Covid-19 Diary : Thursday 2 April 2020

 

I mentioned yesterday a surprising lack of April Fools Day jokes.  Maybe this is part of the reason.

On Tuesday I cited an article about how the virus was spreading through the crew of our aircraft carrier, the USS Theodore Roosevelt.  There’s no way you can practice social-distancing on a warship, and almost every surface is a hard surface ideal for a virus to remain viable on for an extended time.

We can only guess how many other navy ships are suffering similar problems.

The carrier has been anchored just off Guam, and the captain was clearly getting increasingly frustrated about the inactivity on the part of the Navy and his superiors, while meantime, more and more of his crew were getting infected – he doesn’t even know how many in total, due to insufficient testing and long delays in getting results.  He wrote a letter to his superiors that somehow, ahem, leaked to the press the next day.

As you can see, it was a formal and appropriate letter, asking for help in a positive way.  Once the letter was covered in the press, the navy senior leadership started scurrying around – but doing very little.

The captain knew, when writing the letter, that it was a career threatening move, but did so anyway, putting the welfare of his men above his personal career trajectory.  Like all aircraft carrier captains, he was at the very top of his career track and it was expected and almost guaranteed that he would be promoted to Admiral at the end of his captaincy.

On Wednesday, the Acting Secretary of the Navy said that the captain would not be fired.  The Chief of Naval Operations said that the top priority of the Navy was taking care of its sailors.  But now, suddenly, the Acting Secretary, at a hastily called press conference today, announced that the captain has been fired – fired by the very people who created the problem and have yet to solve it.  He said the Navy had lost confidence in the captain’s leadership and judgment.

We agree people should lose their jobs over this, but we couldn’t disagree more about the captain being one of them.  The lack of leadership and judgment is most evident further up the hierarchy and all the way to the very top.

Clearly the top priority of the Navy is not taking care of its sailors, it is taking care of its Admirals and protecting them from criticism, no matter how well deserved.

This is a terrible moment for the Navy leadership that has exposed its basest nature.

Ambiguous Deaths, Again

Remember when I discussed how even death counts were a bit ambiguous, a couple of days ago?  Well, there’s still another ambiguity creeping in to death numbers.  While we acknowledge some countries, as a matter of national policy and pride, are deliberately under-counting their case and death numbers, it seems others are also undercounting, but more due to chaos and lack of resources rather than a deliberate policy.

This article reports on how there seem to be some thousands of unreported deaths in Italy in March.  Not overtly featured, but a related fact, is that if people are dying with undiagnosed Covid-19 infections, they’re both not being counted as a case and also not being counted as a death.

That’s a problem for many of the models and predictions out there.  We’ve already said that any model that uses any Chinese data needs to be rejected as being based on unreliable data that is almost certainly wrong.  Some models have been keen to use Italian data, because it is a large data set, making it more reliable and statistically useful.  You can get smoother curves and more accuracy with larger numbers.

But if Italy’s numbers are as far off as the linked article credibly suggests, all the models and predictions that have used Italian data also now need to be reassessed.

Also today we learned that France has only been reporting deaths of hospitalized patients.  Today it mentioned there are another 884 deaths from people dying of the virus in nursing homes that have not been counted.

Current Numbers

There were no shifts in rankings for the seven states of any size with the highest infection rates, which are :

  • Vatican City/7 cases/8,739 cases per million
  • San Marino/245 cases/the equivalent of 7,221 cases per million people
  • Andorra/428/5,539
  • Luxembourg/2,487/3,973
  • Iceland/1,319/3,865
  • Faero Islands/177/3,622
  • Gibraltar/88/2,612

Here are the top six major countries, showing death rates per million of population in the country.  France and Netherlands swapped places today, France rising (due to the sudden discovery of 884 previously unreported deaths) and Netherlands falling :

  • Italy/13,915 deaths/230 deaths per million
  • Spain/10,348/221
  • Belgium/1,011/87
  • France/5,387/83
  • Netherlands/1,339/78
  • Switzerland/536/62

To put those numbers into context, the death rates per million in US/UK/Canada are 18/43/5.

Today saw the total cases exceed one million.  For major countries and/or outbreaks, and in general :

Same Day
Last Week
YesterdayToday
Total Cases529,614934,2621,014,296
Total Deaths/Percent of all Resolved Cases23,976/16.3%47,174/19.6%52,982/20.0%
Active Cases (ie not yet died or cured)382,258693,124749,296
US Cases/Deaths/Case rate per million83,672/1,209/253214,482/5,093/648244,230/5,886/738
UK Cases/Deaths/Case rate per million11,658/578/17229,474/2,352/43433,718/2,921/497
Canada Cases/Deaths/Case rate per million4,043/39/1079,677/114/25611,283/173/299
Worst affected major country/case rateSwitzerland/1,365Spain/2,227Spain/2,397
Second worst country affectedItaly/1,333Switzerland/2,053Switzerland/2,175
Third worstSpain/1,236Italy/1,829Italy/1,906
FourthAustria/767Belgium/1,205Belgium/1,324
FifthNorway/621Austria/1,189Austria/1,236

It is time for another look at Norway and Sweden.  As explained in previous reviews, Sweden has the most liberal approach of not restricting many forms of social contact of any European country, whereas Norway is following a more common restrictive approach, and has been since mid March.  We’ve been tracking both the new cases and the daily deaths in both countries, with particular focus on the daily deaths as the ultimate measure of the comparative impact of both policies.

The above chart is adjusted to reflect the difference in populations, so as to fairly compare the two countries.  As is starkly apparent, Norway’s social distancing requirements are allowing it to greatly slow down its growth in deaths.  But Sweden seems to be showing a weak exponential growth in its daily deaths.

With just about all other factors being the same, and the two countries having similar case and death counts prior to when Norway tightened its controls (and adjusting for the time it takes for such changes to flow through the system), we start to see, much as expected, towards the end of March a significant divergence between the two countries.  Is anyone, other than the Swedish authorities, surprised by this?

Who Should Pay?

Airbnb quite fairly said people who had booked rooms through their service could cancel and get a full refund.  That seemed entirely appropriate and fair.

But its hosts disagreed vociferously, seeming to think it was more fair that they should keep all the deposits and prepayments, even for people who necessarily cancelled because it would now be illegal to travel and stay at each host’s property.

That’s a telling insight into some of the greed and opportunism that is driving the rush by many people into providing Airbnb rentals.

Now it seems Airbnb has caved in and is paying $250 million to its hosts to compensate them for lost bookings.  On the face of it, this is a generous gesture by Airbnb, but we feel it is entirely uncalled for.  Why should the booking company in the middle – the company that has put huge sums of money into its hosts’ pockets, now be considered liable for the virus outbreak?

Are other booking services now reimbursing regular hotels and motels for cancelled bookings?  We very much doubt it.  But the curious symbiosis between Airbnb and its hosts is that each needs the other, and if anything, Airbnb needs its hosts more than its hosts need Airbnb, due to the steady rise of alternate services that compete with Airbnb.

So Airbnb has allowed itself to be bullied, to the tune of $250 million.  If Airbnb thinks that buys itself any loyalty from its selfish bullying hosts, I fear they’d be wrong.  Giving in to bullies never stops the bullying.

Timings And Numbers

I read an interesting paper earlier today.  It said – and I agree – that the key virus metric to monitor, so as to understand what is happening, is the daily death rate.  The article acknowledged the lag between the impact of new measures and a change in the death rate, but because most other data is unreliable, as a real-world compromise, this is the number to look at.

The article went on to say that the dividing line between not-good and terrible is to keep the daily death rate doubling at a rate of more than three days per doubling  To double in three days means each day you have a 26% increase (it compounds which is how 3 x 26% comes to a total 100% increase).

I created a chart to show the US daily death rate increase, each day, and compared it to the growth rates that imply 2, 3, 4 and 5 day doublings.  The 1.0 value line on this chart implies a steady state, and while no values were below 1, if they were, they’d signal a drop in the daily new case – that’s something we desperately hope to see.  And the 2.0 value line means doubling every day.  The dashed straight lines show the rates needed for 2/3/4/5 day doubling.

As you can see, with Italy, Spain and the UK also overlaid, the US daily death rate has often been greater than a doubling every three days.  On the basis of misery loving company, the other three countries have occasionally had “off the scale” bad days much worse than seen with the US numbers.  I’ve made the vertical axis logarithmic to “open up” the lines and to more fairly have distances match the day counts, and I’ve averaged the daily rate over a rolling two day period to smooth the jaggedness of the lines and also to recognize that there are some inconsistencies in daily reporting.

Clearly we’ve a way to go before we’re consistently below the 3 day doubling line.

Still talking about death, it is hardly surprising perhaps, as shown in this article, that Louisiana is suffering so much more severely than California.  Two words.  Mardi Gras.

Here’s an interesting story about some of the math behind the models.  If you don’t want to read it all, just remember so much of this is guesswork layered on top of inadequate data that comes complete with huge errors in how it is collated.

So it is good to know then that some of the model makers are revising their models, pretty much on a daily basis, to reflect each new day’s reality and how it diverged from their earlier prediction.  Unfortunately, what we’re seeing this week are revisions going in the wrong direction – pointing to more deaths and longer times to start entering a “recovery” phase.  (I’ll explain why there are quotes around “recovery” in a second standalone article subsequently – I think I’m finally “getting a handle” on this entire mess and it deserves its own article.)

This article states the obvious – we have lots of international visitors (and also Americans returning home from international travel).  Nonetheless, it is interesting to get a feeling for the magnitude – the sheer numbers of people crossing our border every day.  It helps explain how it is the virus was able to so securely get established in the US, with the unstoppable force of an incomimg tide washing up against a sand castle on the beach.

We see a mix of very optimistic articles predicting that as soon as this all blows over, travel numbers will rapidly recover and return to “normal”.  Indeed, some articles go even further, and suggest there’ll be a travel boom, due to the pent-up demand by people wanting to travel and all rushing to go somewhere.

We totally disagree.  With each passing day, the harm to our economy becomes more and more severe, and it is less and less likely that people will instantly find themselves back in the same situation they were in before this all started.  It seems unavoidable we’ll be in a recession, and possibly even worse.

Furthermore, we don’t think there’ll be a clear and definite date when the world says “yesterday, the virus was a problem, but today, it is now finally solved”.  There won’t be an official “All Clear”.  Rather, the perceived risk will start to reduce, and the tolerance to risk will start to increase, so we see a gradual slow build of travel numbers again, and an extended time to ultimately get back to the levels of 2019.

This article agrees with us.

Closings

China continues to post astonishingly low counts of new cases each day (today it is 35 new cases) and continues to claim that nearly every one of its new cases is in the form of someone arriving into the country from somewhere else.

But we also see articles like this, referring to China preparing for a second wave of infections.  Just another indication that all is not as it seems in that mysterious country.

To close or not to close?  This is a question to which there is never likely to be universal agreement.  A senator was today saying that a national shelter-in-place order would be an overreaction.  We’re not sure we agree, especially because we’re most of the way to that point anyway, but on a crazy uncoordinated series of state and county and even city level decisions, with different restrictions and exceptions and different expiries.

We keep in mind what Dr Fauci said a week or two ago.  “If it feels you’re overreacting, you’re probably getting it right”. We agree with him, not the senator.

Here’s an interesting series of pictures of central downtown areas of cities at noon, showing how empty they are.  Well, all except one….

Shortages

We’ve regularly pointed out the the nation’s fixation on the count of ventilators is misdirected.  We’ll run out of staff to care for the ventilated patients before we run out of ventilators, but no-one is daring to raise that as an issue.  It doesn’t have the same level of sound-bite appeal, and is harder to shift the blame to someone else.

However, there’s another dependency that might be at least as critical as the staff to support the ventilators.  The drugs to give to the sedated patients on the ventilators.  Those are running low, too.  Again, that’s not something that sounds so good in a press conference soundbite.

We’re getting “help” from frenemies as we struggle to address the pressing need for medical supplies of all types.  Russia sent us a plane load of supplies, and we’ve promised to return the favor when the tables turn and Russia finds itself in a similar situation to us.  To put things in perspective, currently Russia has 3,548 cases in total, we had over 27,000 new cases today alone.

And China has sold a plane load of supplies to Massachusetts in a very complicated deal, due to administrative issues over how the supplies should be quickly shipped from China to Mass.  The article praises China for its “cooperation” but we see so many ways that China’s cooperation could have been vastly improved.  For example, how unnecessary it was to demand that the crew of the charter airplane flight – a crew that by agreement would not leave the airplane during the maximum 3 hours China was allowing the plane to be on the ground – should have Chinese visas.

 Logic?  What Logic?

The Canadian/US border closed a couple of weeks ago to all but essential traffic.  We can understand Canada not wanting to let Americans in at present.  Canada has 11,200 virus cases. We have 242,000 cases. But why were we in the US considering deploying troops to protect us from Canadians coming across the border?  We’re at much greater risk from our fellow citizens, not from Canadians.  The Canadians should worry about us, not vice versa.

Similar logic applies to growing calls and some actions to close off state or county borders.  Why close your border if the next state has a similar virus rate?  What benefit is there from that?  If we’re to start imposing restrictions on movement that are clearly and totally at odds with the Constitution, surely we need utterly compelling reasons to do so, not just local paranoia.

Virus?  What Virus?

Shades of Fawlty Towers and “don’t mention the war”.  Even saying the word coronavirus is enough to get you arrested in Turkmenistan.  We’re not sure how this protects the country and its citizens, but apparently it is working – there is no official presence of coronavirus in the country.

But, who knows, maybe there’s an unnamed “other” virus present?

Medical

Here’s a great article that discusses the question of whether the virus can indeed be aerosolized and hang, suspended, in the air like a fog or mist.  Actually, it is no longer a question.  It is, and has been for some time, a clearly decided matter.

The article points out several key things in a generally accurate and fair coverage.

First, it highlights the appalling incompetency of WHO yet again.  WHO are still maintaining there is no aerosol type risk, even though an overwhelming body of real-world evidence conclusively shows the risk present.

Some people are suing China via a class action lawsuit through a law firm in Florida; we’d recommend suing WHO as well.

Second, the article also looks at the mask situation and asks a question that has occurred to many of us.  Why are masks essential and effective for health workers, but of no value to ordinary people like you and me?

The obvious truth has to be that everyone benefits equally from a mask, but the greater exposure risk and essential nature of protecting our precious healthcare workers should see them given first priority to masks.  But it is possible to explain that directly, rather than lying to us.  The problem with lying is that the more the authorities lie, the less we trust them, and so when it comes to important truths, it is hard to accept and distinguish the truths from more lies.

The article discusses masks in helpful detail, and points out something many people don’t realize.  Normal masks are not 100% effective.  Pick a number, any number, for how effective they are – the article suggests that a surgical mask filters 89% of viral particles, a tea towel 72% and a t-shirt 50% (a lot depends on how these things are respectively worn).

Think of masks and other precautions as akin to shifting the odds in Russian roulette.  Would you rather play Russian roulette with a revolver loaded with six bullets, or three bullets, or one bullet?  Each extra precaution you take is like removing another bullet from the revolver’s cylinder.  Most precautions are not guarantees, but they shift the odds in your favor.

Word is coming out that not all the tests are giving accurate results.  We’ve known for some time that the test kits shipped from China to Europe were little more accurate than tossing a coin, and now it seems some of the US tests are giving false negative results as much as 1/3rd of the time.  A false negative is when the test says “You don’t have the virus” but you actually do.

While a 100% accurate test would be best, if I had to choose, then “out of an abundance of caution”, I’d prefer a false positive (ie a “you do have the virus” result even though you don’t) over a false negative.

This series of comments about what a lady learned during caring for her sick boyfriend embodies some useful lessons.  Treat her medical observations with caution, but the more practical comments are very helpful.

Here’s some good news – well, good news if you’re a mouse.  One of the many possible coronavirus vaccines (the article lists three other known vaccines being developed and trialed, there are others in other stages of development as well) is providing some early promising results during testing on mice.

But don’t go thinking that means we’ll have a vaccine in our hand in time for Christmas.  That’s almost surely not going to be the case.

Money

The Dow weakly recovered today, nosing up 2.2%, and closing at 21,413.

Other

Elon Musk got a great dose of adoring press for saying that Tesla was going to supply ventilators to hospitals, free of charge.  But the devil is in the details – something that isn’t always his strongest suit.  It turns out he bought a bunch of second hand/surplus BPAP breathing machines, stuck Tesla labels on them, and sent them on.

But they were BPAP machines, not ventilators, and medical advice has advised against using them because they tend to increase the risk of viral contamination in the exhaled air flow.  So they won’t be used.

We’re glad SFO decided to “save the population” rather than “save the planet”.  It must have been a difficult decision.

Here’s a nice video distraction if the days are starting to pass slowly – watching live-streaming from Sydney’s excellent Taronga Zoo.

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.

 

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David.