Covid-19 Diary : Sunday 7 June, 2020

 

Today saw a couple of watershed numbers.  There was also a credible and disappointing hydroxychloroquine study published a couple of days ago, so I thought another diary entry would be appropriate.

The total number of worldwide cases broke through the 7 million point today (and worldwide deaths exceeded 400,000 for the first time yesterday).  Here in the US, our total case count passed 2 million with little sign of much slowing, although our death rate has been dropping encouragingly.

Although the daily death rate has dropped, the IHME website increased its projected total US deaths by 4 August to 140,496, up about 5,000 from its most recent earlier prediction.

It is also worth noting that whereas, in the past, the end of the projection period was a time by which daily deaths were projected to have dropped to zero, meaning the projected total was a final total; as you can see above, this new model is still showing 354 new deaths on 4 August, making the projection merely a number at a certain point in time, not a final total of all Covid-19 deaths.  That is a significant and not much commented on change.

It no longer offers a final total, nor a clear promise for when we’ll finally be clear of the virus, indeed, the website shows a gentle (if that is the right word in this context) increase in new infections towards the end of the time series.

When can we go out, act normally and without fear, and not wear a mask?  While the New Zealand success story might seem like an outlier – a small island nation able to wall itself off from new incoming infected people – how about Vietnam?  Their daily new case count is now usually zero, and occasionally one.  They have a population of 97.3 million, and land borders with Cambodia, Laos and China.  For that matter, Laos – a smaller country with only 7.3 million – hasn’t had a new reported case since 12 April, and has borders with Vietnam, Cambodia, Thailand, Burma (Myanmar) and China.  How are these people keeping their virus numbers so low?

It almost makes one wonder – what if, against all the odds, China actually was and still is telling the truth about its virus case numbers, too?

Other examples of much more successful that the US countries can be found – compare for example the new case rise and fall in Italy – the country that for a while had the worst affliction of the virus of anywhere in the world – with our own experience in the US.

There’s something very wrong with what we’re doing in the US, and there’s precious little reason to believe that the answer to our problems is to open the country up further and faster.  The Rt.live site is showing 14 states today with possible growing rates of new cases.

Current Numbers

This is an interesting chart, from this page.

Clearly, no region is immune, although equally clearly, some have been hit much harder than others.  The reason for that remains a total mystery, and an intriguing one to answer.  If we could understand why the virus hits some countries worse than others, we might find, as part of that understanding, a cure/preventative.

Top Case Rates Minor Countries

RankOne Week AgoToday
1QatarQatar
2San MarinoSan Marino
3Vatican CityVatican City
4AndorraAndorra
5BahrainBahrain
6LuxembourgMayotte
7KuwaitKuwait
8MayotteSingapore
9SingaporeLuxembourg
10IcelandIceland

 

Top Case Rates Major Countries

RankOne Week AgoToday
1SpainChile
2USASpain
3ChileUSA
4BelgiumPeru
5PeruBelgium
6UKSweden
7ItalyUK
8SwedenItaly
9PortugalPortugal
10FranceBrazil

 

Top Death Rate Major Countries

RankOne Week AgoToday
1BelgiumBelgium
2SpainUK
3UKSpain
4ItalyItaly
5FranceSweden
6SwedenFrance
7NetherlandsNetherlands
8USAUSA
9CanadaCanada
10EcuadorEcuador

 

I Am Not a Doctor, But….

Here’s another study on hydroxychloroquine that shows disappointing results.  But, yet again, the study doesn’t test HCQ together with zinc, that being the combination which is thought to be most effective.

And, now, a study that seems to be generally well designed and conducted, to see if people who may have been exposed to the virus could reduce their chances of then contracting it by taking HCQ after the potential exposure but before being diagnosed with Covid-19.  That’s a good thing to test for, because one of the claims for HCQ is that it works best in the early stages of the virus developing.

Regrettably, it only had the patients taking HCQ for five days – a longer period might have been interesting to test.  Its five day treatment showed a slightly lower incidence of developed Covid-19 cases, but too small a difference to be statistically significant.

Again, the big question is “What about zinc???”.  But unlike most other studies, this one sort of featured zinc use in its study as well.  If you go to Table S8 in the appendices, you’ll see further analysis of any discernable difference between patients who took zinc and patients who did not take zinc (and also of Vitamin C use as well).

Unfortunately, we don’t know anything about the type and amount of zinc that was taken, or when, and there was no random assignment of who would or would not take zinc (and/or Vitamin C).  Also, unfortunately, the group sizes were so small that there is no statistical validity in the results, but the results certainly did not look very encouraging.

So what can we conclude?  The main part of the study seems to credibly suggest that HCQ – at least, in the form of a five day course after a potential exposure to the virus – does not confer any obvious or substantial benefit.  That is disappointing.  As for HCQ + Zn, that was an afterthought in the study that was not well quantified or qualified, and so the results have no meaningful value, but, although possibly flawed, they also for sure don’t point to any transformatively positive outcome of an HCQ + Zn combination treatment.  Again, a disappointing outcome.

This article tries to cheer us up by saying HCQ is “not dead yet”.  That is true, and there are non-scientific but real-world examples a-plenty where HCQ seems to have had enormous benefit.  (Why does it seem to work well in real-life but not in trials?)  However, the actual value/benefit for HCQ, while possibly not yet negated, has also clearly not been affirmatively established.

As one door closes, another opens?  Here’s some more good news about famotidine aka Pepcid.

This article suggests people with blood type “A” may be at greater risk of contracting a more severe case of the virus. Type A blood is the second most common in the US.

And for a piece of good news if true.  We reported a week or so back about a claim that the virus may be declining in potency in Italy – a claim that was disputed by some experts in Italy, while supported by others.  Now there is a claim the virus may be weakening in the US, too.

Timings And Numbers

Two of the big challenges are trying to understand how many people have had the virus without realizing it, and trying to understand if having the virus means you then get immunity from future infections.

In both cases, the key thing to measure is whether or not a person has developed antibodies.  It has been assumed that everyone who had the virus would develop antibodies, but now a senior medical officer says that only 10% of people who have been infected have developed antibodies.

This is interesting for a number of reasons, but also makes it very much harder to understand the true extent of cases out there.  As for future immunity – always a rather uncertain hope – about the best that could be said would be that if you didn’t need antibodies to rid yourself of the virus the first time, you’ll probably be just fine a second time.

Closings and Openings

Here’s a great world map that shows the different policies of every different country in terms of if they’ll admit visitors or not.  It comes courtesy of IATA, and they promise to keep it up to date.

Logic?  What Logic?

The only thing even more useless than using a thermometer to test if people have the virus or not is to ask them to tell you if they are infected.  This is even more useless than the bad old days of the “big three” security questions – “did you pack your bags yourself”, etc.

Call me a cynic, but it seems to me that if a person has already gone to the airport in anticipation of flying somewhere, they are not likely to then volunteer to a checkin agent “well, actually, I’ve probably got the coronavirus, but I’ll be careful”.

However, United is now going to require passengers to declare they are “safe” to travel.

Medical

I regularly bemoan the rush to buy “fashion” masks, without any thought to if they actually provide any protection whatsoever for either the wearer or other people around them.  All masks are not created equal.

As an example of that, when official N95 respirator masks were in critically short supply, China invented a new mask rating “KN95”, and started selling KN95 masks at impressively high prices, with the suggestion being they were the same as US-certified N95 masks.

So what does it take for a mask to be designated KN95?  Nothing.  You could gather together a fish net or fly screen and print “KN95” on it if you wished.  KN95 is nothing other than a marketing designator.

This article points out that the vast majority of these masks fail to meet their claimed/implied standard of filtering.

Thank you, China.  First you give us the virus, now you sell us overpriced and dangerous PPE.

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

 

Please click here for a listing of all our Covid-19 articles.

4 thoughts on “Covid-19 Diary : Sunday 7 June, 2020”

  1. I think the “what are we doing wrong here” is fairly obvious. I did a quick and dirty look at the data (limited number of data points but enough). Looking at NY and NJ combined, FL, GA and AL combined and Texas.

    The NY/NJ curve looks pretty much like Italy — shifted by about 3 weeks. And there is still work to do with over a thousand confirmed cases daily even as I write this (down from peak of about 14K).

    The combined FL/GA/AL curve and the TX curve are either raising or flat lining. The only reason the US overall graph doesn’t look worse is simply the significantly higher cases in the NY/NJ region. That area’s improvements hide worsening things elsewhere. There is also the problem of where the inflection happened and where it gets reported (think of all of the spring breakers leaving FL).

    The states that got hit later, closed down for much less time, are not really improving. Plus you are seeing wonderful justifications. Yes FL reported over a thousand cases for several days now, its all because we are testing more — and had nothing to do with an Rn of about 1 (aka the trend will continue forever!).

    1. Hi, Biz

      I guess I’m a bit slow today; you say that what we’re doing wrong is fairly obvious, but I don’t see a simple statement of what it is. Care to elucidate?

      I do understand that the US combined figures obscure individual trends in individual states. That is true and makes sense in a manner similar to the spread of numbers in, eg, the EU.

      But, as part of the “obvious” answer to what we’re doing wrong, why are some states growing steeply in numbers at all? And, why are other states flat-lining rather than dropping down to (almost) zero?

      The obvious answer might be “failure to observe social distancing”? But I’m unconvinced. It seems like the easy/obvious answer, and so I’m automatically a bit suspicious of the eagerness to trot it out. It is one of these “impossible to confirm” claims, because how do you scientifically and consistently measure social distancing? Even the interesting social distancing relative measures on the IHME website only show relative levels within a state and don’t dare try and come up with an absolute scale, which is a great shame. It would be enormously interesting to see a consistent scale across all states.

      This image shows social distancing with the highlighted lines, as per the key below the image, showing NY, FL, and an aggregate for the US. Curiously, NY seems to have been the very best all the way through, and FL seems to have been consistent with the US average all the way through. So it is hard to see any obvious correlation between social distancing, as measured on this site, and infection levels.

      My “quest”, right from day one, has been to try and solve (or at least better understand) the puzzle of the wide range of infection rates, even in apparently similar settings. What is the reason that some Asian countries such as I mentioned today have been so mildly impacted? Why does Qatar have 2.5 times as many cases as adjacent Bahrain, or seven times as many cases as nearby UAE? Or, in Europe, the difference between Spain and Portugal.

      And so on, including, of course, the differences between states in the US. How to explain OR (1140 cases/million) compared to neighboring WA (3253) and CA (3334)? ND (3779) and SD (6184)?

      I’d also like to better understand your claim about Florida’s testing. It seems that FL’s testing levels are lower than the national average (58k/million in FL, 65k/million nationally). Maybe this all started happening in the last month or so in FL? The chart about testing on this page doesn’t give a clear answer (leastways, not to me) https://covid19.healthdata.org/united-states-of-america/florida and I do note that the line of both confirmed and estimated infections has been and is projected to remain somewhat steady, and so too the level of daily deaths.

      FL has a population of 22 million. By the “best case” standard, that would allow for 22 infections/day. Instead, it is reporting close to 2,200 infections a day. 100 times higher than ideal (well, ideal is of course zero).

      If you can complete this sentence, it would really be helpful. I can’t.

      The reason the case numbers in the US have stayed reasonably steady for the last month (or maybe even two) is because …..

    1. Hi, Don

      Thanks for sharing this. There is a huge problem, though, and hinted at by the fact that much of the data used by the CDC is only through the end of March – a happy time at which only 5,161 people had died. Now that we have a total of 114,000 deaths – 22 times as much data – the calculations should be updated and refined.

      The problem is that the rates the CDC project are roundly contradicted by reality. As of today, the US is reporting 2.042 million cases and 114,000 deaths. That’s a fatality rate of 5.6%, which is 14 times higher than their “best estimate” scenario.

      Doesn’t say much for their estimating skills, does it. I think I’ll take a demonstrated reality over a theoretical projection based on two month old data any day. And sadly, doesn’t say much for the Ron Paul Institute either, who just parrots numbers rather than checks them.

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