Covid-19 Diary : Sunday 19 April, 2020

 

The current sense of unreality that is always in the background came to the front again yesterday evening.  I was watching the latest season of Amazon Video’s excellent Bosch series, and whereas normally one can quickly engage in the stories and characters, this time I found myself being jarred by the disconnect between reality as we know it and the world as shown in the new Bosch season.  No-one had masks, there was no social-distancing.  I found it harder to immerse myself into a program that, while just freshly released, seemed to be a lifetime out of date, due to this.

How will entertainment display this situation?  We might not know for some time.  Production has been suspended for many soaps and other productions.

Reader Bill sent in a link to a fascinating set of charts, state by state, showing how the effective virus reproduction rate has changed over time in each state.  If the rate is greater than 1.0, that means the virus numbers are growing, and if the rate is less than 1.0, it means they are shrinking.  Clearly the objective is to get the number as far below 1 as possible and to keep it there.

Almost all states start off with a high spreading rate, then their rates drop down as social distancing measures start to take effect.  The chart above, for Connecticut, shows what we’d expect as a result.

But, perplexingly, the CT chart is the exception rather than the rule.  Yes, most states show a reducing speed of new infection rates, but then, in more often than not, the curve either stops heading downwards, or even turns around and starts to climb again.

As you can see in this chart, above, for Washington, on 31 March the reproduction rate dropped below the 1.0 threshold and cases started to decline each day.  But on 11 April the slope reversed, and now we have positive growth again.

This pattern is similar but not always so obvious in most states.  It is very perplexing because – and certainly in WA – the last few weeks have seen better social distancing compliance, stores instituting stricter distancing procedures, and a shift from no-one wearing masks to almost everyone wearing masks.  There have been no relaxations of any of the social distancing requirements (until in some states in the last day or two).  So the reproduction rate should have been continuing to steadily drop.

In theory, we’d expect to see the line continuing to descend or at least stabilize somewhere in the below 1.0 zone of new case numbers decreasing.  Why the huge shift (in WA) from a low of 0.237, which if maintained would have seen the almost complete elimination of the virus in 2 – 3 weeks?  Instead, with a current rate of 1.4, the number of new cases will treble in two weeks.

What has happened?  Several possibilities spring to mind.  The first is that greater testing is boosting the detection/confirmation of new cases – there is no actual increase in cases, just an increase in detected cases we now officially know about.  Another is that the virus has become more efficient at spreading, and a third is that some significant portion of the population is starting to “cheat” and not continue to follow best social distancing procedures, allowing the virus to start to return and grow again.

We’ve not seen any sign of cheating in WA, and we’ve not seen any discussions of a new more infectious strain of the virus.  We hope it is the first case – the benign explanation of simply greater testing.  We currently have tested 1.2% of the entire US population, with 3.9 million tests now administered.  That is twice as many tests in numeric terms as any other country, but in terms of “per head of population” several other major countries have tested twice as many people per million population.

Current Numbers

Here are the rankings for the eight states of any size with the highest infection rates.  There were no changes in ranking today.

  • San Marino/461 cases/the equivalent of 13,586 cases per million people
  • Vatican City/8 cases/9,988 cases per million (unchanged)
  • Andorra/713/9,228
  • Luxembourg/3,550/5,671
  • Iceland/1,771/5,190
  • Spain/198,674/4,249
  • Gibraltar/132/3,918 (unchanged)
  • Faroe Islands/185/3,786

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

  • Belgium/5,683/490 deaths per million
  • Spain/20,453 deaths/437 deaths per million
  • Italy/23,660 deaths/391
  • France/19,718/302
  • United Kingdom/16,060/237
  • Netherlands/3,684/215

To put those numbers into context, the death rates per million in the US/Canada are 122/42.  The world average (not a very reliable number) is 21.2.

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

Same Day
Last Week
Yesterday Today
Total Cases 1,852,257 2,330,856 2,404,866
Total Deaths/Percent of all Resolved Cases 114,194 160,754 164,925
Active Cases (ie not yet died or cured) 1,314,752 1,573,614 1,615,093
US Cases/Deaths/Case rate per million 560,300/22,105/1,693 738,792/39,014/2,232 763,594/40,527/2,307
UK Cases/Deaths/Case rate per million 84,279/10,612/1,241 114,217/15,464/1,682 120,067/16,060/1,769
Canada Cases/Deaths/Case rate per million 24,383/717/646 33,383/1470/885 35,056/1,587/929
Worst affected major country/case rate Spain/3,568 Spain/4,158 Spain/4,249
Second worst country affected Switzerland/2,937 Belgium/3,208 Belgium/3,322
Third worst Italy/2,586 Switzerland/3,166 Switzerland/3,205
Fourth Belgium/2,558 Ireland/2,989 Ireland/3,089
Fifth France/2,031 Italy/2,910 Italy/2,960

I Am Not a Doctor, But….

I’ve been criticized by some for adding my endorsement of the extreme good sense in focusing in on existing FDA approved low-cost drugs such as hydroxychloroquine to see if they could now be used to fight the coronavirus as well as whatever else they’ve been shown to do, too.

The general response/criticism is to say “but they have side effects”.  No-one is saying they don’t have side effects.  Every drug, starting with aspirin, has side effects, some of which can indeed be harmful or life-threatening, especially if the drug in question is taken in above-recommended dosages.  But particularly in the specific context of hydroxychloroquine, an 83 year old drug and the tenth most commonly prescribed drug in the US, those side effects are totally documented and understood, and accepted in most cases as being an acceptable low risk; indeed in many countries, you can buy these drugs over the counter now without even needing a doctor’s prescription.

In the interests of even-handedness, here is an article critical of using the various products in the chloroquine family of drugs.  But, at least in this article (possibly not in the source documents being used to build the article but strangely not being linked to) we’re not given any details of each of the negative studies.  The same people who are critical about insufficient detail in the positive studies now turn around and cite vague subjective comments in turn.

As I’ve observed before, at least one, possibly two of these cited studies are known to be unfair and deliberately staged to fail.  Remember, if any of the chloroquine drugs are shown to work, they are no longer patented and they cost as little as 30c – not per pill, but for a total course of medication; big pharma is very keen to shift the focus from these unprofitable potential remedies and instead to come up with new drugs costing thousands of dollars per course.

I continue to have no certain opinion about the efficacy of these drugs, and the various other well tested and accepted drugs (for other purposes) but I do know that if I should have the misfortune to fall afoul of the virus, I’ll be desperately swallowing all such potential cures.

Who Should Pay?

There’s a sharp edge to the blame game in terms of which country is responsible for the development and release of the Wuhan coronavirus that is now impacting on 210 different countries and territories, with almost 2.5 million reported cases and almost 165,000 deaths.

That sharp edge is a belief that if there can be shown to be a government level conspiracy to either develop or release the virus, or subsequently a conspiracy to hush up the release, then that government should be found liable for paying reparations to the rest of the world to compensate us all for the costs and losses we’ve all suffered.

Suing a sovereign state is a difficult thing, but one legal opinion suggests – oh glorious irony of ironies – there may be a pathway to finding China liable due to China failing to observe one of its obligations as a member of WHO that would avoid the usual type of “we’re a sovereign state so you can’t sue us” defense at the International Court of Justice.

With that in mind, it is good to see additional calls for an enquiry into the circumstances of the outbreak, this one from Australia.  The big challenge is finding a country that feels itself to be able to “safely” pursue such an enquiry wherever it goes and whatever it finds, and is willing to stand up from the extreme pressure China will bring to bear to ensure that a “correct” (as opposed to “accurate”) finding is made.

The new trade agreement between the US and China, signed on 15 January, contains a clause within it absolving China from any obligation to honor the trade agreement in the event of a natural disaster or other unforeseeable event.

The ink barely had time to dry on the agreement before China was confessing to one such thing – the virus.

Is it possible China deliberately delayed announcing the virus until after the agreement was signed so as to ensure it could be used as an unforeseeable event?  Clearly, if the virus was officially acknowledged prior to the agreement being signed, it would not be an unforeseeable event.

Timings And Numbers

Here’s some extremely good news if true.  But we find it very hard to accept the broader implications of this report, which suggests one third of participants in a Massachusetts city tested positive for antibodies linked to the virus.  If the testing is accurate (itself a point of more uncertainty than would be desirable) and if the group tested is reasonably representative, it gives us hope that more of us have already been through the virus, meaning we don’t have to worry so much about it in our future, meaning that it is even less dangerous than feared, and meaning that we’re already half-way to getting herd-immunity.

But these “if” statements are significant.  No other studies have suggested such a high level, although there was one I mentioned last week from Stanford that was saying there could be 50 – 65 times more infected people out there than we know about.  That too is “good news if true”.

Unfortunately, it seems unlikely that the Stanford study is as valid and significant as its authors hope it may be.  It seems that they’ve inexcusably failed to appreciate one of the classic considerations of any statistical sampling, per the Bayes Theorem.  Here’s a piece that explains the unconsidered error in the Stanford study.

So, with our fingers crossed, we’ll offer up another piece that suggests virus infections are more prevalent than believed.  Again we say, let’s hope it is true.

Closings

We’ve always been surprised at pictures of mass-spraying of outside areas.  We don’t know enough to say if it is likely to make much of a difference or not, but we do know that the chemicals that are strong enough to kill the virus (like the Virex II we use and recommend) tend to be powerful nasty things such as you’d not want to have blowing down-wind from the release site and into your home and lungs, and mass-spraying over cities of plane-loads of such chemicals seems unwise.

Life without Amazon? That’s a terrifying thought! In France, that is a possibility they are struggling with, due to union disputes over Amazon’s safety practices.  However, at least at present, Amazon says it is fulfilling orders to its French customers from warehouses in other EU countries.

Shortages

Here’s something we worried about a couple of weeks ago, and now starting to leak into the mainstream media.  We’re running out of drugs of all kinds, due to the increased usages at present, and lack of robustness/resilience in the supply chain.  Plus, with every other country in the world also simultaneously upping their usages and needs, it isn’t just PPE that is getting short.

Oh, guess where most of our medications come from these days?  Yes, exactly……  China.

Logic?  What Logic?

We’ve struggled to believe stories of people responding negatively to Chinese and Asian people in general, or being fearful of them in case they might be infected with the virus.  There’s just as much chance that anyone/everyone else in the country has it.

But even crazier are people who want to keep away from and shun those who have had the disease and survived.  Survivors are people who are now the least likely to get an infection, people you can safely welcome into your homes, shakes hands with, even kiss if you wish.  Well, as long as they truly are cured and free of the virus, of course.

Virus?  What Virus?

Every day we struggle to reconcile, in our own minds, the conflicting needs of stopping the virus spread and also allowing us some personal liberties and freedoms and halting the economic destruction we’re causing ourselves at present.

So we observe without judgment what is happening in Florida, and actually note reasonably good social distancing in these pictures of their re-opened beaches.  But it will be interesting to see if there are any measurable spikes in Florida’s new case counts in the next 5 – 15 days.

Medical

Talking about social distancing, here’s an interesting illustration of how (potentially viral laden and dangerous) one is spitting aerosolized droplets, even while just talking normally to someone else.

This is an interesting article which gives some general guidelines about how easy/difficult it is for virus to be spread on to another person via various “fomites” (intermediary surfaces).

The symptoms of viral infection just keep getting weirder and weirder.  I’m mentioned that foot inflammation is now a possible sign of the virus, and now that has been extended to skin rashes of all kinds.  Makes one imagine an interesting conversation prior to an intimate encounter when encountering a rash on one’s about to be partner!

Still on the unpleasant side of the virus (is there any other side) here’s an unexpected side effect – needing to have a leg amputated.  Ugh.

We have to say we don’t much like the thought of virus tests that require blood draws (or even finger pricks), and having sticks stuck further up our nose than sticks ought to go are not something we’d enjoy either.  But having a friendly dog come and give us a quick sniff would be something even people wish as delicate sensibilities as our own would probably welcome, and this article talks about trying to train dogs to smell the virus on people.

It is not known if there is a distinctive virus smell, although it seems far from impossible that dogs couldn’t “smell” the viral particles emanating from one’s breath.  But it also remains unknown as to what the danger to the dog might be – there are some ambiguous studies suggesting dogs might be able to contract the virus from people, and possibly vice versa, too.

It is worth repeating – even though there are over 110 different vaccines at various stages of development and testing, there is no guarantee that any of them will succeed.

We do draw encouragement though from all the different methodologies now being tested as different ways to stop the virus in its tracks.

Money

Sometimes largely unrelated items get juxtaposed and tell a story that was never intended to be told.  Such as, for example, the combination of being told that last year the CEO of Royal Caribbean Cruise Lines was paid over $14,000,000 last year and that the cruise line has just laid off 1,500 employees.  Or, to put it in an unfortunate and even unfair perspective, that is almost $10,000 per laid off employee that the CEO bagged in earnings last year, in large part as a result of the contributions of front line staff such as the 1,500 now laid off people.

The issue of how fairest to divide the sacrifices among people at present is one that deserves more discussion than it is getting.

Other

I’m trying to avoid as many risks as possible at present, but here’s one risk I’m going to manfully accept.

 

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.

 

8 thoughts on “Covid-19 Diary : Sunday 19 April, 2020”

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, Don

      I skimmed through the video (I hate videos, they are so time inefficient). It seems the guy just parrots and amplifies the study. That is not without value, but it assumes the study is correct to start with. The link in today’s diary entry is much more apropos – it points out the fundamental flaw in the study’s analysis.

  1. clevelandmb

    Is there any info on the % of deaths with / without / unknown underlying conditions? If say 80% had some, how much does that lower the risks for those without?
    Also any data on those that practice/don’t practice strict social distancing?

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Ugh, had a long reply and then lost it.

      So, more briefly this time, as a starting point, all data about everything is incomplete, inaccurate, inadequate. There is occasionally data cited about underlying conditions, but it is very very subjective.

      However, clearly, if 80% of deaths feature some type of underlying condition, that would seem to be good news for people who don’t start off the game behind that particular eight-ball. The most severe underlying condition of all? Age! (But of course, with advancing age is sadly increasing chance of other underlying conditions too, so maybe the age condition is not the prime factor.)

      There have been “macro” level studies of social distancing vs death rates – for example, my occasional updates on Norway vs Sweden. But asking individual patients – not that I’m aware of.

  2. lifegotinteresting

    Two quick comments.

    Your statement not to be afraid of “recovered” Covid infectees made sense with one caveat. They have been finding that (at least some) recovered patients continue to shed virus for multiple weeks. So I’d stay with the social distancing and mask-wearing for now.

    In terms of the comment that high asymptomatic infection is good, well, that’s true in terms of death rates. But we don’t know the long-term effects of Covid. We do seem to know it can “hide” in the body and cause neurological, circulatory, cognitive, and other potential problems (affecting longer-term health). I’m just saying there may be added costs to acquiring herd immunity beyond just the immediate deaths.

    I agree that if it works, using dog screening would be a game changer. A rate of 750/hour and immediate results would be great.

    As far as China goes, they are mounting a big propaganda program. Here in Asia, Discovery Channel (and to a lesser extent CNN) are airing programs that focus on China’s outstanding efforts to battle Covid, it’s intrepid scientists, etc. No humility, no accepting responsibility for what they have unleashed. Remember China has unleashed 4 different viral epidemics/pandemics in just the last 20 years. For a great many reasons we need to disengage with China.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, Peter

      You touched on an interesting point in your final comments (and in your other comments too!). It suddenly struck me last night – “All these recent viruses have been coming from China”. Why is that, one wonders.

      Do you have any references to the continued virus shedding for multiple weeks after recovery? Not saying I don’t believe you, but I’d love to read more on that topic to better understand it.

      Similarly, while I’ve read about the possibility of the virus hiding and reappearing, I’ve not yet seen any convincing study on that point. There is a possibility that the virus hiding/reappearing is simply the result of an incorrect test suggesting a person had been cured. There have been several stories about South Korean people who were cured and now are coming down with the virus a second time; to date I’ve not seen a study that convincingly establishes the cure part of that process.

      Certainly, a vaccine is better than requiring us all to “roll the dice” and get infected/hope for a low-impact infection as part of contributing to herd immunity! And, yes, this can be a terribly nasty affliction.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, Peter

      Thanks for the link. While my usual strategy is to ignore everything that comes out of China, this seems modestly persuasive. On the other hand, it is surprising that no western studies have followed up on this Beijing study, and there is absolutely no sign in any country of this study being considered and behaviors modified. I wonder why.

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