Covid-19 Diary : Wednesday 29 April, 2020

 

Here we all are, a day away from May, but no tangibly closer to the end of this virus curse than we were a month ago.  The last month has seen 922,000 new cases reported in the US and 59,172 deaths.

The only difference of note in the last two months has been a shift from “we must close” to “we must re-open”.  Tragically, the balance of that mirror-image symmetry is we closed too little, too late, and now look to be opening too much, too soon.

The illustrious Dr Fauci says a second outbreak is inevitable, but he is wrong.  There is no inevitability about a second outbreak whatsoever, other than that which results from our foolish behavior and the bad decisions of our public health and political leaders.

Maybe Fauci has already acknowledged we’re run by fools and idiots.  In which case, yes, a second outbreak is indeed inevitable, although let’s not get ahead of ourselves.  We’re still in the middle of the first outbreak.  At our present rate of “progress”, the second outbreak (which Fauci sees coming on the far side of summer) will instead be an extension of the continuing first outbreak.

Where is the clear evidence in these charts we’ve got past the first outbreak?  New cases and new deaths have hovered around the same range for an entire month.  This is part of my frustration – we’ve spent an entire month with nothing material to show for it.

I’m getting beyond frustrated.  Every day, the internet is filled with erroneous reporting, sometimes by “experts” who should know better, filling our lives with wrong information and wrong advice.  We must all be focused on the same essential vision – how to get through this and how to best get rid of the virus.  But where is the commentary about that?

Why can’t the same reporters who chorus together so wonderfully in tune when it comes to hating Trump, also band together to spread an appropriate clear and consistent message of positive steps to take to get us out of this mess, as quickly as possible, and as non-impactfully as possible?

The answers are out there.  They are not complicated to explain.  You’ve read about them in my daily diary entries.  Here they are again as seven short and simple bullet points :

  • Stricter controls and stricter enforcement at present to assertively and more quickly reduce the disease spread
  • Waiting until we get below one new case per million per day before relaxing controls
  • Wearing masks in public
  • Selective opening first of low risk/high economic benefit activities, while leaving high risk/low economic benefit activities until last
  • Batch/group testing with instant results so we can test at least 10 million people every day for infections
  • A “traffic light” system to monitor and restrict/unrestrict people’s movement and mixing abilities based on their risk profiles
  • Border controls so new bearers of infection are identified before they are allowed into the country

Currently, none of these seven points are being consistently adopted, and most are being ignored entirely.

And when the reporting itself isn’t erroneous, the stories they give us are terrible – for example, yesterday we learned about how New Yorkers came out en masse to watch the Air Force Thunderbirds and Navy Blue Angels fly overhead.  Today, there’s an item about Southern Californians doing what they like to do on a warm day – go to the beach.  Both activities are open opportunities for the virus to surge in numbers again.

Also today there is news of Costco returning to normal opening hours next week, and requiring all shoppers to wear masks.  That is splendidly sensible, and we congratulate them for this measure.  But Twitter exploded with people protesting their right to be stupid, for example

Im a free citizen of the UNITED STATES OF AMERICA I will not comply with your mask rule! My body, my choice!

That is so wrong, on so many levels.  It has already been long and almost universally accepted that we don’t have unrestricted right to self-harm ourselves.  Look at seat belt laws and smoking restrictions.  Which leads in to the second and third points – doing harm to oneself invariably spills over to other people too.  For example, if we’re talking about an alcoholic or drug addict it is suggested that such people harm the lives of ten other people too.

And, for the third point, the thing about wearing a mask is that masks provide at least as much protection to the people around as they do to the mask wearer, directly.  If a person gets infected (perhaps because they didn’t wear a mask), then continues not to wear a mask, they can be expected to infect another 2 or 3 people, and if the newly infected people also don’t wear masks, they similarly each infect another 2 or 3, and we’re back to the geometric/exponential rising of new cases again.

Whether or not people have a right to not wear a mask inside someone else’s shop, no-one has a right to do something that unnecessarily risks the health and indeed life of many other people around them.

None of this is new.  I’ve several times observed that the main problem is not the virus, but ourselves and our unwillingness – at all levels – to adopt appropriate behavior modifications to stop the virus spreading.

This should be easy to understand.  The seven points, above, are simple and sensible.  Why aren’t we adopting them and enforcing them?

Current Numbers

Here are the rankings for the eight states of any size with the highest infection rates.  Qatar has moved up one place, displacing Gibraltar.

  • San Marino/563 cases/the equivalent of 16,592 cases per million people
  • Vatican City/10 cases/12,484 cases per million (unchanged)
  • Andorra/743/9,616 (unchanged)
  • Luxembourg/3,769/6,021
  • Iceland/1,797/5,266
  • Spain/236,899/5,067
  • Qatar/12,564/4,361
  • Gibraltar/141/4,185 (unchanged)

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

  • Belgium/7,501 deaths/647 deaths per million
  • Spain/24,275 deaths/519 deaths per million
  • Italy/27,682 deaths/458
  • United Kingdom/26,097/384
  • France/24,087/369
  • Netherlands/4,711/275

To put those numbers into context, the death rates per million in the US/Canada are 186/79.  The world average (not a very reliable number) is 29.3.

The UK played “catchup” today, dumping a huge number of additional deaths that it had not previous counted (because they were happening in care homes rather than in hospitals), and that was enough to move it ahead of France.

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

Same Day
Last Week
Yesterday Today
Total Cases 2,637,673 3,137,761 3,219,240
Total Deaths 184,217 217,948 228.190
Active Cases (ie not yet died or cured) 1,735,831 1,964,118 1,990,949
US Cases/Deaths/Case rate per million 848,717/47,659/2564 1,035,765/59,266/3129 1,064,194/61,656/3215
UK Cases/Deaths/Case rate per million 133,495/18,100/1966 161,145/21,678/2374 165,221/26,097/2434
Canada Cases/Deaths/Case rate per million 40,190/1,974/1065 50,026/2,859/1325 51.597/2,996/1367
Worst affected major country/case rate Spain/4,457 Spain/4,965 Spain/5,067
Second worst country affected Belgium/3,614 Belgium/4,084 Belgium/4,129
Third worst Ireland/3,376 Ireland/4,025 Ireland/4,102
Fourth Switzerland/3,266 Switzerland/3,381 Switzerland/3,398
Fifth Italy/3,098 Italy/3,333 Italy/3,367

I Am Not a Doctor, But….

It is amazing to see the difference having high powered public relations consultants makes.  Last week, I reported on a failed trial of Gilead’s drug Remdesivir – the results were so bad that the trial was terminated early.

The drug, even if it works, is far from the “magic bullet” we’re all hoping for – it is not the “take one pill twice a day for a week” low-impact and low-cost cure for a Covid-19 infection.  It currently requires ten days of IV infusions of the drug (there is a possibility this might be able to be reduced, perhaps to five), and at least in the clinical trials, seems to also require hospitalization.  Sure, if it works, it is much better than nothing, but – at the risk of repeating myself – it is not the magic bullet we’re hoping for.  It also seems to be in short supply.

However, notwithstanding the first trial’s failure and the overall unappealing nature of the drug even if it does work, headlines exploded today reporting the drug’s success in a second trial.  Here’s one of the more measured reports.

I marvel at the hypocrisy of the people who criticized every positive hydroxychloroquine outcome but are now rushing to embrace the Remdesivir trial, even though it suffers from many similar weaknesses and data limitations as do the several HCQ trials.  The same people who theatrically worried about the known side effects with an 80 year old drug are now ignoring the side-effects being uncovered with this relatively new drug.

We hope it is not just because Gilead is a $100+ billion company that is encouraging people to now praise this test result.

Here’s an article that tries to reconcile how Remdesivir simultaneously failed one trial and succeeded at a second.  The short answer – neither trial had enough data, and neither applies to enough situations as to be significant.

Don’t get me wrong.  If I become unwell enough to require hospitalization, I’d be eager to have Remdesivir treatment too.  But I’d much prefer the “take a pill” treatment at the first onset of symptoms, rather than Remdesivir IV infusions after getting so sick as to need hospitalization.

Timings And Numbers

I noticed a curious thing in the latest set of rt.live graphs showing, state by state, the rate of growth or shrinkage of virus cases.  When you now put your cursor over one of the state minigraphs, you see a dotted vertical line appear indicating when lockdown type restrictions were imposed on that state.

In theory, starting from about five days after that date, you’d expect to see the slope of the line change and start to tilt more steeply downwards.  But can you see, on the line for any state at all, any clear impact of the lockdown order and the virus spread?  Apart from possibly one very weak correlation, I can’t.

Does that mean some of our locking down requirements were unnecessary and of no value?

That’s an important question to ponder, particularly when you keep in mind that we have been told by some of the model projection makers that our social distancing guidelines have reduced the probably death rate by 20-fold or more.  Where is the evidence of this?

That’s also an important question to ponder when you keep in mind the multi-trillion dollar cost of this lockdown so far.  Where is the confirmation of any benefit from it?

The other interesting point is that all the states show reducing rates of virus growth.  From the very start of the data series on 11 March, all states are showing the rate of viral growth is declining, not increasing.  Why is this?

It should be considered, in attempting to answer that question, that most states adopted earlier restrictions prior to the shutdown orders.  You can see the timeline of what each state did and when on this site (choose the state you want from the drop down box which starts off saying “United States of America”.

To take New York as an example, on 12 March NY state started restricting mass gatherings, they closed some businesses on 16 March, then schools on 18 March.  Lastly, non-essential services were closed and a stay-at-home order imposed on 22 March.

So, adding at least five days from each of those dates, we should start to see a change in the rate of virus growth from 17 March, and then steepening further on 21 March, again on 23 March, and most of all after 29 March.

Can you see any of this on its chart?

Experts (whoever they are) generally believe that, left to its own devices, the virus should be spreading at a rate of about 2.25 – 2.75.  No state shows that rate of spreading at any time.

Maybe the experts are wrong, and/or maybe the rt.live analysis is wrong (and it has certainly gone through some huge changes over the last week or so), but we’re really like to understand and reconcile the discrepancy between the terribly harmful social distancing measures we’ve adopted and the impacts on the rate of viral growth as a result of these measures.

Talking about mysteries, we notice a curious thing.  The countries with the highest death rates are generally advanced western nations, the countries with the lowest death rates are not.  This is completely the opposite of what one would expect – surely advanced western nations would have the best healthcare systems.

Here’s a list of the top ten and bottom twenty countries in terms of their deaths/million.  For the top ten countries, I require the countries to be of “reasonable size”, and for the bottom twenty countries, I require them to have had at least 1500 virus cases reported.

I did twenty bottom countries because I was seeking to find any advanced western countries in the list.  It was a struggle.

In round figures, you’re 100 times more likely to die in an advanced/developed nation than in a less advanced nation.  Why?

Worst Ten Countries Country Deaths/Million
1 Belgium 647
2 Spain 519
3 Italy 458
4 UK 384
5 France 369
6 Netherlands 275
7 Sweden 244
8 Ireland 241
9 Switzerland 198
10 USA 186

Best Ten Countries

Country

Deaths/Million
1 Nigeria 0.2
2 Uzbekistan 0.3
3 Ghana 0.5
4 India 0.8
5 Thailand 0.8
6 Bangladesh 1.0
7 Kazakhstan 1
8 Pakistan 2
9 South Africa 2
10 Cameroon 2
11 Iraq 2
12 Afghanistan 2
13 Azerbaijan 2
14 Singapore 2
15 Oman 2
16 Japan 3
17 Indonesia 3
18 Australia 3
19 China 3
20 Malaysia 3

The US has currently totaled just over 61,000 deaths, and it is projected it may have 73,000 by the end of the pandemic.  So, maybe 12,000 deaths to go, possibly more (and also possibly, but improbably, fewer).

With those numbers in mind, we are puzzled by the news, today, that FEMA has just ordered 100,000 body bags as part of a “worst case scenario preparation”.  We don’t know how may body bags at present are supplied by FEMA rather than via normal sources (we’d guess very few) so we wonder why FEMA is now, at this late stage, ordering so many more.

Closings and Openings

We find this a very interesting set of poll results.  Despite politicians claiming a lot of pressure to start re-opening things, there seems very little popular public support for the actions they’re now taking.

Shortages

One of the strangest parts of the “this is a crisis” theatricals that we’ve been exposed to was the US Navy Hospital Ship Comfort, and its dramatic arrival into New York, in a scene reminiscent of a cheap 1950’s western and the cavalry arriving, bugles blaring and guns blasting, just in time to save the settlers from the Indians.

The 1000 bed hospital ship spent its first week empty because it was not equipped to treat people with the virus, and there was no need for additional beds for “normal” patients.  It was then transformed into a 500 bed facility for coronavirus, but in its three weeks in that role, it treated a total of 182 patients, and has been empty for the last few days.

So, never needed, and empty once more, the ship will return to its Norfolk VA home port tomorrow.

Virus?  What Virus?

The airlines claim no-one has ever caught the coronavirus on a plane.  Well, actually, what they say is that no-one has ever been proven to have caught the virus on a plane.  Part of the reason we are somewhat dubious of their claim can be seen in this article and the terrifying visualization of the spread of a cough in a plane.

To be fair to the airlines, there have been other studies, long before this virus, that have suggested that there is little transmission of other infections on a plane, and the airlines claim that the top to bottom flow of air and their HEPA type air filters cut down greatly on how far a cough can spread.  We don’t know how accurately the model and visualization incorporates the actual air flow on a plane, but it does seem to be somewhat credible and definitely unencouraging.

Oh – the other part of the reason we don’t believe the airlines’ claim about no-one catching the virus on a flight?  We just know that at least half the time we take a long distance flight in winter, we’ll end up with a cough/cold/sore throat within a few days of getting off the plane.  Sure, we can’t prove we caught it on the plane, but statistically, there’s a meaningful link between a long flight and some type of infection, at least for us.

Money

A good day on the Dow, reportedly buoyed by the good news about Remdesivir (although we consider it a bit premature to label it as good news).  The Dow index lifted 532 points to close at 24,634, a 2.2% gain for the day.

 

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.

7 thoughts on “Covid-19 Diary : Wednesday 29 April, 2020”

  1. Can you blame people for not wanting to wear masks when all the “authorities” told them it was useless and wouldn’t protect them and, as a bonus, they were too stupid to know how to wear one correctly? The problem is not with the American people, it is with the liars that make up our so-called leaders. They (we) feel we are being played.

  2. I have to disagree withe conclusion that the US Navy Hospital Ship Comfort was “never needed.” There is more than adequate proof that many hospitals in NYC had over crowded ERs and stretched staff.

    The utilization of the ship was limited by restrictions. It was NEVER used as a primary destination. So a patient only got there after getting the initial treatment at another hospital. Initially the only way a patient could be transferred there was after a negative Covid-19 test. That, of course, took time and in some cases, the patient was already treated and released by the time the results came back or, in probably more cases, was not longer stable enough to be transferred.

    Ever after allowing Covid-19 patients, they still had to be transferred from another hospital. So a logistical challenge and many serious patients could not easily be transferred.

    The ship was docked on the west side of mid-town Manhattan. Probably almost the best place to be far from the population centers of NYC. While Manhattan has about 20% of the city’s population, the population density isn’t near midtown. And over half of NYC’s population is in Queens and Brooklyn. On a different island than Manhattan (Long Island). So even if the ship would have taken primary patients (first stop for the ambulance), it wasn’t well located.

    So had the ship accepted patients directly — maybe even initially only accepting trauma cases (e.g., gun shot victims, car crashes) and been docked where the population actually live (say the Brooklyn cruise ship dock) it would have been better utilized.

    I’m sure it would have been possible to put even more restrictions in place to guarantee it would not be well utilized but the rules in place and the placement of the ship came pretty close to guaranteeing under utilization unless things had gotten ever worse than they were at many hospitals.

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

      Happy to agree to disagree on “never needed”. And I’d be careful about the “more than adequate proof” claim. Remember that the NY Times outright lied about hospitals being so short of ventilators that doctors were having to decide which patients got them and which patients were left to die.

      But the numbers of patients do speak for themselves. Can we agree on “never used” (other than for 180 odd people)? To make it easier for you, I’ll happily agree it was the most ill-managed possible set of arrangements for how the ship would be used.

  3. lifegotinteresting

    It feels to me that wearing masks is just common sense. It’s a barrier for the asymptomatic spreader on one side, and for the uninfected on the other. It may not be perfect, but it helps.

    It was always ridiculous when the Surgeon General told us not to wear them, because they were ineffective/possibly dangerous for us to use, while at the same time telling us not to hoard them because they were needed by medical staff (huh?),

  4. I wholeheartedly agree with the last sentence.

    There are numerous articles on pretty much every type of news source about certain hospitals being overcrowded. I believe the New York Post and Fox News are good examples.

    ttps://nypost.com/2020/03/29/this-nyc-hospital-is-so-crowded-a-coughing-man-gave-up-and-went-home/

    https://www.foxnews.com/media/new-york-city-doctor-reports-new-coronavirus-cases-are-plummeting-proving-that-social-distancing-is-working

    I can find in the NY Times opinion section articles about running out of ventilators such as the one written by a Dr. Horn (Mass. General). I an also find reporting on the governor warning that they were within six days or running out. Fortunately the number of new hospital admissions finally leveled out and the forecast was wrong. I’m not sure where the outright lie comes from — opinion pieces are not fact checked news, they are personal opinions. Reporting what the governor said is news although one could argue that it needs better fact checking.

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

      I’m surprised (or maybe not – facts are a strange concept to the NY Times) that it doesn’t fact check op-ed pieces. The op-eds I’ve written for newspapers have been fact checked and discussed with me prior to being printed. I’ve had to be able to demonstrate sustainably valid opinions and confirm any facts claimed.

      Besides which saying “doctors are having to refuse treatment” is not an opinion, it is a stated fact. And it was written by a NY Times reporter, not an op-ed piece. I linked to it a couple of weeks ago.

      There’s a huge difference between “we are turning patients away right now” and “we might run out in six days”.

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