Covid-19 Diary : Thursday 23 April, 2020

 

There’s a minor change to the headings in today’s diary entry, but the underlying meaning is profound.  I’ve changed “Closings” to – well, you can see, below.  But it is a joyless change – the thought of re-opening establishments prematurely threatens to just drag us all further down into the mire, and extend the overall pain and confusion of everything.  As you’ll also see below in a graph, while the US seems to have happily stopped growing its daily new case count, there’s no clear sign that the cases are dropping.  Sure, various explanations such as “we’re testing more now so we’re detecting more now” can apply with reasonable validity, but it sure would be heartening if we could start to see an obvious and steady decline.

I’m introducing a new section, too that might appear semi-regularly if it proves popular.  After the piece a couple of days ago about how listening to music you like might strengthen your immune system, I thought I’d occasionally mention a piece of music that might help, and to start off, we’ll revisit what is Britain’s most favorite piece of classical music (I’d mentioned it in the opening comments on 13 April).

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/501 cases/the equivalent of 14,765 cases per million people
  • Vatican City/9 cases/11,236 cases per million (unchanged)
  • Andorra/723/9,357 (unchanged)
  • Luxembourg/3,665/5,855
  • Iceland/1,789/5,243
  • Spain/213,024/4,556
  • Gibraltar/133/3,948
  • Faroe Islands/187/3,827

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

  • Belgium/6,490 deaths/560 deaths per million
  • Spain/22,157 deaths/474 deaths per million
  • Italy/25,549 deaths/423
  • France/21,856/335
  • United Kingdom/18,738/276
  • Netherlands/4,177/244

To put those numbers into context, the death rates per million in the US/Canada are 151/57.  The world average (not a very reliable number) is 24.5.

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

Same Day
Last Week
YesterdayToday
Total Cases2,177,2952,637,6732,718,139
Total Deaths145,304184,217190,636
Active Cases (ie not yet died or cured)1,485,5541,735,8311,782,004
US Cases/Deaths/Case rate per million675,527/34,522/2,041848,717/47,659/2,564880,204/49,845/2,659
UK Cases/Deaths/Case rate per million103,093/13,729/1,519133,495/18,100/1,966138,078/18,738/2,034
Canada Cases/Deaths/Case rate per million29,929/1.191/79340,190/1,974/1,06542,110/2,147/1,116
Worst affected major country/case rateSpain/3,956Spain/4,457Spain/4,556
Second worst country affectedSwitzerland/3,089Belgium/3,614Belgium/3,693
Third worstBelgium/3,003Ireland/3,376Ireland/3,566
FourthItaly/2,794Switzerland/3,266Switzerland/3,293
FifthIreland/2,688Italy/3,098Italy/3,142

We saw a headline somewhere earlier today about China experiencing a new regional outbreak somewhere in the north of China.  That is entirely unsurprising.  But then we also saw that yesterday China reported 30 new cases and today China has reported 10 new cases, and no additional deaths on either day.

If that’s a regional outbreak, well, let’s just say we wish our outbreaks were of similar size, rather than the 30,000+ new cases and 2,000+ new deaths we’re currently reporting every day.

I Am Not a Doctor, But….

Here’s a mildly interesting article which features an interview with the President of Senegal (the interview is in French with English simultaneous translation).

Of course, he is using the virus as an excuse to demand the world forgive his country’s (and probably all of Africa’s) accumulated debts, something Africa loves to hope for on a regular basis.  But he slightly weakens his case when he boasts about how successful his country has been in controlling its Covid-19 outbreak, with currently 479 reported cases and 6 deaths, which brings up the more interesting point.

The Senegal death count in particular is much lower than the world average (1.3% compared to 7% if simply matching deaths to total reported cases).  While the numbers are very low for both cases and deaths in Senegal, meaning there’s not a lot of statistical significance in the 1.3% calculation, it is more than five times lower than the world average.

Why is that?  The President tells us that all patients are promptly treated with hydroxychloroquine.  Sure, this isn’t a clinical study, but it is still another positive observation.

Who Should Pay?

Here’s a Wall St Journal article worrying about a return of inflation.  We echo their fear about something that seems inevitable.

While $280 billion is chump change compared to the trillions the government is spending, there is still a feeling of unfairness when we read this article about how America’s billionaires have increased their net worths by $280 billion since the start of the virus impacts.

Timings And Numbers

I wrote yesterday about the implications of discovering a new “Patient Zero” who died of the coronavirus back on 6 February.  I did some quick figuring from that data-point, including what we know about how many people each infected person in turn infects, and the cycle of infection from one person to the next to the next, and added in new chains from other early infected people, and came up with a guesstimate that there could have been, in late March, 100 times more people who had been infected by the disease than were officially reported.

This very inaccurate guess was interesting and, if nothing else, provided another route to confirm the claims, based on sample testing in California, that perhaps there are 50 times more cases in California than are known.

Today there is another study that suggests when the first case in New York was identified, there were already 10,000 infections undetected in New York, with similar situations in other cities too.

This new study doesn’t seem to then look forward from those early numbers to suggest the implications for the gap between reported/known cases and total unknown cases today.  But it would seem reasonable to infer that if there were 10,000 times more cases than were known back then, there are still many more cases than are known, now, because there hasn’t been any sudden spike/shift/adjustment in case numbers.  The daily growth in case numbers has been steady and consistent with the concept of a growth in known cases only, with presumably a similar growth in unknown cases at the same time.

On the other hand, if we take the current number of known cases (880,000) we can only increase that 375-fold before we end up with the entire population of the US having been already infected.  That is impossible, because we’d start to see a significant decline in new cases as we approached the point of herd immunity (thought to be 60% of the population or slightly more).

As you can see from the chart above, we may have reached a leveling off of new cases in the US, but we’re still a long way from seeing an appreciable decline.  We also think it more likely that the leveling off is due to social distancing rather than approaching herd immunity.

It is also very interesting to look at the state by state growth/decline numbers on this site.  It shows 13 states with declines, another six right at or very slightly below steady state (ie case counts starting to decline every day), another seven right at or very slightly above steady state (ie case counts still increasing every day), and the other 25 states with still clear daily increases in new cases.

Another glimpse at a possible underlying reality also comes from New York.  Semi-random sampling of people at grocery stores suggests 14% of everyone in the state have coronavirus antibodies, which implies they have already had the virus.  This contrasts with an official case rate of 1.4%, which suggests ten times the number of actual cases compared to reported cases.

There are almost certainly not 10,000 unknown cases for each known case.  We’re not even convinced there are 50 unknown cases for each known case.  But we will accept there is some significant number of unreported cases out there, and the ten-times number in the study cited immediately above feels supportable.

Because herd immunity is one of the possible “exit strategies” from this virus, there is a desperate need to better understand how many people have had the virus and so at what rate we are approaching herd immunity.  It is also important to acknowledge there is not yet any guarantee that herd immunity will ever become a thing – think, for example, of the common cold (also a coronavirus).  With the cold, there’s neither a vaccine nor a “once you’ve had it, you’ll never get it again” type of immunity either.

Here’s an interesting article that takes a different approach to calculating Covid-19 deaths.  It looks at the average number of deaths that would be expected, and simply says “anything over this number is Covid-19”.

That is an approach that is open to criticism, but it is no worse an approach than any of the other ways of counting Covid-19 deaths, and better than many.

The result of the analysis is to suggest that the official death count has under-reported Covid-19 deaths by at least 28,000 in the last month across a selection of selected cities and countries.  The article didn’t total up the official death counts, but they are about 52,000, so this adjustment adds adds another 54% to the numbers in the selected areas.

This shouldn’t be extrapolated to apply to all reported deaths, everywhere, and really all it boils down to is another measure showing problems with counting deaths.

Closings and Openings

It has been interesting to see the comments of the Las Vegas Mayor.  She has advocated for the re-opening of her city, including casinos, restaurants, and conventions, and offered up the city as a “test” to see what would happen with reopening.

The surprising thing is that almost no-one will publicly support her desire to re-open the Strip right now (which actually is not in the city limits of Las Vegas anyway).  The state governor, county commissioners, the congressman, and assorted employee unions have all denounced her call.

So we wonder just exactly who is calling for accelerated business re-openings, anywhere?  Details here.

Actually, we can answer that last semi-rhetorical question.  The governors of GA, SC, TN and OH have said they are starting to allow businesses to gradually re-open.  Colorado expects to start opening things on 1 May.  These openings are all weeks, even months, ahead of the re-opening guidelines offered in the IHME model projections, although the model is not proving to be very robust.  Details here.

Shortages

The thing that is perhaps most seriously in increasingly short supply at present?  Jobs.  The last week saw another 4.4 million new claims for unemployment, bringing the total new claims over the last five weeks to 26.5 million.

Computer monitors, yeast, barbells, kombucha and tortilla shells.  Can you guess what these items all have in common?  They are on a list of unexpected items that are in short supply at present.

Here’s an interesting and perhaps amusing perspective on the evolving nature of what is in short supply.

Logic?  What Logic?

We all know the simple concept of how difficult it it to prove a negative.  China knows that, too.  And so now China is demanding that before we start blaming itself for being where the Wuhan coronavirus originated from, we first must prove that it didn’t originate in the US.

The problem is, of course, that if we give in to that demand and somehow (don’t ask me how) we prove it did not originate in the US, it seems a certainty that China will then shift to each and every one of the other 200+ countries in the world, one at a time, serially accusing each of them and demanding they too prove their innocence.

A much overlooked issue in our response to the virus outbreak is the appalling ineptitude by schools in shifting from classroom to distance learning. I’m seeing it with my high-school daughter every day.  In Washington, the schools were closed state wide on 12 March, but it is only this week they are starting to offer “remote learning”, six weeks after closing.  The remote learning is disappointing because there are no Zoom meeting type live lessons or other interactive teacher led experiences, instead there is just lesson materials and assignments for students to do individually.

So, I’d give the school system in WA an F for their ability to respond to their closures.  But what about the impact on the students and their grades?  Well, the school system is more forgiving than I am.  The Seattle School District has decided that their students will be given either “A” or “incomplete” grades, and the state Superintendent of Public Instruction has told all schools they are not allowed to fail any students.  No student failures, perhaps, but surely another massive failure on the part of a public service.  Details here.

Virus?  What Virus?

Remember the American Airlines flight a couple of weeks ago where they crowded the dozen passengers all into the last few rows of the plane rather than spreading them out through the cabin?

Well, AA is at it again, this time managing the quite difficult feat of almost completely filling a plane for a flight from Miami to LaGuardia.  Unlike in Canada, where all flights now require all passengers to wear masks from before boarding until after deplaning, there was no such requirement and so people were packed in like sardines, same as in “the good old days”.

AA also says it will continue to sell most seats on its flights.  They conceded they would block out half of the standard middle seats on a plane, but read that statement carefully.  Half of the standard middle seats.  But none in any of the premium parts of coach class.  So, in other words, we guess that means they’ll still sell planes up to almost 95% full – in other words, more than they generally achieved back pre-virus.

Here’s something for the idiots at DoT to chew on.  Instead of demanding airlines waste money by still operating flights that neither the airline nor passengers want, why don’t they demand that in return for the billions of federal assistance, airlines limit the number of passengers per flight?

We’re not quite sure which is the more dismaying.  The venal greed of AA, or the yet-again uncaring incompetence of the DoT.  Details here.

Medical

What is it with ventilators?  For weeks, all we ever heard were claims of desperate shortages of ventilators, lies about doctors being forced to choose which patients got ventilators and which were refused treatment and left to die, and still more lies from states claiming they needed tens of thousands more ventilators when it turns out now, with the clarity of hindsight, what they already had on hand was more than sufficient.

But that’s only one part of the ventilator craze.  The other part of it is the extraordinary unthinking rush by many doctors to shove tubes down their patients’ throats and start blasting oxygen into their lungs, whether the patients need it or not, based on nothing more than a blood oxygen percent measure.

As we’ve come to understand, while ventilators might help some patients in some cases, they are an extremely invasive procedure that should not be undertaken lightly, and more than half (some studies say as much as 90%) of intubated/ventilated patients die.

This brief article (with links to other related articles) points out a surprising degree of over-eagerness on the part of doctors to put their patients onto ventilators.  In some cases, doctors had to argue with patients who were comfortable as they were, and even happily conversing with friends and family on their cell phones, telling them they were in grave danger of death and needing to be urgently sedated and intubated.  We do understand that hypoxia can be subtle, but if a patient is happy and lucid/sensible, to force them onto a ventilator seems like cruel and unusual punishment.

There is a growing suggestion that less invasive forms of supplemental oxygen might be sufficient and less traumatic for many patients (and less resource-intensive for hospitals as well).

Remember back to the 1940s and 1950s, possibly even the 1960s?  Perhaps you don’t, but that was when cigarettes were going through their phase of advertising themselves on the basis of “More doctors recommend (our brand)” and advocating cigarettes as a remedy for sore throats and assorted other ailments.

Well, guess what.  France – a country still very much subjected to nicotine addiction – is now testing to see if nicotine and smoking mightn’t strengthen a person’s resistance to coronavirus.

Money

Thursday saw the Dow struggling to rise, before closing the day a mere 0.2% up on Wednesday, with a 40 point gain to 23,515.

Rumors

Two things that both belong in the rumor category today.

The first is this.  A sardonic joke?  A slip of the tongue not realizing the microphones were on and cameras rolling?  A deliberate “accident” to signal to the public a truth that they aren’t allowed to share?

We’re inclined to believe it more likely to be a joke than an accidental/deliberate revelation because what are the chances of a group of White House reporters, of all people, keeping a huge secret like this?

The other item is mysterious – the unexplained retraction of an article showing how widely the virus could spread on a bus.  The original article seemed fairly sensible and factual, and now the writers of the article (in China) aren’t responding to emailed questions.

It is certainly true that the original article made it harder to believe the low reproduction rate for the virus in China, providing yet another hint that China’s numbers are as fake as the $15 Rolex watches you can buy in its markets.

Musical Interlude

A number of studies have suggested that listening to music can not only calm you, but also boost your immune system.  The most important element in terms of what type of music works best seems to be it should be music you like.

Having said that, it is clear some types of music are more inherently “beautiful” and relaxing than others.  Is heavy metal or rap music beautiful and relaxing?  We acknowledge that some people like such music forms, but does it relax them or just zombify them?

We thought we might offer up some pieces of classical music that are hopefully both approachable and enjoyable, and also more on the relaxing than energizing side of the spectrum.  So we’ll not suggest the opening “O Fortuna” section from Carl Orff’s Carmina Burana – much too high energy, perhaps (although it is relevant to note there are other sections of this very varied one hour collection of songs that are sinuously and sometimes esoterically beautiful).

Instead, our first piece, with a lovely write-up here, is Britain’s most popular piece of classical music, as determined by this year’s Classic FM audience poll (and also coming tops in many previous years, too).  Showing that parochialism is as real in musical appreciation as it is in anything else, it is by a British composer, Ralph Vaughan-Williams, and is his piece, The Lark Ascending.

 

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.

5 thoughts on “Covid-19 Diary : Thursday 23 April, 2020”

  1. MARGARET MACKENZIE-HOOSON

    Perhaps the outbreak reported from Harbin is more important than ‘somewhere in China;’ because Harbin may be the area that is getting the people from Russia, or the Chinese coming back in from Russia where there may be more infections than we know about….

    1. Hi, Margaret

      Is the outbreak in Harbin? I didn’t really remember where. My point is that to describe such a tiny number of new cases as an “outbreak” seems rather amusing. (Today’s count is 6). And remember that these case counts are for the entire country, including major ports of entry such as Beijing and Shanghai.

  2. A curiosity. Is there data on the testing percentage or philosophy for the high inflection rates and highest death rate countries/areas?

    It would be interesting to see if there are correlation

    There are lots of variables but with deaths being a lagging indicator of serious cases, understating testing differences may provide some ability to “normalize” or forecast the ultimate rate at least where there is enough similarly in the country (e.g., social distancing, comparable medical systems).

  3. Just a point on the frustration in the weekly summary about Public Health officials. I agree there were/are lots of problems. I think aiming all the frustration at them ignores that they ALL work for someone — that someone is (ultimately up the chain) a political appointee or an elected official.

    I’m guessing most readers, like I, have had a bad boss at sometime in their career. It is amazing the damage a bad boss can do in terms of poorly allocating budgets, having a tin ear to problems, making bad staffing decisions, etc. Same is true of the elected leaders and their appointees.

    There is blame to go around

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