Covid-19 Diary : Sunday 3 May, 2020

 

A nice slow Sunday, even the day’s statistics aren’t as bad as sometimes, but that often seems to be the case on a Sunday.  The big opinion piece for the day is down in the “Timing and Numbers” section.  I’ve felt awkward about this for sometime, and feel it needs to be said.

Current Numbers

Here are the rankings for the eight states of any size with the highest infection rates.  Qatar moved from #7 to #5, Iceland dropped from #5 to #7, and Ireland displaced Gibraltar at the bottom.

  • San Marino/582 cases/the equivalent of 17,152 cases per million people
  • Vatican City/11 cases/13,733 cases per million (unchanged)
  • Andorra/748/9,681
  • Luxembourg/3,824/6,109
  • Qatar/15,551/5,398
  • Spain/247,122/5,285
  • Iceland/1,799/5,272
  • Ireland/21,506/4,355

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

  • Belgium/7,844 deaths/677 deaths per million
  • Spain/25,264 deaths/540 deaths per million
  • Italy/28,884 deaths/478
  • United Kingdom/28,446/419
  • France/24,895/381
  • Netherlands/5,056/295

To put those numbers into context, the death rates per million in the US/Canada are 207/98.  The world average (not a very reliable number) is 31.8.

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

Same Day
Last Week
YesterdayToday
Total Cases2,994,4363,482,8973,564,110
Total Deaths206,973244,760248,151
Active Cases (ie not yet died or cured)1,908,7562,130,0162,162,947
US Cases/Deaths/Case rate per million987,160/55,413/29821,160,774/67,444/35071,188,122/68,598/3589
UK Cases/Deaths/Case rate per million152,840/20,732/2251182,260/28,131/2685186,599/28,446/2749
Canada Cases/Deaths/Case rate per million46,895/2,560/1,24356,714/3,566/150359,474/3,682/1576
Worst affected major country/case rateSpain/4,847Spain/5,252Spain/5,285
Second worst country affectedBelgium/3,981Ireland/4,289Ireland/4,355
Third worstIreland/3,901Belgium/4,273Belgium/4,306
FourthSwitzerland/3,358USA/3,507USA/3,589
FifthItaly/3,269Italy/3,462Italy/3,485

I Am Not a Doctor, But….

Everyone talks about the need for testing, although most people fail to appreciate exactly the strengths and limitations of testing – in particular, the need to get results quickly, and the rapidly expiring value of a test (ie, you can become infected five minutes after being tested).

There’s another issue that keeps on keeping on as well.  The accuracy of the tests.  You would think this to be the absolute essential element of any testing procedure – that the results it generates are accurate.  An at-home pregnancy test costing as little as $5 is generally 99% accurate.  But these multi-hundred dollar laboratory tests for the coronavirus are massively less accurate, creating potentially very distorted perceptions of who has and who had an infection.

Details here.

Here’s a long shot possible treatment for people suffering from the virus.  As is always the case, it is very early days yet and way too soon to express confidence in this, but it is another “cross our fingers and hope” possible treatment.

And here’s an article explaining how some researchers have been testing 47 existing approved medications that might also help cure a Covid-19 infection.  Several of them show signs of promise, although again, it is exceedingly early days and way too soon to be too hopeful.

And now, remdesivir.  Here’s an article that describes it now as “scientifically proven”.  That would seem to be stretching the truth beyond breaking point.  There has only been one refereed study of remdesivir that has been published so far (in Britain’s ultra-authoritive The Lancet publication) and that study “scientifically proved” remdesivir was useless.

There has also been a controversial trial in the US for which preliminary results have been released; as I explained yesterday, apparently when it seemed this second trial would also disappoint, the people conducting the trial changed the parameters for what was being tested, and then ended the trial before full data could be obtained.  That’s a bit like changing a car test from “can it drive 500 miles on a tank of gas” (when, with 300 miles driven, the gauge is showing almost empty) to “can it reach a speed of 75 mph on the freeway” and claiming the car test was a success while hoping no-one would realize the thing being tested changed halfway through the test.

Here’s further exposure of the concerning nature of the US remdesivir trial and its subsequent crowning as a successful cure.  Yes, I’ll still accept it if I’m unwell, but please can I also have plenty of the other possible treatments too.

Here are some sensible words on vaccine issues from Bill Gates.  Of note is how his foundation is definitely putting their money where their mouth is and making a huge investment in vaccine development.

Timings And Numbers

This is an interesting article that sheds more light on the claim the virus takes an average of ten years off a person’s life.  We particularly liked the chart, shown on the left here, that indicates how age selective the virus is.

One of my mantras is to approach this pandemic on the basis of working smarter, not working harder.  So there’s a huge issue staring us in the face when we look at this chart.  As you can see, 79.4% of everyone who dies is 65 or older (almost half this group – 30.7% – are over 85, 27.3% are 75 – 84, and  21.4% are 65 – 74).  12.6% of deaths are among people 55 – 64, 7.8% are aged 25 – 54, and no-one 24 years or younger died.

Now, think about this.  Who are the people most and least affected by a “stay at home” order.  Retired people are least affected, because they no longer need to work, and can stay at home with little or no harm to their income.  Who are the people most affected by a stay at home order?  Probably younger people – fresh out of school/college, with debt, accumulating assets, raising a family, and needing every dollar they can earn.  Say, the people in the 25 – 54 age bracket.

Yet, who are the people who get the most and least benefit from the stay at home order?  The older people get the most benefit, and suffer the least.  The younger people get the least benefit, and suffer the most.  That doesn’t seem very fair or balanced (and, note, we’re older rather than younger, so we have no hidden agenda in saying this).

Why don’t we allow everyone under 45 (or 40, or 35; pick any number you like) to do everything the way they normally would, and offer to subsidize the cost of staying at home only for people over that age.  Most of the economy could continue with only very little impairment, meaning we’d be able to afford to pay the staying at home people and not destroy our entire economy, which currently is suffering the twin problems of collapsing production/earning but spiralling costs/expenditure.  At the same time we’d not be worrying about shortages and problems.

That would be a smart way to approach the virus.  What we’re doing at present is hard not smart.  Why can’t we change this?

Closings and Openings

Our continued high counts of new cases and deaths is in large part because our stay at home orders have never been well adopted nor enforced.

Every day I see a dozen families mixing and playing together in the cul de sac I live on, and the police refuse to do anything about that.  In some counties, the Sheriff has said he’ll refuse to enforce the Governor’s orders, whatever they are.  And elsewhere, we’re either seeing states let up on their restrictions, or more and more people just decide to stop following them.

This article shows the truth of the last statement.

Logic?  What Logic?

Here’s an interesting article that contrasts the approaches adopted by Sweden (relaxed, few restrictions) and New Zealand (strict lock down).  Sweden currently is showing a case rate of 2210 per million and a death rate of 265 per million.  New Zealand’s numbers are 308 and 4.  On the face of it, New Zealand is the clear winner, right?

Maybe.  Or maybe not.  The article agrees that right now, NZ has suffered much less than Sweden in terms of cases and deaths.  But which country has the more sustainable model, looking further into the future?  New Zealand’s model relies on keeping its borders closed until the rest of the world is safe; and until that happens, its largest industry – tourism – is largely destroyed.  (Only “largely” rather than completely, though – there is still domestic tourism and also the probability that NZ and Australia will start allowing unrestricted travel between each other.)

The article wonders if maybe, longer term, Sweden’s model might prove the better one.

We have no opinion on this yet – too many unknowns.  But we do agree this pandemic is of course a world-wide problem that will need a world-wide solution.

Virus?  What Virus?

This is interesting about how China is trying to rewrite internet “history” of its Wuhan virus labs.

We agree with Dr Birx – seeing protesters with no masks and no social distancing is indeed, as she says, “devastatingly worrisome“.

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.

 

11 thoughts on “Covid-19 Diary : Sunday 3 May, 2020”

  1. Two quick comments on the risk/benefit by age group:
    – Based on numerous headlines, there have been deaths under 24 years old — including infants in CT and IL. I suspect the rate is so small as to not show on the chart. It doesn’t change your point but there is a non-zero risk. (I couldn’t find that graphic to see if there was a footnote with the underlying rates).
    – A challenge in finding ways to work smarter is we don’t live in an age range separated ways. A school aged child could be raised by their grandparents. 30 year old staff work at nursing homes (and taking their temperature is false security). This doesn’t mean the approach isn’t a good idea, just it is logistically very complex.

    1. Hi, Biz

      Yes, there are very young people who die. But the numbers in the Wall St Jnl study were too small to even rise above 0.0%. The graphic was half way down the WSJ article.

      You are absolutely correct about the difficulty in separating younger and older people. But if you had a couple of trillion dollars to play with, I bet you could solve that problem! 🙂

  2. Fred Harrison

    I certainly agree we need a more strategic approach to stay-at-home rules. Here in the UK, as of mid-April, 87.3% of deaths attributable to C-19 were of people 65 or over. And of those, it’s been estimated that two-thirds would have been expected to die within a year of other causes. I’m in that age group, but even I have to wonder why some 30-year-old should sacrifice her career to protect me.

    But there is one catch. Many of the most vulnerable, both in North America and in the UK, are in institutional care. And the sicker the residents are the more likely they are to be attended to by a rotating team of physicians, nurses, nursing assistants and others, most of whom will live elsewhere. In Russia — a place I watch closely on account of friends and in-laws — the case rate is rising alarmingly. But the death rate remains very low. Why? At least partly because the local culture does not embrace institutional care for the elderly. There are almost no care homes. The old stay home and look after the kids or do some light housework.

    So along with a more targeted approach to isolation, we clearly need better ways to manage health care in old age homes.

    1. Certainly, institutions are not designed to isolate patients.

      But I’d hold off on Russia’s numbers just yet. They’re having very rapid daily increases in cases, so to look at deaths, it is necessary to match today’s deaths with the new cases detected about two weeks ago. When you do that, their death rates skyrocket.

      1. Fred Harrison

        Today’s death rate in Russia is 9/million, compared with the UK’s 423/million and the US’s 211. Hardly skyrocketing. But you may prove to be right. Let’s see what happens to the Russian stats in a couple of weeks.

        1. You misunderstand and your rebuttal is unrelated to anything I said or suggested. I’ll explain more carefully.

          You should compare today’s death rate with the new case rate of two weeks ago. Today, there were 76 deaths in Russia. Two weeks ago, Russia reported 5,642 new cases. So the (extremely approximate) death rate is 1.35% rather than 0.9% by matching total deaths to total cases.

          That’s 50% higher. Maybe not a sky-rocket, but certainly a significant change.

          To look at the numbers you now introduce, yes, Russia’s death rate is very much lower than that of US or UK. But it is simplistic to extract one factor alone and give it prominence as a/the reason for the variance. Look at New Zealand or Australia, for example, which have a similar approach to old people’s homes as does the UK and US. Both have death rates almost identical to Russia rather than to either US or UK.

          There is another interesting point of difference between Russia and all four western countries. Russia has fewer old people in general. So that’s a contributing factor to its lower death rates compared to US/UK, but doesn’t explain why NZ/US, which many more older people, and many more in old folks’ homes, have a similar death rate.

          I am very intrigued by the enormous differences in deaths, by any and all measures, between countries. It is not random variance. There is something (or perhaps several things) causing this that no-one understands, and which we should be assiduously seeking to identify so we can shape our response.

          1. Fred Harrison

            I understood perfectly well actually and wasn’t offering a rebuttal. I wasn’t aware there was a debate. I definitely wouldn’t choose to argue the accuracy of Russia’s reported numbers and I didn’t even mention Russia’s claimed 0.9% mortality rate. I’m well aware of the rumors that many C-19 deaths are, in Russia, being attributed to pneumonia or other proximate causes. I’ve no way of knowing whether that is the case.

            So even your claimed 1.35% death rate — compared with 5.8% in the US — is quite possibly an underestimate.

            Your point about the data differences between and among countries is well taken. How, for instance, should we react to third world countries like Ethiopia, Angola, Yemen and Burundi reporting deaths/million of 0.03-0.08? Is it because the ambient life expectancy is so low that people seldom live long enough to become fatally vulnerable to C-19? Or are they simply not reporting complete data. Bit of both, plus other factors, I imagine.

            As you suggest, it’s one of the many mysteries that need detailed study.

          2. The huge spread in death rates is one of the most urgent questions that demands solving. Why indeed are some of the most underdeveloped countries in the world reporting the least impact of the virus?

            The life expectancy issue is interesting, and definitely needs to be considered in any analysis

            https://www.worldometers.info/demographics/life-expectancy/

            But who knows what other factors may be at play as well. All of Africa has largely escaped much impact from the virus (click on the “Africa” tab on this page and look particularly at the deaths/1M pop column which is probably the most reliable of all the data reported). Apart from the tiny islands of Mayotte and Sao Tome & Principe, few countries have enough data to be statistically valid.

            But, and looking only at countries with more than say 2000 cases, we see

            (Ugh, sorry, didn’t format)

            Country Death Rate Life Expectancy
            Algeria 11 77.5
            Morocco 5 77.4
            Egypt 4 72.5
            South Africa 2 64.9
            Cameroon 2 60.3
            Ghana 0.6 64.9
            Nigeria 0.5 55.8

            There’s a weak correlation there between life expectancy and death rate. More data is needed, and this correlation rather fails when we switch to Europe/North America/Oceania – there’s a huge range of death rates matched alongside a narrow range of uncorrelated life expectancies.

            But there might be something significant about US and Canada – Canada has a somewhat older population and half the death rate.

            Country Death Rate Life Expectancy
            Belgium 692 82.2
            Spain 548 84.0
            Italy 485 84.0
            Britain 433 81.8
            France 386 83.1
            Netherlands 302 82.8
            Ireland 267 82.8
            Switzerland 207 84.3
            Portugal 105 82.7
            Germany 83 81.9
            Austria 67 82.1
            Romania 44 76.5
            Czech Rep 24 82.4
            Poland 19 79.3

            United States 214 79.1
            Canada 104 83.0

            Australia 4 84.0
            New Zealand 4 82.8

            On the other hand, none of these numbers are “final”. Some of these countries still have active infection rates and growing death rates, and that’s a very important consideration too – where on the curve is each country. And maybe there’s the biggest hint of all – it is the “curve management” that has been most impactful – by controlling the infection rate (harder to accurately measure) and therefore by direct extension, the death rate.

        1. I agree that “social distancing” is much more significant than whether older people are in aged care facilities or living with their families, and probably (see earlier comments) more significant than the amount of old people in a population overall.

          That probably is also the most convincing reason why the US death rate is so high. But does it explain Belgium, Spain, Italy?

          Note also the curious contrast between adjacent countries. Poland and Germany. Portugal and Spain. Belgium and France/Netherlands. These are very striking.

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