Covid-19 Diary : Wednesday 6 May, 2020

I regularly point out that there are only three possible outcomes from this virus, and sometimes jokingly mention a fourth.  The three possible (positive) outcomes are we develop a cure, we develop a vaccine, or we develop herd immunity.  The fourth is not so positive – we all die.

The grim reality is there is no guarantee of developing a cure, no guarantee of developing a vaccine, and so far, there is also no guarantee that herd immunity will become a solution, either.  The only one of these solutions that is absolutely for sure an option is the fourth one, although to be clear, “we all die” may be overstating things.

With probably more than half of all people who get the disease having had it without even realizing, it is unlikely we’d all die; on the other hand, if we don’t get herd immunity after having contracted the disease, maybe the second or third or fourth time we get the disease (particularly if it mutates into a more harmful form) proves to be our unlucky time, a bit like playing Russian roulette.  Just because you pull the trigger and hear only a click does not mean Russian roulette is harmless or safe to keep playing.

This also points to yet another thing we don’t know about the virus – why so many people seem to experience it without any symptoms at all, but others die.  This is another of the essential questions that we desperately need answered so we can learn from the answer.

Back to the point I’m trying to build up to here.  This is an excellent article which points out the grim reality that the “fourth option” may yet become the only outcome.  It is of course a very unwelcome concept to discuss or share, and we can understand why our leaders are not talking about this more, but just because it is unwelcome does not mean it should be ignored.

In surprising news, it seems the White House Coronavirus Task Force is to be disbanded.  Or if not disbanded entirely, perhaps changed and repurposed.  We’d like to hope this is because it has now completed its initial job, but it is very hard to see any sign of that.

If you can see any transformative reduction in either new cases reported or daily deaths in these two charts, please let us all know.  To me, I see a month of stalled nothingness, and wasted/lost time.  Maybe there is the slightest of downward slopes to both lines, but it seems fair to expect a slight upward tilt to appear as the effects of state openings starts to flow through to these statistics, five or so days subsequently.

We need the task force to double down in its tasking, not to say that it has now done all that needs to be done.

Current Numbers

Here are the rankings for the eight states of any size with the highest infection rates.  Qatar moved another position up the list.

• San Marino/608 cases/the equivalent of 17,919 cases per million people
• Vatican City/12 cases/14,981 cases per million
• Andorra/751/9,720 (unchanged)
• Qatar/17,972/6,238
• Luxembourg/3,851/6,152
• Spain/253,682/5,426
• Iceland/1,799/5,272 (unchanged)
• Ireland/22,248/4,506

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

• Belgium/8,339 deaths/720 deaths per million
• Spain/25,857 deaths/553 deaths per million
• Italy/29,684 deaths/491
• United Kingdom/30,076/443
• France/25,809/395
• Netherlands/5,204/304

To put those numbers into context, the death rates per million in the US/Canada are 226/112.  The world average (not a very reliable number) is 34.0.

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

The UK now has highest total number of deaths in Europe, but not the highest death rate per head of population.

It is this latter measure that is more meaningful, but try telling that to commentators and opposition party politicians, who are now rushing to castigate the UK government for this terrible outcome, while conveniently overlooking the massively higher death rates in Italy, Spain and Belgium.

The same as in the US, it is terribly unfortunate when people with political agendas deliberately distort the truth to score meaningless points against “the other side”.  The virus doesn’t care about politics, and while we should hold our public health policy makers accountable, we should not deliberately distort the truth for political advantage.

It is also very easy for people in opposition to say “there should be more (fill in this gap any/every way you like)” without ever being accountable for actually putting in place a supply chain to create and distribute whatever it is they are calling for more of, or without ever needing to worry about the cost and economic implications of the thing they are demanding more of.

I Am Not a Doctor, But….

I instinctively turned away from this article due to the offensive nature of the first half of it, and what continues to be extremely thin lines of reasoning to support the rat’s nest mess of claims and more claims to do with President Trump simply firing a couple of people.

But a friend encouraged me to try and get past the initial outpouring of political nonsense, and he was right.  The article then turns to comments on remdesivir.  Rather as I expected, now that President Trump has joined the chorus of people supporting remdesivir, some people on the left are switching their own tune effortlessly.  First they held it up triumphantly as “proof” that hydroxychloroquine was bad, but now that Trump also supports this new drug, they are saying that remdesivir is also bad.

Such people may or may not be correct about HCQ, and they may also be correct that remdesivir is bad.  While we don’t see the fact breatlessly reported in the article that it was developed by a profitable pharmaceutical company as meaning it is bad, we do note with concern Gilead’s increased investment in lobbying, and we are surprised at how the drug was accorded “orphan drug status” without any apparent justification.

On the basis of “follow the money” we are utterly unsurprised at the guess that a course of remdesivir, which costs Gilead perhaps $9.32 to make, might be sold for $4,500 or more.  To say nothing of the cost of the hospitalization for the patient while receiving the treatment for 5 – 10 days.  This compares to a dollar or two for a handful of “take at home” HCQ tablets.

For sure, if $4,500 results in a successful cure and a dollar or two does nothing, then remdesivir is the way to go.  But, so far, there is no proof either that remdesivir does anything significant at all (quite the opposite, the only refereed study found it was useless), or that HCQ does not.

Oh, and remember the ongoing chorus from people expressing shock and horror that HCQ has side-effects – well-known side-effects that surprised no-one who has looked at the published literature and the 80 year history of a drug that is the tenth most commonly prescribed drug in the US?  Why are these people now silent about what seems to be a higher level of side-effects with remdesivir – an experimental drug about which little is yet known?

As I said above, it is a tragedy, and probably resulting in countless lives being lost, when we can’t evaluate medical treatments without allowing lobbying and political pressures, both pro and con, to invade what should be an apolitical evaluation.

Timings And Numbers

Do you think the US is over-counting or under-counting its virus deaths?  This survey shows an interesting split, with Democrats favoring an undercount and Republicans favoring an overcount.  Again, it is terrible that we can’t face this lethal threat without letting politics interfere.

We’re starting to see more awareness of earlier cases of Covid-19, in the US and elsewhere.  For example, Florida, the Sundance Film Festival, and everywhere in general.

The lesson I take from this is that the line “Trust me, I’m a doctor” is about as convincing as “The check is in the mail”.  It is astonishing that the medical community has been so sluggishly slow to recognize the appearance of a new viral infection.  It isn’t as though the concept of new viral infections is unheard of – it is a threat that many of us lie awake at night worrying about, on a “not if but when” basis.  But our front-line doctors and the public health officials who are full-time focused on monitoring and detecting such new threats – they were all asleep at the switch, with their eyes wide shut.

This is not just a US failing (and neither is it a politically influenced outcome, either!).  It seems to have been duplicated all around the world, costing us an unknown amount of time.  While our leaders – political and professional – have plenty to answer for, so too do the front-line people in clinics who were uncuriously misdiagnosing patients and misreporting causes of death, and displaying no interest in unusually high death rates.

As I’ve also observed, this backdating is also relevant when it comes to understanding and plotting the growth/spread of the virus.  If the virus had been silently growing, unreported on, for some weeks; when people finally started acknowledging its presence and knowing to consider it as a factor, surely we would have seen cases and deaths not start at 1 and then very slowly ramp up to 2, 3, 4 and so on, but to start at 10 or 100 or 1000 and then go up from there quickly.

Which brings me back to the ultimate challenge – there is so much we don’t know about the virus.

Here’s a great explainer that shows how it is possible that a test correctly described as “95% accurate” actually gives 40% errors.  It is an example of the Bayes’ theorem at work, and shows how sometimes, probability is very unintuitive – at least, until you know Bayes’ theorem.

Closings and Openings

Here’s a great map that shows which states have rising rates of Covid-19 and which have falling rates.  As you can very clearly see, there are more ochre colored states than green colored states.

Carnival is selling cruises, starting from 1 August, with some rates as low as $28/night, to tempt people back on board its ships.

Note that these rates, which are probably for windowless cabins next to the engine room, do not include taxes, fees, or port charges.  We’re sure there are additional costs for everything else imaginable, as seems to be the case these days on what used to be “all inclusive” cruises.

However, never mind discounted rates.  You couldn’t pay me to go on a big-ship cruise in August.  No way.  But there is one potential saving grace.  With a five day cruise, the chances are that people can get infected on the cruise (the typical incubation period is 4 1/2 days or longer), and be back home before the end of the incubation period, meaning the cruise itself won’t suffer from another nightmare quarantine.  The cruise line can also happily claim “we had no cases of the virus on our cruise”.

As I said, you couldn’t pay me to go on a big-ship cruise in August.

Shortages

Never mind the shortage of meat or toilet paper.  Not so much attention is being given to another continuing rush of buying and stocking up, and the associated shortages that are being suffered by people wishing to get better equipped for these increasingly troubled times.

Logic?  What Logic?

There’s another dimension to political stupidity at present.  The bleeding hearts who are now anxiously wondering if people should be allowed to volunteer for tests of new vaccines.  This is not a question that should be asked.  The people have volunteered.  The world needs such people.  You may as well ask if people should be allowed to volunteer to serve in the armed services, or in any other dangerous career, or to go sky-diving.

Just keep in mind there are only four ways we might resolve this crisis.  Doing nothing, and not accepting volunteers to help develop possible solutions pushes us closer to the fourth option.

Talking about political correctness, here’s a doubly stupid article.  It talks about a “second wave” of virus infections.  But look again at the two charts near the top – we’re still in the very peak of the first wave.  There won’t be a second wave until the first wave has been resolved.  There may well be a return to growth, but this is not a second wave, and it is not inevitable.

We should stop also using the term “second wave” because it is a passive term that absolves us all of responsibility or guilt, and implies the return of the virus is as inevitable as waves at a beach.  We should instead say “a colossal failure to contain”.  Because that is what it truly would/will be.

The other part of the article’s stupidity is citing the second wave of Spanish ‘flu after World War 1.  The much misunderstood element of the second wave of that ‘flu is that its second wave was with a mutated more deadly form of the virus.  That is why it was more deadly.  Not because it was a second wave, but because it was a different wave.

Snake oil salesmen love to make vague scientific sounding claims about their various potions.  Whereas once snake oil was sold by itinerant traveling salesmen who would literally and hastily leave town just at the point the locals were starting to discover their potions were useless, more recently they have been camped out on the internet, and using the internet to create chains of seemingly supportive articles that in a circular manner cite each other as proof of their claims, and using “reputation management” companies to ensure than no articles can be found through search engines to disprove their claims.  There is probably more snake oil being sold these days, described as “supplements” and “herbal remedies”, than was ever sold a century before.

The worst type of snake oil these days is technical snake oil.  If you’d like to see this on offer, read any of the excited claims about thermal cameras and the protection they are giving, “ensuring” that people infected with the coronavirus will be detected by this expensive amazing technology.

As I’ve written before, the technology does not work.  An asymptomatic infected person does not have an elevated temperature (that’s what “asymptomatic” means!).  Would someone please tell these people that.

Even more nonsensical is the claim that Heathrow Airport is “trialling” passenger temperature checks.  What does “trialling” mean?  Will Heathrow first do a temperature check, and then, as part of the trial, require the passenger to also submit to a medical test to see if they are infected?  How else can it truly try out the temperature checking?

Or is the claim about the trial merely an offensive bit of nonsense by the airport’s PR department, and is the trial nothing more than checking to see if the units reliably power up when switched on?

These are expensive devices.  But, newsflash :  Just because they are expensive does not mean they are effective.

Talking about expensive and effective, a similar argument is being used by the airline lobby group, IATA.  It says there is no value in not placing passengers in middle seats, and also says that even if middle seats were not filled, the two other passengers in the aisle and window seats would still be too close together, but then says it doesn’t matter, because you’re perfectly safe on a plane, no matter how full it is.

That’s a wide-ranging series of statements!  Not all of them are valid.

On the other hand, many thanks to Delta, who is doing the right thing, and without complaint.  Thank you, Delta.

Coming back to the “it is all about the money” it is interesting to read that Frontier will now offer to block the middle seat next to you for $39.

Maybe that’s a fair price to pay, but what happens if both the aisle and window passengers want to block the middle seat.  Do they both have to pay $39?  Or does it then reduce to $19.50 per passenger?

Virus?  What Virus?

Southwest is promoting airfares on special at present, saying it is time to start flying again.  One of their discounted routes is a flight to Hawaii for only $300.

That sounds appealing, perhaps, but what happens when you land in Hawaii?  Last I heard, you’d then be required to accept a mandatory two week quarantine.  I guess that is disclosed somewhere in Southwest’s fine print?

Money

The Dow is down again today, losing 218 points (0.9%) to close at 23,665.

Rumors

Just coming in late today is fascinating news that the military will not accept anyone wishing to join if they have previously been infected by the coronavirus.  Apparently there will be no exceptions to this policy, no matter how healthy a would-be recruit now tests as being.  This raises several interesting questions, starting off with “Why?”.

If a person has been infected and fully recovered, why would they not be allowed to enlist?  What does the Dept of Defense know that we don’t know?

Also as yet unknown is what will happen to the many thousands of servicemen currently infected with the virus.  Will they be medically discharged out of their service?

Other

Should one wear a face mask or not?  For some of us, it is a social etiquette question rather than a matter of complying with the law, but if you live in Brussels, it is an extremely complicated legal question.

It is true that wearing a face mask can make breathing a bit more difficult.  But we’re not certain this person has come up with a beneficial solution.

Truly lastly for today, here’s a fascinating video that proves how uncreative the “creative” and highly paid people at advertising agencies are.  It shows a mixed together medley of virus-era advertisements, showing how so many ads are interchangeably the same – same music, same text, same visuals – no matter what the product they are selling.

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

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