough.  Today’s updated TSA passenger count shows that a mere 6.5% of the passenger numbers for the same day last year traveled.  The airlines need to cut their flights back much further to staunch their losses.

But not everyone agrees with me.  The DoT is complaining to US carriers that if the government is now giving them bailout funds, the airlines need to reciprocate by continuing to operate flights, whether or not the public actually uses them.

This is the sort of idiocy that used to be a big part of airline regulation, and which, until suspended due to the virus, used to be attached to the “use it or lose it” rules regarding slots at congested slot limited airports like Heathrow.

We can understand the concerns that some communities will become more isolated without multiple daily flights everywhere, but perhaps the DoT didn’t get the memo – at present we all need to be doing two things :  Making uncomfortable sacrifices galore, and desperately drastically limiting any and all movements outside the safety of our own home.

We need fewer, not more, flights.  And most of all, we don’t want to encourage the airlines to lose still more money and then go back to the government saying, quite fairly “You made us do this, so please now pay us for our extra unnecessary losses”.

Here’s a clever promotion – a Russian airline is rewarding its frequent fliers who don’t fly, but stay at home, with frequent flier miles each day.  That both encourages (to a tiny extent) people to stay at home and then gives them an incentive to start traveling again when it becomes appropriate to consider traveling again.

Now that the July Olympics have been delayed a year, no-one should be surprised that the Dubai Expo 2020 has also been delayed by a year, although the Expo was scheduled to open in October (and to run for six months).

The big signal I see from that announcement is few countries really believe things will be back to normal in October.  That’s a politically unpopular thing to say, so it is not being mentioned other than sotto voce, but clearly this cancellation suggests not to expect a miraculous return to normalcy by October.

Shortages

My sense has been that the earlier shortages and nearly-empty-shelves, together with the disappearance of toilet paper and pasta, is something that is largely over.  I was speaking with a New York stater today who said his local supermarket even had a large display of hand sanitizer and I think he said masks, too.  So I’ve not been quite as focused on this topic, while remaining aware that if things start to break down, this remains a vulnerability and a critical issue.

And then I found this article today.  It does seem to be overly alarmist, but it shows one possible direction in which we may be headed.  Perhaps the easiest rule of thumb to follow is that while our new case rate is growing each day, so should your supplies be growing too.  When we’ve hit the peak and the daily new case rate is starting to drop again, then you can start to (quite literally) eat into your supplies.

This story bemoans that private groups amassed 17.8 tons of medical gear and sent it to China on 7 February, with the State Department coordinating.  That was at a time when China was severely suffering from the virus, and Johns Hopkins was still advising there was no danger in the US (see our item yesterday).  So we think it a bit unfair to second guess the kind generosity that was on display back then.

Oh yes, besides which, we got over 80 tons of medical supplies back just yesterday, with lots more to come.  As I calculate it, on balance, we’re way ahead on the deal.

Here’s a lovely and positive article that shows how the US still can be great at manufacturing.

Logic?  What Logic?

A friend was having problem with his emails not being delivered to readers of his newsletter.  So he wrote to AOL’s email “postmaster” support, to ask for help and maybe to get his email whitelisted or something, because as far as he (and I) could tell, his email was totally conforming to all industry guidelines and best practices.

He got this message back

Email support is currently unavailable due to COVID-19 health and safety considerations for our employees. For help with an issue, search our help articles at help.aol.com.

Regards, AOL Customer Care

Is AOL the only high-tech company in the world where its workers can’t work from home?  Or is it just using the excuse of the virus to drop their usually disappointing service down another notch?

In Russia, they’ve announced a suspension of both marriages and divorces, due to the virus.  It reminds me of an interesting statistic.  More marriages break up during/after a vacation than during normal life.  The sudden “stress” of being closely thrust together with your “loved one” seems to be too much for some couples, and rather than being a “second honeymoon” or even just a simple shared experience, it can result in divorce.  The article does note that divorce rates are showing an uptick in some places already, probably as a result of increased contact time when sheltering at home together.

Another “is China telling the truth” story.  This article tip-toes around the issue, but manages to sneak in an interesting data point.  If China is now rid of the virus, as it is apparently claiming, why is is now delaying its annual national college entrance exam by a month (from early June to early July), and leaving the door open for even longer delays in Beijing and the province in which Wuhan is?

There’s only one possible answer to that question, isn’t there.

Virus?  What Virus?

Admirers of Prince Charles (apologies if I incorrectly used the plural) will be relieved to learn that the Prince has now been cleared of the coronavirus that he was tested as having a week ago.

That exposes an interesting thing.  We know that while most cases of the infection become symptomatic within 4 1/2 – 7 days, a significant portion take up to 14 days to complete incubation, and some can go out as far as 30 days on rare occasion.  Plus there’s the recent discovery mentioned yesterday or the day before that people can continue to transmit the infection for a week or more after testing clear of the infection.

The rest of the world therefore requires 14 day isolation/quarantines for people who test positive, and indeed a cogent case could be made for lengthening it.  So why does Britain only require a seven day period?

There have been several colossal “turning points” in the evolution of this global crisis where spectacularly wrong decisions have been made.  The first of course is China refusing to admit to any problems for an uncertain number of weeks/months.

The second is WHO refusing to listen to Taiwan, who told them in late January, that they had evidence that the virus was indeed being passed from person to person, something that WHO and China were at the time denying.  Two weeks later WHO was still saying it had not received any evidence of person to person transmission of the virus, allowing most of the world to therefore just sleepily look at the now obvious and skyrocketing Chinese infection as being “something over there” without considering it might pass on to other countries.

WHO’s political correctness cost us at least 15 days of time.  Today, the US had a total of  177,000 cases and 3,889 deaths.  15 days earlier, on 16 March, it had a total of 4,434 cases cases and 87 deaths.  If we’d been advised of the truth of the threat 15 or more days sooner, how many thousands of people would still be alive who are now dead?

But that is just an introduction to my main point.  WHO is still ignoring Taiwan, even now.  The virus knows no boundaries or borders, but WHO certainly does.

The problems and risks associated with going on a cruise are hopefully now universally known and accepted.  But spare a thought for people on “compulsory cruises” – sailors in the world’s navies.  Here’s an item about the growing spread of the virus on one of our aircraft carriers.

We don’t really know the extent of the virus impact on any/all of our fighting forces, because last week the Defense Department said it would stop sharing the information because it might help any present or future enemies.  We fully understand the logic behind that, but we also fear that the concern about revealing militarily sensitive information implies that the virus impacts are greater than is being vaguely perceived.

Medical

Researchers in the UK created a smartphone app where people could report their symptoms.  They are now starting to get enough data, they believe, to be able to come up with some valid analysis.  Their surprise finding is that the most significant indicator of a person having the coronavirus is loss of taste and smell.

This result contradicts other studies that has rated that symptom as only a rare occurence.  So treat this with caution, but also understand the way the logic works.  If your sense of taste/smell is normal, you still might  (or might not) have the virus.  But if you lose that sense, you almost surely do have a Covid-19 infection.

Here’s an interesting series of tweets from a gentleman who reports on some of the “treatments” China was giving to its less privileged virus sufferers.

It does raise an interesting question, though.  China is famous for its rich collection of traditional medicines – various concoctions made from barks, plants, animal parts and assorted other things, to say nothing of acupuncture, cupping, and other processes.  Why have we not seen any traditional Chinese medicinal cures appear?

Here’s another item on hydroxychloroquine that reports on a new study to see if the drug will not only help speed recovery and cure from Covid-19, but perhaps also act as a preventative to stop people acquiring the virus in the first place.  That really would be a “back to its roots” transition, because the drug was first famous for being used to prevent malaria.

We’re not going to start taking hydroxychloroquine “just in case” every day (because there are potential side effects – not enough to prevent us taking it if infected, but enough to discourage us from taking it “just in case”), but if it should transpire it has preventative properties, it would be great for at-risk workers to be able to use it.

I was interested to hear in the Briefing today Dr Fauci spoke to the story going the rounds about how the virus can travel up to 27 ft.  He was very dismissive of that claim.  He said in an extreme case, a “prize-winning” cougher/sneezer (my terms, not his) might be able to project particles about that far, but for almost everyone else, the distance was vastly less.  He didn’t seem to feel the current 6 ft distancing guideline needs to be adjusted.

We’re not going to start second-guessing the good doctor.  On the other hand, “out of an abundance of caution”, you’d do no harm to distance yourself as far as possible from other people.

I’ve several times mentioned, in passing, the danger posed by the items you buy in stores or receive in deliveries.  Here’s an article and video from a doctor who echoes my point – he suggests leaving everything outside for three days if at all possible before allowing them into your home.

Putting these last two points together, can I urge you to only go out shopping when you absolutely must.  Don’t go out every day; try and reduce your visits to once a week, and don’t linger in stores when you visit.  Know what you need, quickly get it, and quickly leave again.

Money

The Dow gave back over half its Monday gains, dropping 1.8% and settling at 21,917 at the close.

Rumors

Coincidence?  or smoking gun?  Here’s an article about Chinese virus experiments in 2014/15, in Wuhan, involving the type of viruses that are now known as the coronavirus.

For our part, we consider the accidental release of a virus from a laboratory – something that is dismayingly regular, even in the best laboratories – is a much more likely source of the infection that some weird and ill-explained process of dead exotic animals in a meat market, including animals that apparently have never been seen in the market.

And here’s another article, reporting on the matter from a different perspective.

Other

Reader Peter had suggested walking in nature as a calming experience during these troubled times.  A lot of our chances to do so have now been taken from us.

So here’s an interesting alternate concept.  Focus on some gardening.  For flowers, for food.  In an outdoor garden or on a windowsill if you’re in an apartment.

I was counting my blessings on the phone with a friend earlier today.  We were both very thankful that our respective lockdowns are in single family dwellings, with our houses being surrounded by a small amount of land, so we can at least get out and experience some fresh air, and don’t have to worry about always breathing the neighbors’ exhaled and possibly infected air.  You just know – if you can smell what they cook and what they smoke – there’s a chance you’re getting what they’re breathing and coughing out as well.

But, as fortunate as we are (and as I hope you may be, too), that is nothing compared to this gentleman.

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.