Covid-19 Diary : Tuesday 24 March 2020

It is so quiet.  Now that my state (WA) is under a lockdown, I went outside this morning and consciously listened, something I occasionally do.  Normally, when you actually force yourself to listen, you get to hear all the sounds you generally tune out – cars, trucks, motorbikes, sirens, airplanes overhead, machinery nearby, and so on.

But this morning, what did I hear?  Not the steady rumble of traffic, but instead, an occasional infrequent single vehicle disturbing the silence.  Well, not a complete silence.  I heard birds, some wind in the trees, and in the distance, the laugh and chatter of children at play.  It was idyllic and peaceful, but all things considered, I think I’d be more comfortable hearing the normal noises of everyday ordinary life as it used to be, just a day and a week ago.

Some regrettable milestones passed in the last 24 hours.  The US set a new record, both for itself and for the entire world, with over 10,000 new virus cases in a single day.  No other country has ever “achieved” that.  Italy’s worst day was 6,557, and it seems possible – even probable – that their daily new case count has stopped increasing.  It was still a terribly high 5,249 for today, but compared to 6,557 a few days ago, that’s a very welcome drop.  The best part is seeing the daily case count stabilize rather than relentlessly and exponentially increase.  Maybe Italy’s strong movement restrictions are starting to have an impact.

China’s worst ever day, apart from one anomalous day, was 5,090 new cases.  These days, new cases are under 100 a day and often under 50 a day, and largely from people coming into the country from elsewhere.

The other milestone is total worldwide cases climbed past 400,000.  In the last week, we’ve crossed 200,000 and 300,000, but now, adding another 100,000 cases no longer seems so extraordinary.

We were so pleased to see Dr Fauci back in attendance at the daily Presidential briefing today, standing closest to the President, and being invited to comment on issues.  His absence was becoming a point of concern.  But we wonder how much of that concern was generated by the media – this video clip has Dr Fauci describing his relationship with the President, in his own words as part of a television interview.  I think his own words are a more persuasive statement that anti-Trump commentators trying to create problems where perhaps none exist.

I Am Not a Doctor, But….

I’ve had some people disagree with me on this topic, perhaps because of President Trump’s qualified support for the idea.  But now that Governor Cuomo has also endorsed it, can we take the politics out of the medicine?

If you’re reading this, you’ve already self-selected as being massively more intelligent and thoughtful than the couple who heard a soundbite about Chloroquine, discovered that their fishtank cleaner included chloroquine phosphate as one of its ingredients, and so started taking it by the teaspoon-full, with fatal effects for one person.  The survivor is now blaming her husband’s death on President Trump.

You deserve to be advised of things where value judgments and caution are required.  But please don’t blame either me (or the President) for the consequences of what you do with the information being presented here.

I certainly don’t want to be blamed for any deaths!  But that “any death” door swings both ways.  Yes, for sure, there is a risk of serious side-effects extending even to death if any drug is used inappropriately, or taken in 10/100/however many times greater concentrations than is recommended.  For that matter, there isn’t a thing on this planet, starting with oxygen and water, that doesn’t impact on our body when ingested, in various ways including possibly (some might say invariably and inevitably) negatively.

Which bring me to the other side of the equation.  If there is a drug out there that generally does not harm the people taking it, and which might help people infected with Covid-19, shouldn’t we try and break free of the restrictive grip of the medical monopoly (surely the most “closed shop” of any line of business in the world) and be free to make our own risk assessments and decisions?

It is one thing to be cautious about brand new “super-drugs”.  But if there is an existing drug out there, well-known, well-tested, and free of surprises, one that has been used for other purposes and which may unexpectedly be useful in another role as well, then it seems the downside is minimal and the upside potentially significant.

So, let’s talk some more about chloroquine.  This is not some new controversial discovery.  It is a drug that was discovered in 1934, has been in general use since the 1940s, and is on the WHO Model List of Essential Medicines, a list of its “top” essential medicines, currently featuring about 450 entries in total.

Millions – perhaps even billions – of people have been taking it over the past eight decades, primarily as an anti-malarial drug, but also for other purposes such as lupus and rheumatoid arthritis.  Like every medicine, there are some side-effects, and possible combination reactions if taking with other drugs at the same time.

In the US, in 2017 in the hydroxychloroquine form, it was the 128th most prescribed medicine in the US, with more than 5.6 million prescriptions being written for it.

We’re not going to say the drug is 100% safe.  It clearly isn’t, and there is, among other side-effects, an alarming potential for permanent eye damage as a side effect.  But it is a common ordinary drug in widespread use in the US and many other countries at present, although it can only be obtained via prescription, not over-the-counter.  The only way to obtain the drug without a prescription is to go to one of the off-shore pharmacies and buy from them (see below).

It is primarily the hydroxychloroquine form that is being investigated as a possible treatment for Covid-19 infections.  Initial results appear positive.  They’re not 100%, nor are they sudden and miraculous.  But they are encouraging.

Tests have been done using this drug in combination with a moderately common antibiotic, Azithromycin.  It seems that combining the two has a stronger beneficial effect than using the hydroxychloroquine by itself.

If you decide you want to at least have a supply on hand – maybe just to have in the event of shortages later (hydroxychloroquine is already becoming scarce and rationed in US pharmacies because doctors are rushing to grab some for themselves, which is, itself, a significant thing to consider).  This would mean that if you’re diagnosed with Covid-19, and it becomes impactful/severe rather than inconsequential, you can at least discuss the option with the heathcare professionals caring for you, and if they say “Well, yes, we’d prescribe this for you in an instant, but there’s none available” you can then disclose you actually have some already.

We do not recommend you should take this daily as a preventative.

If you decide you might want to do have some of this drug on hand in case of future need, we suggest you do your own due diligence about dosage and also check to see if you’re in a category of people who should not use it, and check to see if it might react with any other medications you are currently taking.  Useful sources include medscape.com, healthline.com, rxlist.com, and others.  A quick search on Google can get you to plenty of professional reference sites.

We’re not being unhelpful, we just don’t want to get in trouble by giving medical advice.  We certainly found the information readily ourselves, and perhaps you should consider this a qualifying test – if you can develop a reasonable understanding about the dosage, the frequency of dosing, the duration of the course of medicine, and understand the side-effects and other issues, then perhaps you can become your own doctor.

If you decide to get some, then you can try asking your doctor for a “just in case” prescription.  Alternatively, you can order online through one of the off-shore companies.  A reader reports having had consistent good results with https://allinonerxmarket.com/ over a number of years, and I’ve just placed an order with http://www.canadian-pharmacy-24.com/ (which is not at all Canadian!) and will let you know how that works out, too.  I’ve never used them before, and ended up selecting them more or less as a coin toss, there are a number of other potential choices too.

There is always a danger that packages of medicines sent from overseas might be intercepted and seized by US Customs.  That has never happened to me or anyone else I know, but who knows what will happen next time.  The order I placed today included an “insurance” option – if your package doesn’t make it to you, they’ll reship it a second time for free.

I ordered some other medicines too.  I am keen to avoid doctors’ offices at present – it is hard to think of places where the coronavirus is more likely to be concentrated than a doctor’s office!  Plus, who only knows how hard/easy it will be to get an appointment as our entire healthcare system gets more and more overloaded by Covid-19 patients.

So I asked myself “What are all the prescription medicines I have had in the past and foreseeably might need again in the next couple of years”?  Fortunately for me, that is a simple short list, so I added a general antibiotic in case of a strep throat or various other type bacterial infection, and some Tamsulosin in case of (sadly, I should say “when”) I next get another kidney stone attack, declined the free sample drugs the company was keen to give me, and now am hoping to get the order delivered sometime in the next 3 – 8 days.

Cautionary note, restated :  I am not a doctor, and probably you are not one, either.  There are reasons why prescription medicines require a physician’s approval.  Of course, not all countries agree as to which medicines can and can’t be dispensed over the counter, so while our authorities believe certain drugs are “ethical” – ie, can only be dispensed by accredited physicians – that is not a universally held truth.

If nothing else, if you’re able to at least conversationally ask your regular doctor if there are any specific concerns that apply to you in particular regarding the medicines you are mail-ordering, that might be helpful.  But if you don’t have a good relationship with your doctor, they’ll probably not answer your questions and just give you the standard lecture about how you shouldn’t do any of this.

Statistics

Several changes on our top case rate list today (which I’ve now allowed to grow to seven countries), including the return of Vatican City, which had dropped off the list yesterday.  The new top countries in terms of infection density are

• • San Marino/187 cases/the equivalent of 5,511 cases per million people (no increase from yesterday)
  • Vatican City/4/4,994 (they had three new cases today which skyrocketed them back up the list)
  • Faero Islands/122/2,497
  • Andorra/164/2,123
  • Iceland/648/1,899
  • Luxembourg/1,099/1,765
  • Liechtenstein/51/1,338 (no increase from yesterday)

Worldometers has now started tracking another relevant statistic.  They’ve of course been tracking total deaths per country right from the start, but they’ve now added another column to express deaths in proportion per million of population.  This is a meaningful measure, so here are the top five countries, showing death rates per million.

• • San Marino/21 total deaths/the equivalent of 619 deaths per million
  • Italy/6,820 deaths/113 per million
  • Span/2,808/60
  • Iran/1,934/23
  • France/1,100/17

To put those numbers into context, the death rates per million in US/UK/Canada are 2/6/0.7.

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

If trends continue, tomorrow will see Switzerland with more cases per head of population than Italy.  On the other hand, it has a much lower death rate (14 compared to 113 per million).

Talking about death rates, the closed case fatality rate inexplicably continues to grow.  The percent of severe/critical cases to current cases continues to reduce and now is 4.5%, but the death rate has climbed further to 14.7%.  How/why is this happening?  Why is it not trending down, as every analyst and prediction is suggesting?  And, most of all, each day gives us more data from more sources, meaning that this figure is becoming more meaningful and statistically significant.

We’d love to see a medical professional’s take on this.  The only thing we can say is perhaps it takes longer for a survivor to be finally cleared and declared a closed case than it takes for someone who dies.  But if that was so, we’d still expect this timing discrepancy to reduce in significance as the total time series extends.  That had been what we initially observed, but then it inexplicably turned around and the death rate has been growing ever since, as you can clearly see from the chart above.

It is several days since I showed my chart that details the comparative rate of cumulative death numbers for different countries.  I’ve slightly changed the assumptions from the previous chart (I think it was shown on Saturday or Sunday), moving the data series for the UK forward one day to match its data more closely to the other countries.

I’ll just show the “overview” chart today, which is interesting for perhaps two reasons :

• Iran’s continued very slow increase in deaths, almost exactly matching that of China
•  Spain’s growth in deaths is happening faster than in Italy

Who Should Pay?

I was astonished to see Congress trying to attach various provisions to the “Save the Country from the Virus” spending bill currently being debated, to provide money for things as varied as studying airplane effects viz a viz “global warming” and/or possibly setting new emission standards on airlines (these things are changing all the time); tax credits for solar and wind energy (yet again – why no tax credits for the cleanest and cheapest form of power of all, nuclear?); mandatory voting; $300 million for migrant and refugee assistance, $35 million to the Kennedy Center, and a requirement for diversity reporting in corporations.

The list goes on and on and on.  Why do our politicians never see any spending bill without reflexively seeking to add to it, in any unrelated way they feel they can slip in.

Timings And Numbers

An interesting study was released today by a group at Oxford University in the UK.  If their assumptions are correct, then perhaps half the UK population has already been infected by the virus, and in large part, has already recovered from it.  Unfortunately, they start off their complicated research with a huge assumption – that many people will get the virus and not be hospitalized, and then in a somewhat self-referential manner, end up more or less saying “if our assumption is correct, then these numbers prove that the assumption is correct”.

That’s a meaningless statement to make.  Their conclusion is we need to be testing a large random sample of people, and testing to see not just if they have the virus at present, but if they have had it in the past too.  Those results will give validity to their assumption, or contradict it.

Their paper, which I’ve uploaded to my site and you can access here, is complex and dense for the non-statisticians among us.  But even the thought it might be true is extremely uplifting.  Don’t go giving away all your spare toilet paper just yet, but they end up saying that meaningful testing of their analysis should be possible to a degree that would reasonably confirm or contradict their analysis in the next few days – perhaps even by the end of the week.

WHO has now declared that the US has become a potential epicenter for the virus.  This article, reporting on their rather obvious statement, says that now 17 of our states have lock-down orders in effect.  How long for the other 33 to follow?

Talking about lockdowns, enormous India has a mere 519 cases and very slow growth in new cases.  But that hasn’t stopped it from also instituting a national “total lockdown” for 21 days, to ensure the virus doesn’t get out of hand.  It seems that India truly does understand the exponential curse of the virus.

They’ll probably continue to report growing cases for the next week or even two, but then as the lockdown effects start to take over, we should see them return back to a very low level of new infections.

India is definitely doing the right thing.  Why can’t our other 33 states do the same thing?

Closings

There are further collapses in air travel.  Yesterday, the TSA reported screening a mere 331,000 flyers, which is a mere 14% of the same day last year when there were 2.4 million flyers.  So we expect to see further massive cuts to airline schedules.

I heard from a friend in the Denver area.  He went to Costco early today during its one hour “for the over-60s” special opening, and saw a long line wrapped at least halfway around the building.  He also noticed a lot of “very young looking 60+ year old folk”.  I wonder if Costco – and other retailers with similar policies – asks for proof of age during their special opening hours.

He chose not to wait, and went back to it in the afternoon during ordinary hours.  At that time there was no line or crowd inside the store at all, and most of what he wanted was available for purchase.  It would be interesting to know if that experience is being repeated elsewhere, too.

Shortages

I had expressed concern yesterday that the predicted ongoing reduction in airline flights would create a crunch for commercial freight shipping.  Perhaps that was an unnecessary worry – airlines (most notably AA) are responding to the opportunity by now scheduling cargo only flights.  Good for them.

Here’s a great example of how the business community is coming together to address the desperate needs for more respirators, ventilators, and other medical gear.

Logic?  What Logic?

The idiocy of people still disappoints and dismays us.

Virus?  What Virus?

Medical

Here is a great video that shows what happens when you cough, and how far your cough impacts.

Of particular note is that most masks (ie non-respirator type masks) do not stop a cough.  They greatly reduce it, but they’re not a magical cure-all invincible shield.

While we are variously hoping and even weakly being promised cures and vaccines for this virus, here’s an important article that puts things in a more realistic context.

Money

The Dow soared today, rising 11.4% and closing back over 20,000, at 20,705.

But when you look at the last month, and in particular, since the beginning of March, occasional rallies are not unusual and the total amount lost is much greater than the recovery today.  We had been at over 27,000 before the plunge started.

Rumors

Other

This is an interesting example of what we need to be doing – monitoring everyone in the country through their cell phones and close to real-time, matching our whereabouts with those of people thought to be infected and alerting us of this.

Yes, that is ultra-invasive of our privacy.  No two ways about it.  But that privacy invasion might be an acceptable trade-off if it allows us greater freedom of movement, and simultaneously reduces the spread of new infections through our communities.

And if you think it would be impossible to monitor almost 350 million people simultaneously, well, there’s at least one three letter agency that could contradict you.

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.