Covid-19 Diary : Thursday 21 May, 2020

I started off with an opening commentary on social distancing and the six foot “rule”; but decided it was sufficiently important to have its own article, and you’ve probably now already seen it.

So let’s move directly on to today’s numbers.

Current Numbers

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/658 cases/the equivalent of 19,397 cases per million people
• Vatican City/12 cases/14,981 cases per million  (unchanged)
• Qatar/38,651/13,442
• Andorra/762/9,864  (unchanged)
• Luxembourg/3,980/6,370
• Spain/280,117/5,991
• Mayotte/1,475/5,423  (unchanged)
• Iceland/1,803/5,287  (unchanged)

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

• Belgium/9,186 deaths/793 deaths per million
• Spain/27,940 deaths/598 deaths per million
• Italy/32,486 deaths/537
• United Kingdom/36,042/531
• France/28,215/432
• Sweden/3,871/384

To put those numbers into context, the death rates per million in the US/Canada are 291/163.  The world average (not a very reliable number) is 42.9.

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

Today saw the US move up a rank, and now has the world’s second highest large country case rate.  Belgium moved down one.  UK contains to gain on Italy and may overtake it early in the coming week.

I Am Not a Doctor, But….

As the US increasingly relaxes its social distancing and lockdown requirements, we’ve not yet seen any clear or substantial upticks in the number of new infections.  One of the main reasons for this good news – in my opinion – is because at the same time we’ve been relaxing these restrictions, people have been increasingly adopting the use of masks when out in public.

Masks are a huge factor in protecting us and limiting the spread of the virus, and it is astonishing to read on pretty much a daily basis about how vehemently some people object to wearing them.

This graphic, showing mask use by state (from the IHME site), is a very interesting snapshot of our evolving approach to masks.  We’d like to see more and deeper green on the graphic the next time it is published.

Timings And Numbers

It is very hard to know if we’re winning or, ahem, not winning, the battle against the virus.  The problem with simply counting new cases is that as we increase our testing rates, we uncover and record more and more cases that otherwise might have been overlooked and never counted.

So sometimes what seems to be an increase in cases, and something to be alarmed about, is actually more likely merely an increase in discovered cases.

That helps to reconcile this set of mini-charts, showing most states to have steadily decreasing underlying new case rates, and this graphic that seems to show a number of states with increasing case rates.

The ultimate measure of case rates is perhaps death rates, although, as often commented on, most recently when looking at Russia’s low death rate yesterday, even death rate numbers are ambiguous and difficult to count exactly.

The other problem with death rates is they lag changes in transmission rates by about three weeks, and with deaths being very strongly skewed to people who are either elderly or who already have certain pre-existing conditions, they can sometimes rise higher or lower than average just because of where deaths are occurring rather than because of an overall increase/decrease in infections.

Amazingly, we still really don’t know how many people have had the disease, or what the average risk of death is.  Here is a fascinating article that looks at this issue, and uses a generally accepted death rate to “prove” that everyone in New York City must have been infected.  That is clearly not the case, so equally clearly, our estimated fatality rate is too low – the disease is deadlier than we thought.

This in turn means that there are not as many “silent/undetected” cases as we thought, and that is disappointing.  The more people who have been infected, the closer we get to a possible “herd immunity” scenario, assuming that having had the disease actually does then confer some sort of subsequent immunity.

Developing herd immunity is part of the justification for Sweden’s controversial “no lockdown” approach to the virus.  Yes, we’ve been noticing how Sweden’s death rate has been climbing and is now distinctively higher than in Norway for example, two countries that share much in terms of environment, urban/rural split, weather, and lifestyles.  Sweden’s death rate is currently 384 per million, while Norway is 9 times lower, at  43 per million.

Sweden’s response has been that its death rate is higher because many more people have been infected (and most recovered) than in Norway, and that eventually Norway’s infection rate and therefore death rate will catch up.  This has always been a slightly difficult claim to make, because Norway is reporting 1534 cases per million, while Sweden is reporting only twice as many, 3188 per million.  However, it has been noted that Norway has tested twice as many people per million of population, so perhaps that has doubled its reported cases, which would help close the gap (but still leaving a 2:1 factor unexplained).

To bridge this remaining gap, Sweden’s big hope has been the existence of many more undetected asymptomatic cases.  Unfortunately, those hopes were slightly dashed today when this article suggested lower overall rates of infection than had been hoped for, meaning Sweden still has a very long way to go before reaching the point where herd immunity starts to become apparent, and also suggesting that its much freer strategy may not be as sensible as some have suggested.

The hope of a vast unreported and growing number of people who have had the virus without even realizing it is present in all countries.  A couple of months ago, there was a study published in Britain suggesting that even back then, over half the UK had already been infected by the virus.  That was viewed as an unlikely reality when the claim was made, and now, after two months of virus activity in Britain, this article suggests that only 5% of the UK have developed virus antibodies, with a higher 17% in London.

It is worth mentioning that these antibody tests are notoriously unreliable, but even so, there’s a clear clash between 5% now and the earlier suggestion of 50% way back in the very early stages of Britain’s battle against the virus.

The bottom line?  It all remains a mystery.

Logic?  What Logic?

Apple and Google have been working together to develop a mobile-phone based contact tracing service.  It primarily relies on mobile phones automatically “talking” to each other through short-range Bluetooth which typically has a range of about 30 ft or so.  The concept is that if two phones have registered each other’s presence, then if the owner of one phone is found to have the virus, it is easy to determine who else he may have infected.

The devil is in the details, though.  For example, if two people are 30 ft apart (and my Bluetooth devices often have much longer real-world range) for a few minutes, the risk of one person infecting the other is very low.  How will the phones know exactly how close they are to each other?

There’s another challenge as well.  This feature is to be used as a contract tracing app.  But, as discussed in this and other articles, the app gives priority to user privacy.  That would seem incompatible with contact tracing.

Here’s another article that explains what the concept is in more detail, but we continue to feel there’s too much priority being given to user privacy, for example, it will tell you if you may have been in contact with an infected person, but it won’t give location details.  That’s something that might be very helpful in terms of allowing you to understand the probable nature of what/when/where – there’s a huge difference in risk between being outside in a park, 12 ft away, and being crammed up inside a bus or train, 1 ft away.

We understand that not everyone in the country holds our President in as high a regard as we do personally, although we like to think we’re not blinded to his flaws.  What we find extraordinary though is that, according to a Reuters/Ipsos poll, 36% of poll respondents said they would be less willing to take a vaccine if President Trump endorsed it as being safe.  The survey also found that 25% of US citizens said they had little or no interest in taking a vaccine once one has been developed.  (Sorry, much to our chagrin, we lost the webpage link).

For me, I’d not be influenced in either direction by President Trump’s statements.  But I am slightly concerned at the (understandable) rush to developing a vaccine, and am anxious that we might be short-circuiting some prudent extra steps and cautions in the evaluating process, and am additionally anxious that choosing a vaccine might be in equal measure a case of political expediency as medical reality.

I will be vaccinated, but I’ll leave it as long as possible before I do, while waiting to see if anything untoward develops in the large number of people who act as unwitting early-user “beta testers”.

Money

The Dow continues its seesawing, dropping a mild 102 points (0.41%) to 24,474.

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.