Covid-19 Diary : Wednesday 22 April, 2020

 

I’ve been regularly harping on about vulnerabilities in our food supply chain.  These problems are getting worse – for example, this article reports how the nation has now closed over 25% of its pork processing plants in just the last couple of weeks.

There is no reason not to expect further closures.  Of equal concern is there is no reason to expect speedy re-openings.  I’ve decided it is time to get another freezer, although – unsurprisingly – it seems I’m not the only person with that idea and most models are sold out at major online outlets.

I started to write a couple of paragraphs about what to look for in a freezer, and – as is so often the case – it has grown quite a lot, and so I’ll release it tomorrow as a separate feature article.

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/488 cases/the equivalent of 14,382 cases per million people
  • Vatican City/9 cases/11,236 cases per million (unchanged)
  • Andorra/723/9,357
  • Luxembourg/3,654/5,837
  • Iceland/1,785/5,231
  • Spain/208,389/4,457
  • Gibraltar/132/3,918 (unchanged)
  • Faroe Islands/185/3,786 (unchanged)

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

  • Belgium/6,262 deaths/540 deaths per million
  • Spain/21,717 deaths/464 deaths per million
  • Italy/25,085 deaths/415
  • France/21,340/327
  • United Kingdom/18,100/267
  • Netherlands/4,054/237

To put those numbers into context, the death rates per million in the US/Canada are 144/52.  The world average (not a very reliable number) is 23.6.

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

Same Day
Last Week
YesterdayToday
Total Cases2,074,1012,556,7612,637,673
Total Deaths134,073177,619184,217
Active Cases (ie not yet died or cured)1,430,4521,688,7481,735,831
US Cases/Deaths/Case rate per million641,762/28,442/1,939818,744/45,318/2,474848,717/47,659/2,564
UK Cases/Deaths/Case rate per million98,476/12,868/1,451129,044/17,337/1,901133,495/18,100/1,966
Canada Cases/Deaths/Case rate per million28,205/1,006/74738,422/1,834/1,01840,190/1,974/1,065
Worst affected major country/case rateSpain/3,799Spain/4,367Spain/4,457
Second worst country affectedSwitzerland/3,043Belgium/3,534Belgium/3,614
Third worstBelgium/2,897Ireland/3,248Ireland/3,376
FourthItaly/2,732Switzerland/3,229Switzerland/3,266
FifthIreland/2,541Italy/3,043Italy/3,098

An interesting point of comparison – the US today passed the point where it now has experienced over ten times as many deaths as China (even though China is about four times larger).

Not only that, but every two days at the present sees the US suffering more deaths than China has in total from the start of the outbreak through to the present day.

Of course, this also points to the unlikely nature of China’s miraculously low infection and death rates, and even more miraculous recovery.

I Am Not a Doctor, But….

Articles such as this continue to trumpet how bad and dangerous hydroxychloroquine is.  But it is necessary to get beyond the lies and deliberate distortions in the Washington Post and drill down into the study they’re triumphantly citing as proof that the drug is bad/dangerous/useless.

Here’s the study.  Now the chances are you’ll quickly zone-out when bombarded by the esoteric technical nature of its writing, and may even be impressed by the occasional random phrase included as “headline bait” for Trump-hating (and therefore chloroquine-hating) media such as the Washington Post.

But there’s (at least) three things that need to be carefully extracted from the article that are not so obvious with a quick skim through the abstract.  The first is that the hydroxychloroquine, possibly supplemented with azythromycin, was only given to the most unwell of patients.  Is it any surprise then that there were higher death rates among the sickest patients compared to among the less sick patients who weren’t prescribed either/both drugs?  This fact alone essentially and entirely invalidates the study and any conclusions it seeks to draw.

The second point is it seems the treatments did not follow the process recommended for best results from hydroxychloroquine.  Two things in particular stand out – the drug is best given early in an infection, and has never been held out as a way to cure the most severely unwell patients. The other point is there is growing support that the hydroxychloroquine perhaps works best with a zinc supplement – basically a major part of the role for the hydroxychloroquine may be to provide an easy pathway for the zinc to reach the virus and stop its growth.  So, again, are we surprised to learn that when not used as is thought most effective, the hydroxychloroquine doesn’t work well?

The third point is the study does not give us all the details we need to evaluate it – for example, the details of the dosages of each drug prescribed.  Why is that withheld?  How can the study be independently evaluated without dosage information?

There are excellent comments from readers of the article, if you move down the page to the comments below the abstract.

We are left pondering how is it possible that a group of presumably expert medical scientists can issue such a fundamentally and totally flawed analysis and conclusion?

That is the thing that puzzles us the most.  We’ve wondered if it is an automatic rejection of anything Mr Trump mentions, or if it is funded by a “big pharma conspiracy”, and we really think neither explanation is very likely.  We really can’t guess why it is that some parts of the medical establishment seem to be so firmly opposed to hydroxychloroquine to the point of deliberately writing such flawed studies as this one.

Meanwhile, to give the other side of the story, this upstate NY physician tells a compelling story of success with hydroxychloroquine together with azithromycin and zinc.  Yes, his “in the real world” experience is absolutely not a clinical trial either, but with 699 successes and no failures, it can’t readily be dismissed or ignored.

I particularly liked his comment in response to the exaggerated concerns that hydroxychloroquine detractors cite about possible heart problems when taking these drugs.

If there’s a one 10,000th chance of having a heart arrhythmia, but there’s a six percent chance of dying from the virus… It’s a no brainer

Unfortunately, the people with no brains have command of the major mainstream media.

There was an interesting discovery today.  It has now been determined that a lady who died in Santa Clara on 6 February was infected with the coronavirus.  This makes her now the first known fatality in the US, predating the formerly official first death date by 23 days.

This could be enormously significant.

It certainly confirms in a startlingly clear way that the virus was here much earlier than otherwise thought, and the significant part of that is the virus has therefore been spreading for 23 days longer than thought.  What does that mean?

It means that there could be as many 100 times more cases than had been previously thought (that’s what happens, in round figures, when you start with one infected person – 21 days later you have about 100).

I’d go further than that.  If there is one unknown case just now coming to light, maybe there are two.  Well, guess what – there are.  The same article refers to both this lady and a second person who died a few days later, both with the virus.  But I’m not just thinking two extra people and two additional starting points for the virus to spread.  It seems reasonable to guess that, way back in the happy innocent days of mid-January, more than two people contracted the virus in China and traveled to the US.

But, stick with the 100 times number, rather than grow it to some extra number of zeroes.  What does this mean for the actual total number of people who have been infected with the virus.  Currently the US has 850,000 reported cases of infected people.  A couple of recent studies (one with a badly underestimated error range) have suggested that the actual number might be 50 times larger, maybe even more.

I did some simple calculating, based on guesses for when the first ten known patients may have first been infectious, that suggested by 28 March, there could be as many as 11.5 million cases in the country.  I went no further than that because various social-distancing factors would be starting to come into play by then.  This contrasts with the official count of 125,000 known cases on 28 March – my number is 92 times larger.

That was an amusing number, because it coincided quite closely with my earlier different methodology guess of “23 extra days means 100 times more cases”.

Does that mean we should take today’s count of 850,000 and multiply that by 92-100?  Not necessarily at all.  But, based on my “figgerin on the back of an envelope” it is an interesting additional perspective to support the possibility of a 50 times undercount, so maybe that means we have had 42 million cases so far.

That not only shrinks the death rate percentage down from a scary 5.5% to a much nicer 0.1%; it also means that so far, 13% of the population has been infected.  That’s nowhere near the herd immunity we need (we need five times this amount, to bring us to over 60%), but it is a whole lot closer to it than would be the case if the 850,000 case count number applies.

So, as I said, this discovery is potentially very significant, and in a good way.

Some people cling desperately to the hope we’re being told the truth about the virus.  I’m not one of those.  I believe the truth is being shaded so as to avoid public panic.  These of course are the most insidious of all untruths – those told to us “for our own protection”.  (Yes, I acknowledge that some truths are being shaded for political reasons as well.)

A clear case in point would seem to be facemasks.  First we were told they were useless, and there was no point to wearing one; indeed, some companies banned their employees from wearing them for fear of creating “an unwelcoming atmosphere of fear”.  Now, we’re told facemasks are essential, and some states have mandated that everyone must wear one.

Let’s also keep in mind that a month ago, we were being told that surgical and N95 type masks were useless/unnecessary.  Now we’re being told that made-at-home cloth masks – which indeed do qualify for the description of almost useless – are vital and mandatory.

So, in less than a month, the truth has flipped 180 degrees.  The authorities can’t have been right both times.  One time was either a stunningly incompetent error or an outright lie.  I’m not sure which is the more comforting concept – incompetence or mendacity.

Now that they’re acknowledged as important and beneficial, here’s a great article that tells you more than you’d ever want to know about masks, and with plenty of links within it to still more resources.

One thing it does not tell us however is reported in another item today.  A study shows that the cloth masks we’re being urged/mandated to wear could be made much more effective (well, it would be hard to make them much less effective) by wrapping a band of panty-hose or stocking over the top of them.

I’m still getting comfortable with wearing a normal mask.  Adding a panty-hose band as well is a whole ‘nother thing to adjust to!

This is a great article; I hope most doctors read it, because it suggests an important paradigm shift in what to treat for people suffering from a severe attack of the Covid-19 virus.

Who Should Pay?

The first tranch of funds for small businesses, as part of the $2.2 trillion bill, was quickly over-subscribed and exhausted.  The Senate has now approved almost another half trillion of funding for this and assorted other projects.

And, yet again, how easily the word “trillion” rolls off the tongue.

In what must surely be the least surprising headline of the year, a survey has found that 84% of Americans want another stimulus check.  The only surprising element is why the number is that low.  The $1200 clearly doesn’t give anyone much additional lifeline; of course people would want and even need more.

Did you know that some lucky people are collecting both state and federal unemployment payments.  The state payment is whatever it is, varying by state, and the federal payment is $600/week (the same as $15/hr).  For many people, add the two payments together and they’re getting more money, out of work, than they were getting working 40 hours a week.

So is it surprising then that this business chose to close because it couldn’t afford to pay its people as much as they’d get by being laid off?

On the other hand, this business got a government subsidy to stay open and keep paying its employees, but the subsidy for paying employees is less than the employees would get unemployed, and now the employees hate the business and its owner.

What part of these two outcomes is within a country mile of being sensible?  Why do we continue to passively empower our hapless representatives in government to throw money where it is not needed, as if it were an unlimited commodity where it is better to be “safe” than “sorry”, and better to give people too much rather than not enough, yet at the same time allowing for ridiculous contradictions in the same bill to exist that create and reward “bad behavior”.

Sooner or later, there has to be a financial reckoning for our economy and all of us who live in it.  But maybe, within that reckoning, we’ll solve a different problem – the toilet paper shortage.  A period of hyper-inflation could see us like Venezuela, where high value bank notes cost less per square inch than toilet paper.

Timings And Numbers

People like to talk about how the second wave of the Spanish ‘flu was more deadly than the first.  They are correct, but usually they fail to explain why – the second wave was more deadly because the ‘flu evolved into a more deadly strain.

So you can’t directly extrapolate from Spanish ‘flu to Wuhan “flu” and automatically expect the second wave of this virus will be more deadly than the first.  Virologically speaking, it is likely to be little changed from what we are suffering today.

But this article quotes the CDC director as worrying the second wave – ie, this coming winter season – will be more deadly because it will see a peak in both regular ‘flu cases and also Covid-19 cases, too, thereby overloading the hospital system even more than has been happening at present, with regular ‘flu numbers dropping down to near zero.

Would it be too much to hope that we use the six months between now and when the regular ‘flu season gets into full swing wisely and prepare for the onslaught?  Build up our supplies of PPE and equipment, add to our hospital beds, etc.

It is helpful to get a sense of timings for when vaccines might appear in quantity – this article says a possible new vaccine could be made available, with 600 million doses ready, some time in the second half of next year.  But the two companies involved in its development haven’t even started trials of the vaccine yet, which makes this both a crazy-fast timeline and also a very optimistic hope that all will go well.

Closings

This is an interesting report on the financial health of traditional department stores.  The short summary – many/most of them are on their last legs and may not survive this period.

However, don’t stop at that point.  Major department stores represent 30% of the total shopping mall space in the country.  If the major stores close, who would replace them?  Does this place the survival of shopping malls in jeopardy, too?  The article goes on to point out that other shops in malls often have a provision in their lease that if the major department stores quit the mall for any reason, then they can end their lease without penalty, too.

So the future of shopping malls becomes very unclear.  Perhaps they’ll evolve into a broader series of uses, maybe with a mix of office space as well as retail, perhaps a hotel/motel, leisure activities, maybe even apartments, too.

Shortages

(We’re not sure how accurate this chart is on the left…..)

Here’s an article with a scary headline – “Food Rationing Confronts Shoppers Once Spoiled for Choice”.  Get used to the concept of rationing, we fear it may soon become a thing.

Amazon is being sued for increasing the prices of essential items by up to 1000%.  We have very little sympathy for Amazon and its pricing, and often see examples of outright lies being tolerated on their site – claims of a discounted price based on a fictitious “list price” which is way higher than what the manufacturer sells the item for themselves.

We know that some list prices are fake and impossible to really validate, but when a manufacturer is also selling direct, clearly whatever price they have set on their site has to be considered the true list price.

Logic?  What Logic?

We wrote yesterday about the craziness of an outright ban on immigration for 60 days, as is being put in place by President Trump.  Now the craziness has got even worse.

After pushback by various groups, the ban has been modified.  Regular immigrants can not come to the US, but foreign worker type immigrants can come.  This begs two questions.

First, how is it tenable to suggest that foreign workers are less likely to have the virus than other categories of immigrants?

Second, how can we claim to need foreign workers at all with currently 22 million unemployed Americans, and more adding to that number every day?

We’re not necessarily saying “ban ’em all”.  Nor are we saying “let ’em all in”.  We’re saying we expect at least some shred of sense to underpin this order, and currently, we can’t see any at all.

Talking about sense, it is 13 days since the peak usage of hospital resources in New York.  So why have they issued, today, a “do not resuscitate” guideline telling paramedics not to resuscitate heart attack victims, due to congested hospitals?

Virus?  What Virus?

This is something that needs to be repeated, because we are increasingly seeing no doubt well-meaning but medically naive suggestions for controlling the spread of the virus involving “self reporting” if you feel unwell, or checking temperatures.  The virus mostly spreads via people with no symptoms.

For this stark and simple reason, any type of control that relies on detection of symptoms will fail.

Talking about fails in how to contain the virus, reader Peter sent in a link to an issue I’ve seen but not given a lot of focus to.  The virus can continue to spread, sometimes for weeks, even after a person has been declared to be cured and free of the virus.

The linked article is heavily reliant on Chinese data, which doesn’t comfort me at all, but it seems fairly clearcut in what it establishes.  Why does this seem to be ignored by most western medical authorities?

Medical

I’ve said it before, and I fear I’ll keep saying it in the future.  The more we learn about the virus, the worse it seems.  Two items for today :

Money

After losing ground on Monday and Tuesday, the Dow inched higher today, rising 2.0%, and closing up 457 points at 23476.

 

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.