There’s a looming and alarming new challenge (threat) on the horizon, in an area I’d never thought to question, but now I’ve become aware of it, problems seem inevitable.
We have repeatedly covered how statistics have been misunderstood, misapplied, and miscalculated. We have also seen a stark contrast between the hate being piled onto hydroxychloroquine (almost entirely for invalid reasons) and the hype being piled onto remdesivir (and please remember the only formal refereed study of what is now being considered a “wonder drug” is that it was useless, and even the unrefereed study merely found it reduced hospital stays by a few days for some patients).
We have struggled to understand how there has been such a rush to condemn one drug and praise the other, both without any real underlying facts, and the same people who have rushed to condemn HCQ as not being proven to be effective have rushed to praise remdesivir, without considering there is even less proof and less suggestion of major benefits than for HCQ.
We have cynically wondered if this is because there is no money to be made in HCQ – a drug long out of copyright and costing pennies per dose, whereas remdesivir is being promoted by its makers, Gilead, with a full public relations department and lobbying budget, and is a drug they are believed will be making thousands of dollars profit per dose from.
Okay, that is the background to set the scene.
I had never thought about potential vaccines in this same context. I’ve been delighted to see reports on dozens of different vaccines all wending their way tortuously through complicated trialing procedures and at wonderfully high speed, and somehow I’d thought the outcomes of such trials would be in a binary form – that is, either a vaccine passes or fails, and if it passes, I’d naievely thought that means everyone who is given the vaccine gets effective protection from the coronavirus.
But we’re now starting to see nuances beneath the surface of these vaccine trials. For example, please read this article that suggests Britain’s leading contender possible vaccine is producing only partially effective results in its trials on monkeys. Do we want an official vaccine that is only partially effective? Here’s another article which tells the story in a slightly different way.
But at the same time, the UK government is pressing on, at full speed, with establishing a “rapid deployment facility” (a slightly ridiculous term full of hype) to create doses of the vaccine, before it has been proven, and without much apparent concern for the lack of success in the trials so far.
It goes without saying there is overwhelming financial pressure for a vaccine to be anointed as a success, and enormous riches for the company that wins that prize. These pressures are not just acting on the drug companies, they’re acting on the entire economy – for example, today, the Dow rocketed up 912 points due to good news on several potential vaccines.
But does this mean the UK government (or US government) might find itself faced with a choice between a “partially effective” vaccine available now and an uncertain future with possibly more promising vaccines still being developed and not available for another six months or year? And if a “partially effective” vaccine is selected now, what happens to the development of fully effective vaccines? Will they still be fast-tracked? Almost certainly, the company selling the partially effective vaccine will lobby for things to return back to the normal 5 – 10 year development/testing cycle for competing vaccines.
I suddenly find myself with much less confidence in the entire vaccine development process. It no longer seems like the best vaccine will be the one that wins, it may be the vaccine with the best PR and lobbying departments, and a half-way credible tale of half-way successful “partially effective” results and able to be deployed soonest.
Oh, one more thing. I read an interesting but unsourced suggestion today that even if we come up with a vaccine, there’s not enough “medical glass” in the country to make 330 million vials.
Here are the rankings for the eight states of any size with the highest infection rates. There has been no change in the ranking today.
- San Marino/654 cases/the equivalent of 19,279 cases per million people (unchanged)
- Vatican City/12 cases/14,981 cases per million (unchanged)
- Andorra/761/9,849 (unchanged)
- Iceland/1,802/5,281 (unchanged)
Here are the top six major countries, showing death rates per million of population in the country. :
- Belgium/9,080 deaths/784 deaths per million
- Spain/27,709 deaths/593 deaths per million
- Italy/32,007 deaths/529
- United Kingdom/34,796/513
To put those numbers into context, the death rates per million in the US/Canada are 278/155. The world average (not a very reliable number) is 41.1.
For major countries and/or outbreaks, and in general :
|US Cases/Deaths/Case rate per million||1,385,834/81,795|
|UK Cases/Deaths/Case rate per million||223,060/32,065|
|Canada Cases/Deaths/Case rate per million||69,981/4,993|
|Worst affected major country/case rate||Spain/5,735||Spain/5,940||Spain/5,950|
|Second worst country affected||Ireland/4,685||Belgium/4,772||Belgium/4,796|
I Am Not a Doctor, But….
An interesting disclosure was made by President Trump today. He is currently taking daily doses of hydroxychloroquine as a preventative measure, in the hope it might ward off the Covid-19 disease.
This is an amusing case of the wheel going full circle. HCQ’s first use was as an anti-malarial preventative drug, something you’d take while in a region where malaria was present. There has been speculation about whether HCQ would work both to combat a coronavirus infection and also to prevent one too, the same as it does for malaria. Because it is such a mild drug with so few side effects (please keep reminding yourself, whenever you read the statements about its deadly side-effects that HCQ-haters love to offer, that it is the tenth most commonly prescribed drug in the US and is on the WHO list of essential/safe drugs) and because it is so inexpensive, it would seem ideal for this, if it actually does have a preventative capability.
So, why hasn’t testing been done to evaluate HCQ for this purpose? Shouldn’t this be a high priority study? I’ve two answers to that, both of which might surprise you.
First, testing has been done, already. Remember, it is the tenth most commonly prescribed drug in the US at present. Why not see what is happening to people who are taking it every day at present, as a treatment for lupus or whatever other malady it is prescribed for, and see if their rate of Covid-19 infection is higher or lower than average, and if infected, if their infection is more or less severe than average? This could readily be done – the drug can only be obtained on prescription, so there are records of everyone receiving it and their dosages. All the information is waiting for someone to obtain and collate.
There are some rumors of such analysis having been done, but I’ve not been able to track down any authoritative and convincing study. Surely this is something that should be given highest priority – if the entire population of the US could be protected at a cost of something like $33 million/day – call it $1 billion/month – surely that is many thousand times better than the multi-trillion dollar per month expenditures we are making at present, and the tens of thousands of deaths each month the nation is suffering!
The second answer is very cynical, and before I give it, I remind you that when masks were in short supply, we were told by the CDC and other health authorities that we didn’t need masks and they provided no benefit. This was an outright lie, presumably told so as to enable healthcare workers to get priority access to masks, and to keep the cost of mask purchases down due to less market demand. We know that was an outright lie, because now the same people are telling us we should (and, sometimes even, we must) wear masks.
So could it be the reason we’re not being told about HCQ’s preventative role is simply because there isn’t enough of it to go around?
Timings And Numbers
Here’s an article that says most of the new Covid-19 cases in New York are from people staying at home, but venturing out for occasional shopping and other necessary things, rather than people who are working through the pandemic. On the face of it, that might be the opposite of what you’d expect – the “essential workers” seem to be the most at risk.
There are two possible explanations though. The first is that essential workers are doing a better job of protecting themselves, and that’s definitely likely to be part of the complete explanation.
The second is that the essential workers actually are having a higher rate of cases, but because there are so few essential workers compared to “normal people” the total count skews to normal people.
Unfortunately, we’re not told the proportion of essential workers to normal people, so can only guess. Which leaves us with yet another virus mystery.
In a related item about New York, this article looks at the difference between how NY and CA responded to their respective virus threats, in a hope to understand why NY has been suffering ten times the deaths as California. (Not to be pedantic, but when expressed not just in terms of actual deaths, but in terms of deaths/million – 1464 in New York, and 84 in California, the difference is actually 17 times rather than “just” ten times.)
We’re not sure the article provides the full answer, but it certainly provides some explanation.
Bad data and limited data continue to be the stock in trade of everything to do with trying to understand and analyze the virus. There’s another challenge as well – delayed data. This article is an interesting look at how long it takes for new cases to actually make it through the bureaucracy and to finally register on the official count in Georgia. We understand that other states are often similarly inefficient.
If only someone could invent something whereby it was possible to enter data remotely and have it somehow instantly update some sort of a central counting system. Something like the internet and shared central databases…..
Closings and Openings
We’ve been guessing that people are more likely to take road trips this year rather than fly somewhere. That was hinted at in the reader survey we held and reported on a couple of weeks ago, with 76% of readers saying their first trip once it is safe to do so will be “close to home”. Here’s an interesting survey by the Pilot Flying J truckstop chain that seems to confirm that.
Did you know that Friday will be “National Roadtrip Day”? No, me neither. But we suspect this year’s Memorial Day weekend won’t see as much terrible traffic as in previous years. All the more reason to go somewhere, if appropriate and possible, and of course, the lovely low gas prices – under $1.50/gallon in some states – are an inducement too.
This is a good commentary about what has been happening in Sweden. It is particularly good because it is written by a Swede, living in Sweden, rather than by someone, somewhere else, relying on second and third hand stories.
The big lesson in it, at least for me, is that while Sweden had few mandatory lockdown measures, its people voluntarily created their own modifications to normal behavior, using common sense and compromise. If only we could do the same.
Who Should Pay
The US Citizenship and Immigration Services agency is running out of money, because not enough people are applying for citizenship/green cards/work permits/etc at present. It is funded by the fees it charges applicants.
So it has three options. It could increase the fees charged. It could lay off some workers. Or it could ask Congress for money.
No prizes for guessing which option it chose. It is asking for $1.2 billion in emergency funding. It has said it will add 10% to the fees it charges, but has not said if it is reducing its manning level at all (and we know what that means). The agency has 16,650 employees; we can’t start to guess what they all do, particularly because neither the Customs and Border Patrol nor the Immigration and Customs Enforcement agencies are not part of it.
We don’t think it fair that government employees should enjoy guaranteed jobs and stable salaries, even when they’ve less to do than normal, while so much of the private sector is suffering so severely.
Logic? What Logic?
WHO is holding its annual meeting, but one country that wishes to attend is again forbidden. Taiwan. This makes WHO’s claim not to be unduly influenced by Taiwan’s neighbor to the west (China) all the more risible. WHO won’t even grant Taiwan observer status, such as it has done to other disputed-status nations.
There is a growing call for WHO to mount an impartial, independent and comprehensive evaluation of the response to the Covid-19 pandemic. 116 of the 194 countries at the WHO meeting have supported this.
But how likely is it that WHO would indeed conduct an impartial, independent and comprehensive evaluation? We’d say there’d be close to zero chance of that, and close to a max chance of, after years of delay, WHO releasing a mealy-mouthed jumble of platitudes that cast no specific blame anywhere, and of course, absolutely nothing in China’s direction.
The Dow soared an impressive 912 points today, a 3.9% swing upwards, to close at 24,597. Airline stocks were among the best performers, with the NYSE Airline Index rising 14%.
A South Korean football team played a match to an almost empty stadium. But so as to create some sort of “crowd feel” they had a sprinkling of dummies in seats. It subsequently transpired that the dummies were, ahem, sex dolls. The football club disputes this, saying they were not sex dolls, but rather, “premium mannequins”. Of course. Details here.
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 : Monday 18 May, 2020”
It might be worth considering a different reason for why the CDC changed the mask recommendation. We learned stuff!
At one point it was thought (concluded?) that the virus only spread through coughing and sneezing. Later it was learned the enthusiastic singing, heavy breathing (exercising). It seems now it might even spread with just talking.
Part of science is learning and as this diary has repeatedly pointed out there is much we don’t know. So a rather reasonable conclusion is the CDC evolved their recommendation based on learning new information.
It would be interesting to see if it would be possible to get the information on the existing prescriptions for HQC and map it against infection and other health outcomes. I recall there was a large collection of samples in Washington State being used for a flu study. They tried to test for Covid-19 and were stopped by some government agency — they didn’t have patient consent for the test. With perfect 20/20 hindsight that analysis would have shown, at least month before it was understood, just how far the virus had spread.
I’m not sure about the reason for a shift in mask usage being because we learned stuff. There was always a strange disconnect between the claim masks were essential for healthcare workers but not for ordinary people. If we’d been told “masks are helpful for everyone, but healthcare workers are 1,000 times more at risk so should have them first” that would have made sense. But that wasn’t the message being promulgated.
I’m also not sure that the “new” discoveries really were all that new, nor am I sure they were all that surprising. Rather I think it was a case of the authorities being slow to accept the fairly logical totality of ways the virus could spread (and freeing themselves from the Chinese lies and WHO’s endorsement of same about “no person to person risk” and other such canards), and needing to be beaten heavily with a big stick before they’d slowly come around to acknowledging what really seems as fairly obvious.
And another thing I’m not sure about. Masks are helpful to protect both the wearer and the people around them, and are appropriate for diminishing the risk of coughs and sneezes as much as they are for diminishing the risk of breathing/shouting/etc.
Masks always made sense, imho.
Here’s a link to what appears to be a true randomized, controlled trial with Hydroxychloroquine:
Its going to take time to show results but appears to be a solid study
I’m not so sure about the trial you linked to. It starts off by being limited only to patients who require hospitalization. The thing about hydroxychloroquine is that it is believed to be best in the earliest stages of an infection. By the time you’ve got to needing to be admitted to hospital, it might be too late for HCQ to do its thing. That has been the common problem with most of the trials to date – testing for something the drug isn’t claimed to have, rather than testing for what the drug is claimed to have.
I’m also astonished at the trial timeline. It studies what happens to patients after 15 days of hospitalization. So why does it take over a year to conduct? Why can’t we have preliminary results in one week, daily updates, and final outcomes within a day or two of the 15 day period of observation concluding?
There is a bit of apples and oranges in comparing the need for N95 for health care workers and cloth masks for the general public. The former is for keeping the virus out and later for stopping it from getting out.
We were asked to do a number of things out of the abundance of caution so suggesting everyone wear a mask would have easily made sense. I would how many people would have listened then. Especially now the somehow not wearing a mask is making a political statement and, at least in one case, being refused admission for not wearing one is reason for murder.
I digress, I agree with your conclusion, we waited too long.
Good Morning David, thank you for your daily COVID essays. Reading them is enlightening. We are still looking forward to traveling with you in the future. Did your survey of “desired” trips give you some ideas for future planning? Fran.
It would be lovely to have you and John along again, somewhere, sometime.
The survey results were most notable for showing “somewhere close to home” as the most popular choice! Beyond that, and “the usual suspects” there was no clear indication. Depending on timing and travel policies, NZ and Australia scored high and are certainly very safe destinations at present, so maybe there? I’m open to suggestions. 🙂