Covid-19 Diary : Saturday 25 April, 2020

We are all desperately searching for some sign that the US infection is coming under control.  But that sign remains absent.  Yesterday saw a new daily high figure for cases reported (38,958 new cases); this is dismaying and suggests a return to “the bad old days” because the second highest number (34,517) was three weeks prior, on 4 April.  Except that, ooops, with today’s official counting now closed, today we now have the second highest new case count (35,419).

It is true that the new case count is very much influenced by testing, and as we increase testing rates, it is likely we’ll be increasing newly discovered virus cases each day, but it is surprising to see an almost 20% jump from the immediately previous days.  One elevated count can be random chance, two elevated counts in a row could also be random chance, but they might also be a significant indication of an unfortunate restrengthening of the virus spreading.

Death rates might be slightly subsiding, and that is of course the ultimate measure to focus on.  But at around 2,000 deaths/day, and with now 54,256 deaths reported, it seems the current IHME projection for 67,641 total US deaths, which has been drifting upwards in their last few revisions, might still be on the low side of the actual number.

The clear reality is that both new case numbers and death numbers have been staying fairly level each day for almost three weeks.  If your glass is half full, you’re pleased that numbers have stopped their rapid rise.  But if your glass is half empty, you wonder and worry why we’ve not been able to get beyond the first step in this (halting the growth in numbers) and move to the second step (starting to reduce the new case and death counts each day).

It seems the last three weeks have been totally wasted in terms of achieving anything of clear certain benefit.

This is abundantly clear if you go to the excellent rt.live site and look at the daily case rate increase/decrease, state by state (immediately below the first chart).  Remember that numbers above 1.0 mean the rate of new infections is increasing, and numbers below 1.0 mean each day has fewer new infections.

Every state should be showing nice green lines, and either stable or going down lower.  But, as you can see, while essentially all states have had their curves drop from the first few weeks of analysis, many have seen the curves reverse and start to go up again, or flatline and neither rise nor fall.  Are we winning the battle against the virus, or are we actually losing it at present?

It seems inevitable that any reduction in social distancing requirements will see the infection rate go up somewhat.  If a state is currently comfortably in the green, it can withstand a slight increase and still stay green.  But if a state is right around 1.0 – or even above it – then lessening of restrictions will see the line move further above 1.0 and the daily count of new cases start to run away again.  It is too soon to lessen restrictions.

I had another sudden epiphany this morning.  Masks.

Wearing a mask is the lowest cost, least impactful, and most effective protective measure available to us at present.  We must do this whenever we are outside our safe home environment.

Here’s an excellent article that gives a great explanation of the entire topic, and this is a similar article also very well worth reading.  Please do read one or the other and ideally both.

Wearing a mask fits within what I call the “work smarter, not harder” framework of disease control.  I’ve written about this before, and yesterday was calling for sensibly prioritizing how we approach a gradual return to normalcy.  Our current method prioritizes allowing high-risk behaviors that have within them only small economic benefit.  We’re doing this exactly wrong.  We should first allow low-risk behaviors that have large economic benefits.

If we wear masks when in public, the risk of a virus rebound is greatly reduced, and if we selectively open high-economic impact activities with low associated risks first, we can quickly make major steps in returning our lives and economies back to normal.

This is not rocket science.  It is stunningly simple and common sense.  So why isn’t it being done?

Current Numbers

Here are the rankings for the eight states of any size with the highest infection rates.  Today we have another major country added to the list – originally these highest case count countries were statistical anomalies in very small countries where just a random handful of cases was enough to push their rate sky-high (Vatican City in particular) but as you can see, the list is now taking on heavier hitters, including the addition of Belgium today.  Also worthy of note is that Ireland might soon appear on this list too.

• San Marino/513 cases/the equivalent of 15,119 cases per million people (unchanged)
• Vatican City/9 cases/11,236 cases per million (unchanged)
• Andorra/738/9,552
• Luxembourg/3,711/5,928
• Iceland/1,790/5,246
• Spain/223,759/4,786
• Gibraltar/136/4,037
• Belgium/45,325/3,911

Here are the top six major countries, showing death rates per million of population in the country  :

• Belgium/6,917 deaths/597 deaths per million
• Spain/22,902 deaths/490 deaths per million
• Italy/26,384 deaths/436
• France/22,614/346
• United Kingdom/20,319/299
• Netherlands/4,409/257

To put those numbers into context, the death rates per million in the US/Canada are 164/65.  The world average (not a very reliable number) is 26.1.

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

I Am Not a Doctor, But….

Here’s another mention of Ivermectin as a virus cure.  Like hydroxychloroquine, it is an ‘off the shelf’ drug that has been around for a long time and is on the WHO list of essential global medicines, so there’s no need to be too concerned at new side-effects over and above the already well-known ones.

If Ivermectin truly does work as well as this and other articles claim, it could be very impactful.  It is low cost and low impact (probably it is something that you’d take one single dose of – by mouth – and nothing more.

Closings and Openings

Belgium has decided it is time to start relaxing its lockdown rules.  This is a very surprising decision, because it not only has the world’s highest major-country death rate, it is also still experiencing large numbers of deaths every day.

Belgium has a population of 11.5 million, so yesterday’s count of 238 deaths would be the same as if the US reported 6,830 deaths in a single day.  To put that in context, our highest ever day was 2700.

The country is also continuing to report large numbers of new cases reported each day.  I’d advocated an objective to get cases ideally down to one new case per million people per day prior to reopening, which would be 11.5/day for Belgium.  Yesterday they reported 1,032 and the day before was 1,496.  So they’re reporting new cases at about 100 times the rate that would support generally relaxations of lockdown requirements.

We’re not sure this is a good idea.  Details here.

There’s another issue when it comes to how a country starts to selectively re-open itself again.  There’s little point in allowing a business to reopen unless the suppliers and customers of the business have also re-opened.  This is an under-appreciated point.  When there were generally blanket “shut down everything” orders, it was not considered; but with selective re-opening, we can only imagine the frustration and futility of allowing companies to reopen but then having them with no customers to sell to and no suppliers to buy from.

Shortages

It seems every day is bringing out more bad news and still more bad news about coming shortages of meat and other protein sources.  If you missed it before, perhaps now is a good time to consider buying a(nother) freezer and reading my article about what to look for when buying a freezer.

Logic?  What Logic?

It has been suggested it is safer to dine in a restaurant than to eat at home.  That’s certainly a bold claim to make, and we wonder if the person making it might be slightly biased – he is a French chef.

Medical

It is very encouraging to learn the UK is ordering 50 million tests to see if people have already had the coronavirus disease or not.  The UK has a population of about 67 million, so this would be enough to test 75% of the population once.

There are some minor quibbles about this, though.  First, we’re not told what the test’s accuracy rate is – many of these types of tests have been shown, in the past, to be woefully inaccurate, either (or both) in the sense of whether or not they accurately show the status of a person who does have antibodies, and the status of a person who does not have antibodies (two totally different test situations).  Some error would be acceptable, and as long as the results are reasonably close to correct, it would be a very helpful measure of the disease spread throughout the UK population.

The other quibble might be more major.  We don’t yet know if having had the disease once gives that person immunity, and neither do we know, assuming any immunity is bestowed, how long it might last for.

Here’s yet another “terrible news if true” thing.  It is possible that virus particles are attaching themselves to pollution particles and spreading through the air that way.

There have been noticeable correlations between higher than normal viral spreads and higher than normal levels of pollution, but there could be other explanations for this as well as the virus spreading on pollution particles.

Rumors

Who doesn’t remember the famous case of the man who stupidly drank fish tank cleaner “because President Trump recommended it”?

Here’s an interesting article about that case, and it is clear that the article is trying to hint about something without incurring any risk of libel.

Other

We’ve noticed, when we wear a mask, we seem to be rebreathing an appreciable amount of the air we breathe out, and we’ve wondered about the potential consequences of that.

Turns out there may be problems, with some masks, and for some people.

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

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