Covid-19 Diary : Saturday 16 May, 2020

 

Now that I’ve finished writing it, I realize that today’s diary entry is very negative.  It isn’t my wish to be unduly negative, but if there’s a more positive way to spin the items today, I can’t think what it is.  If I’m overlooking good news that should be shared, please let me know of that too, but I see precious little good news, just occasionally failed attempts at trying to spin bad news in a more positive form.

Things got off to a bad start when I got an email from the local congresswoman this morning touting her contributions to the so-called “Heroes Act” – Congress’ move to spend another $3 trillion dollars under the guise of saving the country from the coronavirus.  I instinctively dislike all legislation with fancy names like “Heroes Act” (more often than not, the bills are the exact opposite of what their name implies), so things were off to a bad start.

Without even considering the contents of the bill, there’s a huge fundamental disconnect.  Money alone, even in the unthinkable trillions of dollars, will not solve the coronavirus pandemicThe things that will solve the virus are cheap and easy.  Social distancing and masks, contact tracking, and testing.  Some of the poorest nations in the world are getting this right.  We should learn from them.

Sadly, these essential measures received minimal consideration in this stunning display of “how to spend $3 trillion and have nothing to show for it”.

The only outcome we can expect from this $3 trillion expenditure is the need to pony up another $3 trillion in another month, and then again, and again.  The last round of three trillions of dollars has done almost nothing for us, and rather than “buying us time” it has wasted our time.  We need to spend smarter, not more extravagantly.  Other countries around the world are emerging from their virus outbreaks and surging forward once more, but we’re still in the middle of ours, because we’ve not being doing the necessary things to solve the problem.

Notable in the bill is a provision to “invest” (of course, the more accurate word is “spend” or “gift”) nearly $1 trillion in state, local and tribal governments for “the usual suspects” – public health, EMS, firefighters and schools.  Have you noticed that whenever any tax is being levied, it is always to support these groups?  Whenever any tax-cut is being threatened, it is always these groups that will suffer?

But why does the federal government need to now gift $1 trillion to state, local and tribal governments?  As much as we all love firefighters and schools, why do they now need a sudden influx of federal cash?  Why is the federal government spending money it doesn’t have on state and local government infrastructure under the justification of “heroically” getting through the virus pandemic?  Isn’t it better for the states and local governments to do this, themselves, directly?  Does someone in Washington DC know better than your local government representatives about the needs of your community?

I’d be happy to see surplus money redistributed back to the people on just about any sort of basis.  But none of this money is spare or surplus.  The federal government needs to act the same way we do.  When we have a windfall and spare money, maybe we buy our friends a round of expensive drinks in an expensive bar, buy a new luxury car, go on a world cruise, and so on.  But if we’re desperately short of money, and with debts galore, we cut back on buying expensive drinks for friends and other unnecessary extravagances, and focus on buying basic food for ourselves only.

Congress still doesn’t realize that the US is no longer a wealthy country.  We are currently engaged on a wild spending spree with no thought for where the money is coming from, and with little thought for where the money is going, either.

The coronavirus is being used as an excuse and as a way to rush through an extraordinary amount of spending, much of which would not survive careful line-item scrutiny in normal times.  Out of interest, I added up the “headline” disclosed items of expenditure in the first 10 pages of the bill summary, and it came to $1.51 trillion.  But this is described as a $3 trillion bill.  What is the other $1.5 trillion being spent on?  The first ten pages detail expenditures that the bill writers wish to boast about as small as $1 million, so how is it that $1.5 trillion is somehow overlooked and left buried in the fine print?

Among the disclosed items, ignoring the many strange gifts, such as $10 million each for the National Endowment for the Arts and the National Endowment for the Humanities (I don’t even know what that lucky organization is) or $14 million for fair housing initiatives, or $15 million for housing for people with AIDS, there were some bigger ticket items that stood out awkwardly.  For example, there’s $25 billion being given the Postal Service – the same Postal Service that stubbornly refuses to charge merchants in China as much to mail goods to US addresses as it charges Americans to do the same thing, and now is in financial difficulty because it isn’t generating enough revenue.

We, the American taxpayers, are directly subsidizing extraordinarily profitable Chinese businesses such as Alibaba, and headed by billionaires such as Jack Ma.  Not only are we doing that, we’re making it impossible for small US businesses headed by ordinary people like you and me to compete against these Chinese companies and their billionaire owners.  You can buy items from China, including shipping, for less than the shipping cost alone on the same items from a US company.

That $25 billion needs its own bill and its own deliberation, not to be hidden as part of a $3 trillion bill allegedly trying to spend our way out of the coronavirus crisis.  And let’s require the Post Office to at least charge international mailers at a rate that covers their costs and which is the same or higher than rates for domestic mail service.

But, back to the virus.  What Congress needs to be urgently debating and enacting is how to create and put in place the low cost measures that will solve the virus problem, rather than try to salve the pain by extravagant expenditure every which way, while allowing the virus crisis to continue.

Current Numbers

I’ve now formalized my definition for major/minor countries.  For a country to be considered “major” it must have at least 10 million population.  This brings about two immediate changes – Ireland loses its place in the table below, because its population is 4.9 million.  And Sweden needs to be added to the top six countries in terms of death rates; I’d overlooked that Sweden has 10.1 million people.

Here are the rankings for the eight states of any size with the highest infection rates.  There was no change in rankings today.

  • San Marino/653 cases/the equivalent of 19,250 cases per million people
  • Vatican City/12 cases/14,981 cases per million (unchanged)
  • Qatar/30,972/10,774
  • Andorra/761/9,849 (unchanged)
  • Luxembourg/3,930/6,291
  • Spain/276,505/5,914
  • Iceland/1,802/5,281 (unchanged)
  • Ireland/24,048/4,877

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

  • Belgium/9,005 deaths/777 deaths per million
  • Spain/27,563 deaths/590 deaths per million
  • Italy/31,763 deaths/525
  • United Kingdom/34,466/508
  • France/27,625/423
  • Sweden/3,674/364

To put those numbers into context, the death rates per million in the US/Canada are 272/151.  The world average (not a very reliable number) is 40.2.

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

Same Day
Last Week
Yesterday Today
Total Cases 4,098,276 4,621,407 4,716,988
Total Deaths 280,224 308,155 312,921
US Cases/Deaths/Case rate per million 1,347,309/80,037
4,070
1,484,285/88,507
4,488
1,507,773/90,113
4,558
UK Cases/Deaths/Case rate per million 215,260/31,587
3,171
236,711/33,998
3,489
240,161/34,466
3,540
Canada Cases/Deaths/Case rate per million 67,702/4,693
1,794
74,613/5,562
1,979
75,864/5,679
2,012
Worst affected major country/case rate Spain/5,620 Spain/5,868 Spain/5,914
Second worst country affected Ireland/4,609 Ireland/4,859 Belgium/4,747
Third worst Belgium/4,538 Belgium/4,717 USA/4,558
Fourth USA/4,070 USA/4,488 Italy/3,717
Fifth Italy/3,610 Italy/3,702 UK/3,540

I Am Not a Doctor, But….

It frustrates me to see the continued publication of results from trials of hydroxychloroquine that “prove” the drug is not helpful in treating Covid-19.

I’ll start off with an analogy.  You are thinking of buying a family car to commute around town.  A car publication does a test of half a dozen cars to see which one performs the best – straightline top speed, acceleration, and cornering.  The car you are considering comes bottom of all the tests.

But you are not buying a car to race on the track.  You are buying a car to drive through suburbia, in dense traffic, at speeds never exceeding 40 mph.  The cars that did better in the car magazine testing all cost ten times as much, and are two seaters with no room for your children or your shopping.

The test was useless, because it didn’t test the attributes that were important to you, or the attributes the car model claimed to be good at.  You wanted an economical reliable functional car, not a high end luxury sports car.

In the case of hydroxychloroquine, the drug has never been recommended for later stage patients.  It may have some use during the very early onset of Covid-19 symptoms.  The drug is thought to possibly stop or at least slow down the rate at which the virus multiplies, and to prevent it viably overwhelming your body’s defenses to the point where the secondary symptoms and lung damage start occurring.

In such a case, what sense does it make to test the effect of HCQ on patients who are already at such an advanced state of infection that they need oxygen?  It makes no sense whatsoever.  No-one has ever suggested HCQ will help at that late stage.  The virus has already taken over your lungs.

But trials continue to be done, testing HCQ in this context, and when it is proven to have no measurable effect, either pro or con, the trial is then trumpeted as “proving” that HCQ is useless in all contexts, even though other contexts were not tested at all.

This is such a colossal fail in logic and sense as to be very difficult to accept and excuse as being anything other than a deliberate attempt to unfairly condemn the drug.  Here’s the latest such example.

We want to see testing and trialing of HCQ in the area where its supporters say it does work, not in the area where no-one has ever suggested it might work.  Why is this not being done?

Timings And Numbers

49 days.  That is how long it is said for New Zealand to kill off its virus infestation.  It remains to be seen if their removal of most restrictions will allow them to keep the virus at bay now, but whether that is true or not, they certainly deserve congratulations for their swift triumph to date.

Compare the shape of the daily new case count curve in New Zealand to that in the US.  New Zealand doesn’t have enough deaths to make a death chart meaningful – it has 21 so far, just over 1% of reported cases (the US is currently at 5.9% of reported cases).

Another country hailed as an example of a success is Iceland.  Unlike New Zealand, Iceland didn’t even have a very strict lockdown, but it did have a cooperative population.  Here’s their case count.

They also have a similar problem of “not enough” deaths to form a meaningful chart.  They have 10, which is just over a 0.5% rate of reported cases – 11 times lower than the US at 5.9%.

Here’s an interesting article, written with the thought of outcomes as a result of the US easing back on restrictions – how long does it take to see a change in case rates after a change in social distancing restrictions?

Like everything to do with the virus and trying to measure/quantify it, the answer is not simple.  In theory, if you lifted restrictions on Day 1, then already infected people immediately start infecting more people than they otherwise would, so on about Day 5 or 6, you might start to see a rise in new cases.

But this simple statement is made less exact due to the implications of asymptomatic spreading, and also the changing rates of testing for infections.  So after Day 12 or so, you should have the “second generation” of new cases (ie additionally infected people in days 1 – 5 now in turn infecting another round of people) more strongly appearing.

Someone at Johns Hopkins – we don’t know, it could well have been the cleaner – said it might take up to five or six weeks to detect a response.  That’s a ridiculous answer.  That too is sadly a common occurrence at present – people who apparently are experts making really stupid statements.

Perhaps we should ask someone in Iceland or New Zealand to help, because plainly our experts can’t.  It took them only a week or two to change their curves from upwards rising to downwards.

Closings and Openings

Here’s an interesting list of countries that have mandatory quarantines for people arriving into their country.  We doubt this is a complete list, and it doesn’t also list countries that have simply banned everyone from arriving, quarantine or not (countries such as New Zealand and Australia).

Iceland has a brilliant idea for how to handle people arriving there.  Arriving passengers are given a choice – a virus test to see if they have the virus or not, or a two week quarantine if they’d prefer not to be tested.  We don’t know of other countries also offering the same choice, and assuming the testing is accurate, it seems like the ideal approach.

Meanwhile, for the poor old US, Canada now tells us “Keep Out!”.  We have to say, we totally understand their point of view.

Logic?  What Logic?

The US Navy Hospital Ship Mercy is now leaving Los Angeles.  The Director of the California Office of Emergency Services, in a farewell statement, described its presence as having been “critical to our ability to respond in the first stages of the pandemic”.

The 1000 bed hospital ship handled, in total, a mere 77 patients during the 50 days it was in Los Angeles.  Yes, that’s an average of 1.5 a day.

Does that really qualify as a critical element of the area’s response?  According to the IHME statistics, the state was never short of hospital beds at any time, there always being 5 – 10 times more beds available than needed.  Wouldn’t it be more accurate to describe it as a totally unnecessary overreaction?

Here’s an article wailing about how difficult it is to handle a situation when a customer refuses to wear a mask.  The only difficulty is in the minds of people unwilling to take assertive actions to save our country and our economy.

Handling such customers is the easiest thing imaginable, if someone would have the willingness to declare martial law and announce fatal consequences for anyone seen in public without a mask, and if some of the $3 trillion “Heroes” spending bill was spent on giving everyone masks and then enforcing martial law.

Which is better – draconian enforcement or watching our country die, both in reality and economically?

Enforcement doesn’t even have to be draconian.  It just has to be even-handed, fair, impartial, and consistent.  Like for example, what happened to the Prime Minister of New Zealand recently.

As I’ve said before, our problem is not the virus.  That is easy to beat.  Our problem is ourselves.  We’re taking an easy challenge and making it impossibly difficult.

Virus?  What Virus?

Happily, not everywhere in the US is being so abjectly dysfunctional.  This is an example of how to enforce social distancing, in Hawaii (the state with the second lowest case count per million of anywhere in the country, beaten only by Montana and the lowest death count per million).

We suspect it not altogether a random coincidence that the offender in HI was from NY.

In related HI news, the state has decided to extend its 14 day quarantine requirement for all arriving tourists until 30 June.  That’s a costly measure for HI, a state that relies more on tourism than most, but it is clearly proving to be effective.

Other

Here’s an interesting read of what it is like to work in a grocery store in New York at present.  I felt myself cringing when reading of some of the appallingly insensitive and inappropriate acts of some of the customers.

It has been a negative diary entry today – if you have suggestions for how to be positive while watching our nation bleed itself to death in a slow-motion suicide, please let me know.

But to try and end on a positive note, we’ve all seen way too many terrible headlines recently.  Here are some ones sure to put a smile on your face, instead.

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.

12 thoughts on “Covid-19 Diary : Saturday 16 May, 2020”

  1. Richard Davis – We are what we eat. Sometimes.

    The way to get HCQ back on the front burner and to have good studies done is for Trump to emphatically deny that HCQ can do anything.

  2. David, I think your comments about HCQ are spot on. I realize that many of the media have been doing everything can to make HCQ look useless and even dangerous, regardless of facts. But my real concern is that some medical professionals may also biased against it, depending on their politics.

    My Wife and I are considered somewhat high risk and my very real fear is that if we get sick, we won’t even have the option of being treated with HCQ because our doctors may be biased against it (and I am hearing that many pharmacies won’t even fill HCQ prescriptions). I live in a very liberal part of California, and fear there is bias against it.

    I won’t go on about the many doctors in the US that have had good results, and the foreign countries that use it as their standard of care. Or the fact that we have so few useful alternatives.

    It doesn’t matter to me who has recommended this drug or the political feelings involved. I want our country to have access to a potential effective treatment. And anyone who is trying to bias the facts against a possible treatment, or mis-design studies to get the result they seek, is deliberately hurting people and our country.

    I definitely want HCQ treatment in the early stages of the disease if I get it. Any thoughts on this?

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

      Hi, Peter

      Two thoughts in reply.

      The first is a suggestion to obtain a supply of HCQ directly, especially if you know someone in a foreign country who can buy it over-the-counter at one of their pharmacies and send it to you.

      The second is to acknowledge that there can be heart issues in some patients. You should probably ask your doctor if you’re in an at-risk group or not, and – if you are – what the symptoms/warnings are of heart related side-effects so you know when/if you need to stop taking the pills.

      https://reference.medscape.com/drug/plaquenil-hydroxychloroquine-sulfate-343205#4
      https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19

      The bonus third point is to be sure you don’t take too much of the stuff. Do due diligence and see what dose the studies use; I think the one I linked to today used a higher dosage than others I’ve seen, and my sense is that there is definitely such a thing as “too much”.

      And one further comment. It seems that HCQ works best if you take a zinc supplement too. Again, do your own due diligence. I’m not a doctor, I can’t advise, I can merely observe what others say.

      There is a theory about taking azythromycin as well. This adds to the possibility of heart issues, and I think if your lungs are clear at that early point, it might not be quite so essential if you’re doing it all on your own. If you had a cooperative doctor, then I’d ask him if it was possible to add that too.

      Lastly, when doing a quick literature search before replying, I came across this. I think it adds more confusion rather than certainty to everything, but felt it fair to share it. The writer/commentator seems very fair and dispassionate.

      https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hydroxychloroquine-update-may-4

      Good luck. 🙂

  3. Trying to be optimistic and find some good news. Two things:

    If you look at the trends on rt.live (just pushing last week, 2 weeks ago, 4 weeks ago) is a quick view. We are making some progress. And the IHME curves for some states are truly improving (for example NJ where the case rate seems to be dropping about 10% a week — consistent with an Rn of ~.8)

    I read yesterday that, at least in the lab, the Rn drops about 3% for each degree above 77’F. So there should be a natural slowing of the spread over the summer.

    I have two concerns with later. First several of the states reopening ahead of case reduction are in the southeast where the temperature already or will soon exceed 77′ will have this affect partial mask the increased inflections due to premature opening.

    The second concern is if we have a hotter than average summer, things will start to look really good and instead of using the time to get ready for the increased rate of transmission in the fall, success will be declared and nothing will happen.

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

      Hi, Biz

      It is strange that the really good news on the rt.live site is not being obviously reflected in actual daily numbers, the same for IHME. But keep in mind IHME keeps moving its goal posts!

      Can you find the link to the article about a drop in transmission rates as a function of temperatures. I also note the coincidence that 77° is a nice round number (25°C) which makes the whole thing seem empirical rather than scientific. But will reserve judgment until seeing any study if you can remember where you saw it.

      Your concerns are very much on point.

  4. One thing to point out on the USPS rates charged for international shipments into the US. They are set by treaty that by law the USPS must follow.

    The Trump administration, on the other hand, could renegotiate the treaty.

    USPS is a strange entity, most of what is can and can’t do are controlled by the federal government (try to close a Post Office and see how fast Congress reacts). Yet is it expected to be a profitable ‘private’ business.

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

      Hi, Biz

      I’m well aware of the “set by treaty” excuse. What negative consequence occurs if the USPS says “Hey guys, that treaty was decades ago, prices have changed, we’re doubling our international rates effective yesterday”? Nothing is the short answer. The predictable wailing and moaning from the predictable sources, but nothing substantive.

      If it needs to be Pres Trump who makes that declaration, so be it. Someone needs to do something, rather than allowing the US taxpayer to continue to subsidize Chinese billionaires while making it impossible for US companies to fairly compete.

      This is not a new problem. I wrote about it I forget when – more than a year ago – when I first started noticing how I could buy things cheaper from China than from Amazon, and cheaper from Amazon than from anywhere else in the US, with other places in the US charging me more for postage alone than Amazon/China would charge me for the item and the postage.

      The solution is not to throw another $25 billion at USPS. The solution is to adjust its rates.

  5. Well it really does have to the federal government and a unilateral move by USPS. Government agencies are supposed follow the law … I agree the international inbound rates need to be changed!

    USPS frequently is told how to run — as I said, try to close a post office. Check out the cute little Post Office at 113 Readington Rd, Readington, NJ. Then zoom out say 6-7 miles. Search for Post Offices. There are 7. And when is the last time you went to the Post Office? Does the US really need over 30K post offices? Do we really need Saturday delivery?

    Amazon frequently uses USPS for “last mile” delivery. So Amazon delivers the package to the regional facility (for me there are 2 in the county) and USPS moves the package from there. So Amazon is covering part of the shipping internal.

    If USPS wanted to make money, they should drop the same price to mail a letter anywhere in the country. Why shouldn’t you pay a premium to deliver the bottom of the grand canyon, anywhere that is expensive to serve (all of rural American and NYC), etc. UPS charges differently depending how far and where a package is being sent (or simply refused to serve an address).

    The same price to every address allows companies (especially Amazon) to cherry pick which places to deliver themselves and which to push onto USPS.

    I don’t know if $25 billion is the correct number but certainly postal service is providing an essential service. I think a good argument could be made more essential than airlines (which got more – better lobbyist).

    The bottom line is things need to be fixed. Unfortunately arbitrarily raising the rates for all shippers who use the last mile service will probably just result in lost revenue as it will become cheaper for them to do it themselves for all but high cost to serve addresses.

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

      I agree the Postal Service needs external direction to withdraw from or unilaterally amend its participation in the UPU. But that is exactly what Congress should be doing – rather than giving it and therefore China $25 billion, it should be authorizing the Postal Service to turn its back on yet another dysfunctional UN abomination (the UPU) and do what is right for the US.

      I have no comment about dropping the universal domestic first class mail rate. In general, I like the concept of having a single domestic first class mail rate. This seems to be the case in every country I’ve studied (as an amateur philatelist I’ve looked at such issues somewhat). But you’re conflating two issues – the universal rate for first class mail, and all the other rates the Postal Service charges for all the other types of mail it handles.

      Almost all parcel rates are already distance based, even though, in reality, the least part of the costs is the actual physical transport of a package from postal sorting center A to postal sorting center B. It is all the handling in the first and last few miles that are the labor intense and therefore costly parts of the process.

      There is no sense whatsoever in worrying “if we stop operating this service at a loss, we’ll lose the valuable customers”. That may be typical government thinking, perhaps, but what private company could ever say that? How valuable is a customer if they represent a net negative impact on operations and profit?

      If, in reality, USPS is profiting on a marginal costing basis from serving Amazon and others, then that is great, and it should stop pretending it isn’t. Maybe it can negotiate the rate up a bit, maybe not. But if, again in reality, USPS is losing money, on a marginal costing basis, by providing these services, it must immediately stop.

      Yes, I know that postal rates have to be approved by their oversight body, etc. But it needs to submit a realistic set of commercial rates to that body.

  6. Of course I can’t find the article — it was a few paragraphs in one of the major newspaper’s blog. It was a lab study, so not proven, the result was based on the higher temp and humidity causing the droplets to fall to the ground quicker.

    Of course the reports new infections are inaccurate due to the lack of consistent testing. That said if you look the new case data on rt.live at the individual states there are some positive curves. Also some really negative ones (see Texas).

    The positive ones include AK, MT, HI and VT. The first two are 90% socially distanced all the time. HI is an island from the rest of the country. But VT is down to 1 case per day.

    Additionally NJ and NY plus others are showing solid downward numbers. Let’s just hope after the pictures of all the idiots on the beach in NJ it doesn’t change.

    Many states are flatlining.

    So on a national level, not so good. Some places, there seems to be hope.

  7. Congress can’t change the foreign policy. That’s an executive branch responsibility.

    It would be interesting to see what the what the volume of low cost packages are from China. I seriously doubt that is the sole reason for the current shortfall.

    Supposedly the package handling part of the post office is making money. I believe that’s actual federal law (so first class isn’t subsidizing a service with competitors). Of course cost accounting can be close to a dark art (e.g., how much of cost of each post office is charged to the package operations).

    USPS offers both fixed rate (Priority Mail fixed rate) and weight/zone based shipping. So again you can ship to any address in the country no matter how expensive it is to serve. Something UPS and Fedex don’t do.

    It would be interesting to see what the market would bare. Could the rates charged to the big shippers be pushed up by some amount and be cost competitive.

    Difficult questions and answers are not easy given the mix of political and business challenges.

  8. All good thoughts. I definitely believe in making an informed decision, working with a Doctor’s advice and being cautious with dosage.

    That said, one big study that is often quoted is the VA study where patients given HCQ had a “higher death rate”. Of course, the breathless and mostly scientifically illiterate “journalists” who parrot this, miss the fact that the drug was mostly given to the most seriously ill patients, who had a high viral load already. The mild to moderately ill were mostly not given HCQ, where it supposedly does the most good in suppressing viral reproduction.

    Also, dosage seems to matter. Given that this drug has been prescribed for over 70 years, was given prophylactically for Malaria, and has been widely used for Lupus and Rheumatoid Arthritis (used by patients in sone cases for decades), and is the 10th most prescribed drug, I don’t think it’s the Widowmaker that some make it out to be. But again, we all have to make informed risk decisions – we make them every day.

    I would stick with the 5mg/kg body weight/day dosage that many doctors have discussed, and use it for as short a period as possible.

    Thanks for your thoughts.

    And interestingly, Trump has put his money where his mouth is. If it’s so dangerous, the media should be rejoicing.

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