Covid-19 Diary : Wednesday 27 May, 2020

It is a lovely day here today.  Many people have rushed to claim that the virus will be harmed by good weather.  There is however absolutely no data to support that claim, just wishful thinking; and indeed, I find myself sort of hoping that the virus strength will remain unchanged year-round.

Lack of weather adjustments would make it easier to measure the impact of various lockdown/distancing measures, without having to further adjust for weather related impacts on the virus.  It would also mean we couldn’t lull ourselves into false confidence with a drop in virus numbers over the summer, only to then be “surprised” by its sudden strong return in the fall.

Current Numbers

I’ve made a shift to how I show the data.  There was increasing duplication of information in the several different and slightly confusing tables, this new way centralizes things some more.  The new way is more streamlined and also includes the “top” ten in each case (rather than variously 5, 6 or 8).

I’m omitting the actual numbers, and just showing the “count per million of population” because that is the real true meaningful comparative measure of the virus spread in different countries.

We no longer have selected data for “same day last week”.  I did like that data, but am running out of space in the table.  If it is important, you can simply go back in the archives to compare what was shown on any previous day with today’s data.

There are some gaps today where I had not shown data yesterday, they will all be filled tomorrow.

The table is not as “pretty” as I’d wish, but there are limitations, in WordPress, in RSS, in email formatting (and most of all, in my ability) which all combine and conspire to limit just how well I can format this.

Let’s see what it looks like in emails today and maybe I’ll tweak it some more tomorrow.  Suggestions always welcome.

Now that we have ten entries in each of the three categories, we see some new countries appearing for the first time, or reappearing after having earlier dropped off the shorter lists.

The anomalies that unavoidably appear in the small country list are all the more starkly apparent now.  Concentrating on “large” (ie population greater than 10 million) sized countries (of which there are 90 in total), it is fascinating to see such a huge spread in numbers, even in these large countries where random events are much more minimized.

Contrasts like Portugal and France each having half the case count of their neighbor, Spain, or France and the Netherlands having half the death rate of neighboring Belgium are now more apparent, because they’re all on the same longer lists.

I Am Not a Doctor, But….

Here’s another article decrying the prominence given to the underwhelming but overhyped remdesivir drug, while pointing out that although much of the costs of developing the drug were paid for by the US government, all of the profits – of which there will be a huge amount, based on early reports of what level of extraordinary markup Gilead plans to place on the drug (cost price $10, selling price expected to be in the hundreds or thousands of dollars) will be kept by Gilead.  (This article has much more on the history of remdesivir’s development and the US govt assistance.)

Back to the first article, it also points to necessary data about remdesivir’s effectiveness that has been withheld (which can only mean it is not favorable) and cites a more promising drug combination that would be massively less expensive but which has no hype-machine pushing it into the media, because the drugs are now “public domain” meaning no drug companies stand to make billions of dollars out of drug monopolies.

Shouldn’t we expect our public health officials to dispassionately evaluate drug treatments based on medical facts, not press releases?

I came across a new possible palliative/cure for the virus today.  Quercetin.  This is a fairly long-shot seeming product, and I’m not doing anything more than mentioning it if you like to surround yourself with as many such things as possible.  Do your own research.  Perhaps a starting reference point would be here, then move to this rather self-serving and vague article, then move on to these :  one  two  three (note the very small numbers of people in this trial, which means any results will be far from persuasive unless they are extreme in nature)  four.

Noting it is freely available and not very expensive on Amazon, I ordered a bottle of 500 mg capsules for “just in case” use.  I’d not pay any extra to get capsules that include other supplements such as Bromelain; indeed, I’d rather keep it simple with just the Quercetin.  Otherwise, if you start getting a selection of different products each with multiple ingredients, there’s a danger that several of them have overlapping ingredients so you get too much of something.

Timings And Numbers

I continue to agonize over the imprecision of the numbers we are getting.  I didn’t realize, but apparently hospitals get paid $30,000 per patient they have who dies of the virus; that certainly encourages them to give the virus the “benefit of the doubt” when citing causes of death.

But the most extreme example so far is in my own state of Washington, where anyone, who dies of any reason, who also currently has or had the virus, has their cause of death certified as being due to the coronavirus.  So, as this article reports, to take an extreme example, if you’re the unfortunate victim of a shooting, your cause of death will be attributed not to a gunshot wound, but to the virus.

One has to wonder why it is that some countries are desperately keen to minimize and underreport their virus deaths, but the US is similarly keen to overreport their virus deaths.

Here’s a good article that looks at some possible reasons why the virus numbers are so much lower in less affluent countries in Asia and Africa.  There are huge differences, but we suggest it is too soon to draw conclusions – maybe their virus spread rates are lower and slower.

“It ain’t over ’till its over” has to be a guiding concept – we remember, mirthlessly, at how people rushed to hail Germany as a miracle for having a death rate of 0.5% of cases, and eagerly coming up with all sorts of explanations why that happened.  Now Germany’s death rate is 4.7% – ten times what it was when it was being hailed as miraculous.

We guess the same people are now sifting through African and Asian countries to find the next example of a miracle onto which they can then awkwardly impose their preferred conclusions.

Closings and Openings

A very surprising revelation today.  Much has been made of the divergence of approach as between Sweden and its Nordic neighbors.  Sweden largely stayed open, albeit with some moderate guidelines on group events; Norway (and most of Europe) had strict social distancing measures in place.

On the face of it, the difference in approach is stark and speaks to the benefit of lockdown controls.  Sweden’s death rate is 418/million.  Norway is 43 – almost ten times less.  Denmark is 98, Finland is 56, and other nearby countries are in the same sort of range – Latvia/Lithuania/Estonia are 12/24/50; Poland is 27 and Germany is 101.

While there are plenty of confounding factors to make these death rates fuzzy rather than exact, when you’re looking at 10:1 type differences, clearly there is some sort of underlying impact, although it is a huge assumption to attribute these massive differences to social distancing alone, although that is obviously the temptation and what many people have done.

Sweden has said “Yes, it is true we’ve had more deaths, but we’ve also had more cases; we’re closer to getting herd immunity, and we’ve spared our society and economy the worst of the associated costs of locking down”.  That also seems intuitively correct, although no-one really knows how much closer Sweden is to herd immunity, and for that matter, no-one yet knows if herd immunity will even exist.

And now for today’s surprising revelation.  Norway’s public health authority published a report saying that maybe its lockdown was never needed – that its virus infestation was already dropping before the lockdown was initiated.  The director of the authority said

Our assessment now, and I find that there is a broad consensus in relation to the reopening, was that one could probably achieve the same effect – and avoid part of the unfortunate repercussions – by not closing. But, instead, staying open with precautions to stop the spread.

The devil is in the details (and the semantics), of course.  With the possible exception of China, no country in the world has ever truly and literally locked down its citizens.  What exactly the difference is between, in the director’s quote above, “closing” and “staying open with precautions” may be very slight indeed.

Norway has reported half the number of cases that Sweden has (per million people – 1549 compared to 3476), even though it has tested almost twice as many people (4.4% of the population compared to 2.4%), but somehow has limited its deaths to one tenth as many.  On the face of it, by both these imperfect measures, social distancing has worked for Norway – at least, so far.

So why is the public health authority and its director saying social distancing in the strict form it was implemented, was not necessary?

Here’s an interesting approach to selectively opening up things – based not on the activities, but on the people attending.  It uses two concepts I wrote about way back on 8 April – group testing and some sort of visible indicator to show one’s test status to others.

There are some problems with the suggested implementation in the Forbes article – the time from testing to sending in the results to getting the results back to getting a color-changing wristband might be considerable, and the concept of a wristband that changes from green to red is awkward because for most of the time it will be somewhere between green and red requiring subjective evaluation of “is it too red yet”.

My color-coded app concept is much less ambiguous, and also is more adaptable- the period of time a person is given a green type upcheck isn’t just based on days but also on risks encountered.  If a person tests clear and then stays at home, seeing no-one, their status should stay in the okay range for a lot longer than a person who takes a crowded bus to work every day, works in a meat plant, and goes to a crowded bar after work each evening.

However, as the saying goes, “the excellent is the enemy of the good”.  The Forbes approach is vastly better than our current “one size fits no-one” approach.

Whatever, however, we need to change to a more adaptable and smarter approach to our locking down and distancing.

I continue to have no clear opinion, at all, as to if we have locked down too much or too little, in general terms, and – like all “experts” too, I can only guess what might have happened if we didn’t lock down.  But I am absolutely certain that our lockdown has been totally inelegant and too broad in nature.  It is like banning all people from driving and cars in the evening because some people are more likely to drive drunk in the evenings.  (Or, ahem, trying to ban all firearms from everyone just because of the deranged acts of a very few people.)

We need to do this smarter, not harder.  We can better save the lives of the people at risk, we can better improve the lives of the people not at risk, and we can save our economy and avoid the mega-trillion dollar costs we’re incurring.

Who Should Pay

I recently wrote about Lufthansa getting €9 billion in aid from the German government, subject to the approval of their board/shareholders and the EU.  I’d expected that the LH board would of course approve what its executives had negotiated, and guessed that after some bullying by Germany, the EU would eventually agree to go along with the deal too, even though it probably contravenes their prohibition on state aid.

But in surprising news today, the LH board is saying it is unable to approve the deal negotiated with their government, because they fear the EU might impose unacceptable conditions on them.

That is astonishing for three reasons.  First, something we almost never see here – a board overruling its executives.  Second, turning down the money before the EU has set out its objections (if any), rather than after.  And third, does the airline really/truly need €9 billion or not?  If it doesn’t, why was it asking the German government for the money?  But if it does, what will it do instead?

Logic?  What Logic?

There have been some “shock horror” headlines lecturing us on the dangers of re-opening based on a “spike in cases” in South Korea.  The spike?  In a country of 51 million people, they reported 50 new cases today, the highest number in a month, and compared to a typical day with about 15 – 30 cases.

Sure, 50 cases is more than 15-30, but it is just “random noise” in a country of 51 million people.  I’ve suggested the strictest measure of acceptable new cases should be one case per million per day, and at that level, S Korea is still doing well.  The US is relaxing its lockdown while reporting 60 or more new cases every day.

We expect (and hope) that South Korea will quickly squash this “spike” the same way it did before.

Virus?  What Virus?

The CDC came out with a very disappointing statement today (sorry, lost the link).  In cases where the prevalence of the virus is and has been low, anti-body tests to determine who has been previously infected by the virus could be very inaccurate.  They said that less than half the people who test positive for having been infected may in fact truly have been infected.

This isn’t altogether a surprise at all, but it has largely been swept under the carpet until now.  The implications of this are not good.  It means we have generally been over-estimating the number of people who have been infected.

That is a bad thing for two reasons.  First, it means our progress towards the hoped for “herd immunity” is slower than we’d believed to be the case.

Second, the calculations of the risk of dying from the Covid-19 virus have often been calculated not by matching deaths to known cases, but instead by matching deaths to both known cases and guessed-at additional cases too.  Now that it seems that maybe half the guessed-at additional cases, as implied by this testing, don’t exist, so that means fewer total cases and a higher death rate.

Medical

As I’ve observed repeatedly before, the phrase “out of an abundance of caution” invariably means “I know what I just said/did was really utterly stupid, but don’t you dare criticize me”.

The latest example is from a surprising source.  One of the people trialling the Moderna vaccine candidate (another hyped product with big-pharma big-PR pushing it, but with some underlying concerns) became quite the media star because he was the first man to receive the vaccine (a woman was vaccinated shortly before him so his claim to fame is rather narrowly defined, but he is cooperative and sympathetic, so the PR types seem to love him).

After predictable pieces about how brave and fearless he is, we now learn that – ooops, he suffered a severe reaction to the vaccine, and felt more sick than he ever had before.  However, he chose not to reveal the side effects until now “out of an abundance of caution“.  Say what?

Apparently three of the first 45 people trialing the vaccine have suffered major side effects, so far.  That’s not an encouraging ratio.

As I’ve said before, I’m as keen as anyone else to see a vaccine developed and made available for all, but there’s no way I’ll take it myself until there have been some months pass and a chance for real-world feedback as to any side-effects.

Money

Irrational exuberance?  Too much belief in the press releases about remdesivir (as some are now wondering)?  Call it what you like, but the Dow followed up yesterday’s excellent number with another giant leap upwards, soaring another 553 points (2.2%) to close at 25,548.

Rumors

I mentioned China’s unbelievably low numbers again yesterday.  In particular I said it seemed very unlikely that the virus wouldn’t have spread from Wuhan to other parts of China, the same way it spread from Wuhan to other countries.

Reader Paul wrote in to add to this by saying :

You are right.  The travel ban in China was imposed on January 23rd, and because of the timing of the Chinese New Year celebration, this was after an estimated 5 million people had traveled from Wuhan to be with their families in other parts of the country.

I checked and found this article that confirms 23 Jan for the Wuhan travel ban and a subsequent 25 Jan for travel from other parts of the Hubei province Wuhan is part of.  As for how many people left prior to then, this article quotes the mayor of Wuhan as estimating it was 5 million.

So, as I said yesterday, but now with numbers, how is it possible these 5 million people didn’t take the virus to every corner of China?

Other

I’ve been puzzled at airlines that continue to operate flights between countries that are essentially closed to visitors.  Sure, there are very narrow bands of exceptions to such bans (doctors and nurses are usually welcomed into any country if they’re coming to help out!).  But are there enough of such exceptional people to justify continuing to operate regular services with eg 278 seater 777 planes?  For example, Singapore Airlines is flying a 777-300ER five times a week between Singapore and Zurich.

Switzerland has a complete ban on all foreign visitors.  So too does Singapore.  How many people are likely to be on each of those flights, one wonders?

(The answer is probably that the flights are mainly being operated to transport freight rather than passengers.)

One also wonders about the danger of someone booking a ticket from somewhere to somewhere else, and not realizing that “you can’t get there from here” – the flight might operate, but they’d not be allowed off the plane upon arrival.

But these concerns are nothing compared to an overreaching assumption.  That at least, even if people are not allowed to enter the country, the plane is allowed to land.  But perhaps that’s an assumption that should be checked by the operating airline – as the two passengers and probably four or five crew on a Eurowings flight from Dusseldorf to Sardinia found out, mere moments prior to their expected landing.   Ooops!

Please stay happy and healthy; all going well, I’ll be back again tomorrow

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