Covid-19 Diary : Sunday 19 July, 2020

 

Worldwide, the count of virus deaths passed through 600,000 yesterday.  Almost a quarter of all deaths have been in the US.  Global cases also passed through 14 million total on Friday, and now on Sunday, just over 48 hours later, is already above 14.5 million.

We have a new worry to occupy ourselves with – or perhaps more accurately, an old worry returning to haunt us again.  For the last few months, if we were to get the virus, there’d be a hospital bed, space in the ICU, and even a ventilator available for us.  But with the ramping up of cases everywhere in the US again, that is no longer guaranteed.  Are we going to soon start seeing a re-run of all the hype about ventilator shortages?  I sure hope not.

You can check your state’s situation and projected future here.

This puts in fine focus the selfishness of people who carelessly allow themselves to get infected.  They swamp our healthcare system, making it difficult/impossible for responsible people to get health care.  Indeed, as is occasionally acknowledged, inundations of Covid-19 cases mean hospitals delay accepting other non-emergency cases, and of course, patients delay as long as possible going to a hospital for anything, because hospitals are not nice places to be in at present.

There is an unspoken contract between us and the healthcare system we all share – it will have adequate capacity for our needs, but in turn we are obliged to act prudently so as not to overstress it.  This has always been a key part of matters like mandatory safety belt laws – they are not only to protect ourselves, but to limit the social harm we can inflect on society as a whole if we don’t wear a safety belt.

So why not a similar law for mask wearing?

At present, even something as simple and ordinary as a trip to the supermarket has transformed into an ugly experience, fraught with risks and potential conflict, and ambiguous recommendations or “requirements” that are not enforced on the subject of masks.

How is it a society where half of all adults were addicted to cigarette smoking could outlaw cigarette smoking indoors (and increasingly outdoors too) and police/enforce the bans, but when it comes to a much easier behavior to modify, we’re unwilling/unable to create similar levels of agreement and compliance for mask wearing?

Current Numbers

One point about numbers.  I wince every time I read an ignorant comment describing somewhere as “the worst hit” either in terms of virus numbers or deaths.  These references are never modified by population numbers.  It is totally deceptive and invalid to observe that geographic region A, because it has twice as many cases/deaths as geographic region B, has been harder hit, because quite possibly, geographic region A also has twice as many people in it, thereby meaning that the incidence/level per million people, is the same.

This disparity of course allows commentators to describe the US as “hardest hit” in the entire world, whereas in reality, as shown every diary entry immediately below, there are countries with both more cases per million and more deaths per million.  Sure, not many countries with worse numbers, but a few.

We were very happy to see the US drop down one place on the list of countries with the greatest death rates.  It is possible that in a couple of weeks, it might slip another place, although these shifts in position are not because fewer people are dying in the US (the daily death rate is climbing again, as shown in the graph above), it is because the death rates are climbing even more steeply in other countries.

Top Case Rates Minor Countries

Rank One Week Ago Today
1 Qatar Qatar
2 San Marino French Guiana
3 French Guiana Bahrain
4 Bahrain San Marino
5 Vatican City Vatican City
6 Kuwait Kuwait
7 Andorra Oman
8 Oman Panama
9 Armenia Armenia
10 Panama Andorra

 

Top Case Rates Major Countries

Rank One Week Ago Today
1 Chile Chile
2 USA USA
3 Peru Peru
4 Brazil Brazil
5 Sweden Sweden
6 Saudi Arabia Saudi Arabia
7 Spain Spain
8 Belgium South Africa
9 Russia Belgium
10 South Africa Russia

 

Top Death Rate Major Countries

Rank One Week Ago Today
1 Belgium Belgium
2 UK UK
3 Spain Spain
4 Italy Italy
5 Sweden Sweden
6 France France
7 USA Chile
8 Chile USA
9 Peru Peru
10 Netherlands Brazil

 

I Am Not a Doctor, But….

What will we all do if a vaccine is not developed?  This has been the solution we’re all hanging out for, whether we plan on taking it ourselves or not, and while there are still lots of optimistic comments about being able to have vaccines developed later this year, the comments are all theoretical and based on how long it takes to work through the mechanics of making and distributing the vaccine.  The comments are not considering whether or not any vaccine will actually be valid.

This article touches on the concern we’ve had all along – that an effective vaccine might never be developed.  This other article considers an interesting related point – even if a virus that works is developed, perhaps not enough people will be vaccinated for it to have a chance of creating herd immunity.

We definitely understand people’s concern about the safety of any vaccine that might be developed.

I read last week a claim that we’d need 70% of the population immune – either via past infection or vaccination – for herd immunity to reliably develop.  I’d previously been using 60%.  If 70% is the new number, and if the vaccine is, say, 85% effective, and with 1% of the country having been infected, that means we’d need a vaccine uptake of about 81%.  Current surveys are suggesting more like 50% – 70% of people will agree to be vaccinated.  That’s a problem, and if our society is at close to breaking point right now over largely imaginary issues, I can’t start to guess what would happen with a compulsory vaccination program.

Here’s a frisson of possibly good news if true about a promising new route of vaccine development, but there’s no clear timetable for when a better understanding of the potential to turn this into a working vaccine might appear.

And a smidgen of bad news too – I think we already knew this, but in case you’d missed it, this article tells us the virus is becoming more infectious.

I was laughing at a projection a week or so back that predicted the virus might spontaneously get weaker and go away, all by itself, in 2022.  It is hard to reconcile that Pollyanna-ish hope with the reality, so far, of the virus getting worse rather than better.

Timings And Numbers

Per rt.live, 44 of the 50 US states (plus DC) are showing positive rates of virus case count increases, a number that has stayed steady since the last diary entry on Thursday, although the 7 remaining states have slightly swapped around.  ME UT CT NH SD and AZ are in the case dropping list, and DC was but now is no longer, while NJ has moved in to take its place.

As long as we have open borders, there’s only limited sense in trying to eradicate the virus – indeed, let’s be honest.  No-one in the US is actually trying to do this, and no-one expects we ever will, absent a vaccine or cure.

A good example of the problem is Hong Kong.  As you can see, Hong Kong managed to reduce its virus activity down to a very low level, but now look at it.  Things are worse than they’ve ever been.

A virus control strategy not only has to have an element to reduce its prevalence, but it needs a matching element to maintain a low level of virus activity once it has been reduced.  Otherwise, as Hong Kong vividly shows, the virus will rush right back again.

Another example is Australia (see above), with their influx of new cases also a result of imperfectly stamping out the virus prior to reopening.

Politicians the world over are proving very slow to realize that you can’t trick the virus.  You can’t lie to it, and you can’t pretend it is not there.  All the usual ploys that politicians use to “get rid” of problems are proving to be ineffective when it comes to the virus and its implacable “logic”.

Talking about politicians and their virus trickery, I’ve written before about how gun shot victims in WA were counted as Covid-19 deaths.  Now it is Florida’s turn – a man who died in a motorcycle crash was also counted as a virus victim.

Closings and Openings

Bad news for cruise lovers.  The CDC has extended its ban on cruising, now in place through the end of September.  That’s not to say that the ban won’t be extended again, of course, but for now, definitely no cruises until October.

Logic?  What Logic?

Bermuda hopes to emulate New Zealand’s success, and is describing itself as a safe destination, suggesting that people move to live there longer term while the virus rages in the US.  It is selling one year residency certificates for $263.

However, we’d describe its safety status as very much unclear.  It seems to be having one or two new cases reported most days, and with a population of only 64,000, that equates to a new daily case rate of 15 – 30 per million.  If it were the size of the US, that would be 5,000 – 10,000 new cases a day – much better than the rate we are currently experiencing, but nowhere near zero, which is the objective.

Safety is a bit like pregnancy – it should be considered an absolute rather than relative concept, particularly if you’re planning on upending your life and moving to another country in the hope of finding it.

One or two new cases a day is not safe.  Plus the linked article has no information at all on how Bermuda will quarantine arrivals.

One of the surprising things, to me, about New Zealand is the unusually high rate of infected people who are returning home to NZ.  This page lists every newly infected person, and as you can see, they are averaging 1 1/2 new cases a day from arriving people, and I’m guessing they are having no more than about 1,000 – 1,500 people a day arriving (on Tuesday they show seven international flights, on Wednesday five, on Thursday six, and next Sunday only four).  That is a level akin to the US reporting half a million new cases every day, and currently the worst we’ve ever got to is 70,000.

So if Bermuda is going to be truly safe, it first needs to zero out the presence of the virus currently, and then needs a really rigid control system for arriving people.

That’s not to say that the idea of moving to a safe haven isn’t a good idea.  Stay tuned, I might have a more practical concept to suggest….

Virus?  What Virus?

With the debate in several countries at present about whether schools should reopen after summer, this article is helpful.  It points out that while children might survive the virus better, they are not immune from getting infected, and of course, they can take their infections home and given them to their parents and others.

Medical

This is interesting to know, but of little or no practical value, even thought the article hopefully suggests it is.

Until there are preventive measures that can be taken early on in an infection, all hospitals can do, as the article concedes, is make sure the infected people drink plenty of water!

Of course, some of us will immediately start taking our hydroxychloroquine and zinc and possibly azithromycin too, as well as assorted other medicines and potions!  But if we go to a hospital, they’ll not allow us to continue doing so.

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.

6 thoughts on “Covid-19 Diary : Sunday 19 July, 2020”

  1. You may want to read this article in The Atlantic about herd (or community) immunity: https://www.theatlantic.com/health/archive/2020/07/herd-immunity-coronavirus/614035/. The author makes three points:
    1: Herd immunity is calculated differently for an uncontrolled virus.
    2. The percentage for herd immunity may not be as high as previously thought. it could be as low as 20% or more realistically, 35-40%.
    3. The threshold can change based on how a virus spreads. It depends on our actions. Small preventive measures have big downstream effects from compounding. The herd determines its own immunity. Like masks!
    Stay safe.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, James

      That’s an interesting article, thank you for sharing it. I don’t disagree with the points they raise, but the conclusions they hint at concern me.

      I’m uncomfortable with the overall concept of “herd immunity”. It is a bit like the difference between macro-economics and micro-economics. The economy can be booming and GDP soaring, with “full” employment (macro-economic measures) but an individual person can be out of work, homeless, and destitute (micro-economic measures). Being told the economy is booming is cold comfort to that particular person.

      In the case of herd immunity, the huge weakness in the concept is that it doesn’t mean that you or I become less susceptible to the disease. It just means that overall, each infected person infects fewer others, so an outbreak tends to diminish rather than increase. That’s the macro view. But at the micro view, if you attend a “super-spreader event”, you’re every much as risk, no matter what the herd immunity number may be. Having a public health goal of achieving herd immunity is a limited and insufficient goal, it is only appropriate if the entire world achieves it so the virus truly does die out, rather than continue propagating and re-appearing.

      Herd immunity is good and certainly something to strive for, but it shouldn’t displace longer term goals – cures and global elimination.

      I agree with the article’s contention that herd immunity is not a single constant number. Behavior can influence it. Wearing masks, for example, massively reduces the R(t) rate, and therefore reduces the point at which herd immunity is achieved. But, this example also illustrates the “problem” with claiming herd immunity could be very much lower than the “standard” number of perhaps about 60% – 70%. People wear masks, and don’t mix in large groups, so the R(t) rate drops and the herd immunity point also drops.

      At some point, the virus stops spreading and starts to die out. So what happens next? People start mixing in larger groups again and stop wearing masks. The virus comes back, as it vividly illustrated in the US, where our daily new case count is now twice what it was during the first peak period.

      In other words, a lower herd immunity number assumes within it certain behaviors; when those behaviors cease, the herd immunity number changes too. Unless we’re willing to live the rest of our lives without restaurants and bars and with masks, we should be shooting for high levels of immunity, global compliance, and cures.

      1. I agree with much of what you say, however with respect to your last sentence, with some of the behaviors being exhibited in the US, even about something as benign as wearing a mask, what do you think the chance that we get high US compliance for anything?

        For high levels of immunity to be achieved, we would need some unknown level of compliance in actually taking a vaccine to get those high levels of immunity. I can’t remember the exact number, but I think that about 50% of the US population in one poll said they would not take a vaccine if offered it. If the percentage of people that need to have immunity for the virus to die out is less that 70%, or in the range of 35-45%, then that 50% level of compliance in taking a vaccine could lead to the virus dying out.

        I think that is what this article is trying to say.

  2. lifegotinteresting

    Not to preach to the choir, and probably everyone who reads this realizes; but if we overwhelm the medical resources (people, PPE, meds, O2) the death rate goes from .5% to a much larger number. 10-20% of cases are severe or “moderate”, which need O2, meds, fluids, etc. Without that, things will get ugly. And because of political correctness and foolishness, we won’t even use meds that can help with cases, early on, and reduce the impact on hospitals and medical staff.

    We should have been ramping up production of rapid testing, PPE, meds and O2 for months. But of course, we didn’t. Why have the Surgeon General, CDC, NIH, FDA let us all down like this?

    We need to start thinking about making prescription meds available over the counter, because expecting doctors to diagnose and prescribe may become laughable in the Fall.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, Peter

      The issue of what medications should be “ethical” (ie requiring a physician’s prescription) vs OTC (over the counter, available for anyone to buy at any time) is interesting. It is something few of us have reason to question, normally, and just accept as one of the results of a universal “law” of our life and how it is best/most prudently lived. “Doctors know what is best for us”.

      However, we have been tragically shown that doctors do not know what is best for us with the virus, which – for some of us – has wider implications about doctors and their knowledge in general. Plus, those of us who have traveled internationally have likely visited other jurisdictions where the number of ethical drugs is much more restricted than it is in the US. If other countries can allow for many other medicines to be bought over the counter without the sky falling on their heads, why can’t we?

      I find it with an anti-histamine I take. Polaramine. It is a bit old fashioned these days, but it works well for me and doesn’t make me drowsy. Why is it something I can buy off the shelf in some countries, in other countries buy only if I give my name, address, and show ID and have my purchase entered into a register (it has absolutely no narcotic type properties at all), and in some other countries, can only receive it with a doctor’s note?

      Another interesting point is that sometimes drugs move off the ethical schedule and can be bought by anyone. The drug hasn’t changed, so why was it “too dangerous” for us to buy ourselves before, and how has it suddenly become safe?

      One more consideration. In reality, it is not a binary choice between “must have a doctor’s prescription” and “anyone can buy”. There is a middle ground – requires a consultation with a pharmacist – that sometimes applies as well. This compromise approach seems like it deserves much more focus.

      Call me a cynic, but I consider doctors, lawyers and accountants to be some of the most reprehensible of “closed shop” trades unions. We often find ourselves forced to use them, whether we want to or not. We know they do a lousy job of enforcing their “profession” and its standards, and because of the closed shop nature of their work for hire, rates are ridiculously high.

      I’m going off-topic. Suffice it to say, I agree it would be great to broaden the list of OTC medicines. But I doubt it will ever happen.

  3. lifegotinteresting

    You’re absolutely right. How many remember when drugs like Zantac and Claritin were prescription only meds? I think that had a lot to do with maximizing pharma profits.

    I have a lot of respect for doctors. But in some cultures they are treated as gods. I view them as very knowledgeable “people mechanics”. A good doctor is great to have, like a good mechanic. Someone who listens, who you can share information and thoughts, and who explains things to you, is rare and precious.

    I usually have a good relationship with both, and I share my thoughts and observations, and we mutually discuss options. I’m not a doctor, by any means. But I have a science background. I can read and understand studies, and even some statistics and data analysis, as well as risk. So I don’t think I should just be a good boy and do whatever I’m told, especially when my life and the lives of loved ones are at stake. There are good ones and weak ones; I listen to and follow the advice that makes sense and is supported by facts and solid reasoning.

    I don’t want to be a pessimist, but we need to hope for the best and prepare for the worse. If hospitals become overwhelmed we will need to take care of ourselves. Being told to stay home, take some painkillers and fluids isn’t going to do it.

    We were already rationing care in a big way during normal times. I think it can only get worse – medicine has also accepted the “just in time” and long supply chain model. Reality is that there won’t be enough resources if things get really bad. Our leaders, public health officials won’t tell us this, but it’s true – they will even lie to us to conserve resources, as they did with masks.

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