Covid-19 Diary : Sunday 14 June, 2020

The last few days have seen an interesting study in contrasts.

China has been reported to have gone to a “wartime emergency” after a series of virus cases were discovered in Beijing.

We wish we could believe whatever is reported about China, so we don’t really know for sure much except that there might be about 50 new cases a day being reported in Beijing for the last two – three days.  Beijing has a population of 22 million, so this is about double the “ideal” maximum (one per million people per day).  China pushed the panic button as soon as six cases appeared in Beijing, and that’s what has to be done if a country wishes to keep the virus away.

It has locked down 11 Beijing neighborhoods, and when China locks down a neighborhood, it is a real total lockdown.  No-one leaves their apartment buildings, other than with specific one-off permission being granted.  Sports events and regional tourism have been suspended.  They are even closing schools again.

In other countries, the virus has been re-appearing, too.  In Rome the authorities locked down an entire apartment block after 17 people were reported with the virus.

Spain has seen an increase in its daily new cases.  Although happily way down from when it was reporting almost 10,000 a day, its daily count went from 48 to 84 to 167 in three days.  Spain has a population of 47 million, so it went from one to almost four new cases per million per day.

Meanwhile in the US, our daily new cases continue to average around about 22,000; which is a rate of almost 70 new cases per million per day.  And no-one is doing anything about it, except eagerly removing social-distancing restrictions.

Texas has just recorded its highest ever one-day count of new cases, which the Harris County Executive described as “approaching the precipice of a disaster” and “out of hand right now” – but also, perplexingly, said “The good news is it’s not severe out of hand”.  I’ve no idea how to reconcile those two references to being out of hand.

So what is Texas doing about this?  Well, this article talks about “sounding alarms” and “getting close to re-imposing stay-at-home orders”, and even considering reopening an emergency overflow hospital.  But actual steps to mitigate the virus spread?  None.  Nothing at all.

This article points out that 64 counties in Florida, currently removing their social-distancing restrictions, saw a 42% increase in new cases the week prior to their latest liberalizations.  Testing increased by 8%, so almost all of the increase is due to actual new cases, not just more testing finding more cases.  In the last week they have twice set new records for the most new cases in a single day.

Why are we continuing to remove social restrictions while virus numbers are climbing?

Current Numbers

Saudi Arabia has appeared on the rankings today, and the US has moved up one more place in the death rate table.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

I Am Not a Doctor, But….

I may have found a possible answer to one of the big puzzles I’ve been trying to understand – there are credible reports suggesting the virus has been “out there” several months before it was officially admitted to by China, and a month or two before it was officially acknowledged in other countries.

The problem is that if the virus was indeed “in the wild” months earlier, why hadn’t the exponential growth started back then too?  What was causing it to just stay quietly in the background prior to late January or thereabouts?

The answer may be in this article

 Sometime in the middle of January, there was a change that allowed the virus to become more infectious. It doesn’t mean it’s more lethal, [but] it makes it about 10 times more infectious.

Another quotable quote from the article is this

This virus is going to respond to whatever we do to control it. We make a drug, it is going to resist it. We make a vaccine, it is going to try to get around it. We stay at home, it is going to figure out how to hang around longer.

Timings And Numbers

Here’s a good article that points out the much talked about “second wave” isn’t upon us, it is still the first wave.

Too many people are (deliberately?) misunderstanding the concept of second waves.  They are relying primarily on the Spanish ‘flu experience, 100 years ago, when the second wave was more severe and deadly than the first.  But this is not an inevitability.  The second wave back then was of a mutated virus strain that was more virulent and deadly.  That is the only reason the second wave was worse than the first.

We shouldn’t resign ourselves to a bad/worse second wave, we should instead be proactively and positively acting to prevent it.

Here’s a good article with some great charts and analysis about the trends in the US at present, including the one directly above.  There is little or no obscured good news within them.

Closings and Openings

Again, a contrast with other countries.  China goes to an emergency wartime footing after a dozen cases were discovered.  The CDC vaguely says that it may be necessary to reimplement strict coronavirus measures if cases go up “dramatically”.

Can anyone convert that to a clear “trigger point” that causes strict coronavirus measures?  For that matter, what would the strict measures be?  You’d think the CDC, smarting from justified criticism on all sides, would try to actually come up with something sensible and specific, but instead we get empty meaningless posturing.

Why is it other countries scramble to contain the virus – and largely succeed in their attempts – while we do nothing.  The CDC adds (quoted in the same article) that it expects to see Covid-19 deaths to accelerate in Arizona, Arkansas, Hawaii, North Carolina, Utah, and Vermont over the next four weeks compared to the past four weeks.

So what is the CDC doing about it, other than making vague meaningless statements to the press?

But my questions to the CDC are not intended to absolve the state and local governments and their public health agencies from responsibility either.  If anything, their culpability is much much greater.  The CDC advises, and now there is no official in the country who can claim to be unaware of the virus or the danger it poses.  I accept that in February and March, and alas, in April and May too, there were way too many people with their eyes tightly shut and ignoring the implications of the virus spread.  But with now 118,000 people dead, and a per head of population death rate the seventh worst in the world – and this after a mega-trillion-dollar shutdown – the threat of the virus should be clear to all.

Meanwhile, the deaths keep coming in, and looking into the future, the projections point to the daily death rate to start rising again.

The unfortunate death of one man in Minneapolis has convulsed the country in paroxyms of virtue-signaling and rage.  Where is the rage about the 500 or more people dying each day from Covid-19?  We talk about how the death in Minneapolis was preventable (while being careful not to include in the definition of “preventable” that it would not have happened if the man was not high on a mix of illegal drugs and resisting arrest); aren’t the 500 Covid-19 deaths every day; the 118,000 in total, also at least as preventable?

I was reading this article, and reminded of another element of illogic that does nothing to protect us (or our economy).  We have forbidden people from most of Europe coming to the US due to concerns they might bring the virus with them, but we’ve never stopped to consider people from other virus-ridden countries like Singapore, India, or Brazil.  Why not?  Why are we forbidding Canadians, even though their rate of virus cases is less than half that of here?

The US currently has one of the most liberal policies in the entire world in terms of allowing people from other countries in.  Why?

Who Should Pay

A 70 yr old gentleman in Seattle had a 62 day hospital stay due to the virus.  He survived, but what almost killed him was the shock at seeing the bill for his hospitalization.  The grand total, on the 181st page of the bill, was $1.1 million.

Among other charges was $82,215 for 29 days of ventilator use ($2835/day).  To put that $82,215 in perspective, a brand new ventilator costs $20,000 – $50,000 and has a projected life of about ten years.  A 29 day use fee is enough to buy two, maybe even three, new ventilators.

Imagine if you rented a $35,000 car for 29 days and found you were being charged $70,000 for the rental.  That’s a similar situation.

I’ve not seen the bill, but on the basis of it taking three pages to list all the charges for each day of stay, and noting there were substantial additional charges for the ICU room he was in and every other imaginable thing, I’ll bet that the $82,215 was not an “all inclusive” rate for ventilator, meds, staff, etc.  In other words, you had to pay $50,000 for the rental car, and then extra for the airport fee, the registration recovery charge, the insurance, and so on.

Logic?  What Logic?

Airlines claim to know what is best for Britain. Coincidentally, it is also what they think is best for themselves.

So they have filed a law suit to contest the country’s decision to do the same as most other countries and impose a 14 day quarantine on international visitors.  Not only are they upset they weren’t consulted (why on earth should they be consulted – this is about the virus and public health, not about airline profits) they also claim there is no scientific evidence to support a quarantine policy.

The one thing we’re all desperate for is a vaccine that works.  And when one is found, there’ll be a mad rush as every country scrambles to get as much of it as possible.

Well, every country except the EU.  The EU, in their never-far-from-the-surface US-hating ways, has said they will buy vaccines from anywhere as soon as possible, in anticipation of their subsequently being verified to work, with one exception.  They won’t buy any from the US.

The EU would rather deny vaccines to its citizens than buy them from the US.

Virus?  What Virus?

The US approach to the virus seems to be one of just ignoring it and no longer caring about the thousands of people dying in week.  Russia has a different approach.  They have announced they have won their battle against the virus, so can now relax their restrictions.  There’s just one problem with their “victory”…..

Medical

Here’s some good news.  Popular blood pressure medicines had been thought to possibly make the virus more severe.  It has now been decided that they don’t do this and there’s no need to discontinue them.

This article suggests the virus is mutating only relatively slowly, which increases the probability of being able to develop vaccines that might last for some helpful amount of time.

This is an interesting story reporting what doctors have learned about how to treat patients with severe virus infections.  If you read it carefully, however, you might come up with an interesting interpretation

But an unusually high number of health care personnel in Italy — 20 percent, according to an editorial in The Lancet medical journal — were becoming infected with the coronavirus. They blamed the high flow nasal oxygen, figuring the treatment was aerosolizing the virus, spreading it to doctors and nurses.

As a result, many doctors in the U.S. were initially wary of using high flow oxygen for COVID-19 patients. “We were very concerned, so we didn’t use it,” said Dr. Hugh Cassiere, director of critical care medicine at Northwell Health’s North Shore University Hospital on Long Island, New York.

Instead, patients were intubated and put on ventilators, often right away.

If this means what it seems to mean, is it suggesting that doctors put patients on ventilators, not so much to save the lives of their patients, as to reduce the risk to their own lives?

Please stay happy and healthy (and keep away from ventilators at all costs); all going well, I’ll be back again soon.

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