Covid-19 Diary : Thursday 23 July, 2020

I was talking to the owner of a small tavern/resort in an Idaho country town earlier this week, and asked him sympathetically how badly his business had been impacted by the virus.  His answer was both surprising and a vivid example of the problem we have at present.

“Business is booming.  We’re up 20% compared to last year.  We never closed, and we’ve had people from Washington coming to stay here and eat/drink with us because they can’t do so in WA.”

The outcome?  Shoshone County, ID, (where the resort is located) which for the longest time had no cases at all of the virus, now has plenty.  Idaho as a whole, which also for a long time had been one of the bottom four or five states in terms of virus levels, has now increased to a point where it now has almost 50% more virus cases per million people than WA.  All the irresponsible and most likely to become infected and spread the infection people from WA went to ID, and infected Idahoans (is that the word to describe someone from Idaho?), and the naive Idahoans celebrated the extra business they were getting and laughed at the “stupidity” of WA’s restrictive social distancing measures.  They’re not laughing so much now.

The virus doesn’t respect state lines.  And it always has the last laugh.  While this guy and his business were laughing at WA, the virus was getting comfortable in ID, and now is more active there than WA.

I understand the concept about state autonomy, but the virus doesn’t.  Plus the crazy patchwork quilt of different laws and restrictions, city by city, state by state, make it very difficult for anyone to know what they must do or not do, from town to town.  We need a national policy to deal with this national problem.

The fallacy of a region removing their restrictions is that people will then come to that region from more restrictive regions, bringing fresh cases of the virus with them.  We can’t try to selectively address only the “hot spots”, because people will change their habits and take their risky behaviors to wherever they are permitted, speeding up the return of the virus to more permissive areas.

I’d been writing, a week or so back, about eliminating the virus through a full total shutdown/lockdown for two or more weeks.  Here’s someone else writing on the point.  But as lovely as the concept is, it is also impractical.

It is certainly possible that an almost complete shutdown would eliminate the virus, but what happens next?  There is little benefit in enduring a full shutdown if the very first day after the shutdown has been lifted, an arriving visitor from another country brings the virus back into the country.  We either have to stay in full virus defensive mode (ie masks, social distancing, and everything else) to prevent the virus taking hold again, or we have to truly “build the wall” – around the entire perimeter of the US, and mandate formal quarantining for all people arriving into the US, no matter whether they are returning US citizens or from anywhere else.  Even tiny NZ is struggling to keep its virtual wall and quarantine process in place – too many ex-pat Kiwis are wanting to return home, and the country has filled all available hotels within some hours drive of Auckland International Airport.

In the US, it would be many times more difficult, because of the much larger amount of international travel in and out of the country.  Plus, we don’t have the political will or general social concurrence for any of these three elements – the full shutdown, the full virus-defensive mode, or the total quarantine.

So what is the alternative?  On a national “macro” level, I really have no idea whatsoever.  On a personal “micro” level, I’m stumbling towards a solution of sorts.  Please see the reader survey in Friday morning’s newsletter and share your thoughts on this, too.

Current Numbers

Bolivia enters the top ten major country list today, and I expect it will have moved on up to #9 by Sunday’s next diary entry.  The US has dropped to ninth place in the death list, and may drop another place within a week, being displaced by Brazil, except that probably in about the same time frame, the US will overtake France.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

I Am Not a Doctor, But….

I’ve noticed more and more discussion in the press about vaccines.  Rather than being a distant hope in the far future, we are now getting specific stories about specific vaccines, and firmer timeframes for when they might be approved and available.

But they remain far from a guaranteed savior.  Even if a vaccine is approved, it may not mean much – the FDA has a target for a vaccine to be approved if it is only 50% effective.  For sure, 50% is a great improvement on nothing at all, but rather than setting a target at a mere 50% (and possibly agreeing to approve vaccines with even lower success rates) shouldn’t the FDA set a higher target, so as to encourage the development process to similarly aim high.  Other vaccines have success rates all the way up to almost 100% – shouldn’t that be our goal for the coronavirus, too?

I’d also like to know what the FDA’s target is for how long a vaccine provides immunity.  Are they targeting 3 months, 1 year, or longer?  Clearly, an expedited testing process means we’ll not have any data about the effectiveness of a vaccine far into the future, and equally clearly, it seems unlikely anyone wants to wait long enough to see for sure how long a vaccine confers immunity to people who have been vaccinated.  So we might end up with a 50% effective vaccine that lasts for no-one knows how long.  That’s hardly a world-changing triumph.

There’s also the concern about side effects, both immediate/short term, and also possibly other side effects that don’t appear until weeks/months/years later.  Thinking again of the Thalidomide tragedy, will we test the vaccine on women who then get pregnant (or already are pregnant), and wait nine months to see what types of babies they give birth to?

What we do know is that the occasionally lightly mentioned “minor side effects” can actually be very bad indeed.

The problem is we’re learning of the vaccine development via press releases, not via refereed studies in formal journals.  Do we really want to base our decisions on press releases and media hype, rather than rational factual analysis?  Remember the rush by both government regulatory bodies and the media to anoint remdesivir with almost magical properties a month or two ago.  Now we seldom hear of it, and for sure, there’s no clear impact in our death rates that could be ascribed to remdesivir treatment, because, once stripped of its very all-encompassing hype,  it was never promised to save lives, merely to speed the recovery of people who were not likely to die in the first place.

Can we trust the people who first told us masks were useless before now mandating everyone must wear them to tell us the truth about a vaccine?  The same people who refused to even trial hydroxychloroquine because it is “dangerous” and have tried to make it illegal, even though millions of people, all around the world, safely take HCQ every day for other ailments?

We are pleased to read about the government going ahead and buying up doses of new vaccines prior to the end of their trials and before approval.  It is a great way to cut down the lead times to get the vaccines to the public.  But we’re worried that after spending billions of dollars on hundreds of millions of doses of assorted vaccines, it will add to the pressure to then deem them acceptable.

Here is a hopeful article about a new treatment trial that is described – albeit by the people developing it – as a breakthrough.

This is an encouraging progress report, but a long way short of a full validation, on one of the vaccines currently in trial.  We need to know much more about the nature of the immune response it generates and how long it remains protective.

While we wait for vaccines to be trialed, tested, and approved, Russia’s elite are not quite so patient, and have been getting an experimental vaccine for some months already.  They have – purely by coincidence, we are sure – been selected to join trial groups to test the vaccine.

Now there is finally impossible-to-ignore evidence that the virus can hang, suspended in aerosol form in the air for hours at a time, some people are bravely pointing out that maybe the 6′ distancing rule (which in some countries is only 3 1/4 ft, ie 1 meter) might be insufficient.  How much would be required?  That’s a question no-one really wants to honestly and completely answer, because the number would be one that is impossible to implement in any sort of commercial, office, or retail environment.  Another implication is that plexiglass barriers are also of reduced value – they are still better than nothing, but they are not as effective as had been hoped by some optimists.

Do you remember, maybe two months ago, I reported on an interesting analysis that advocated nightly gargling with dilute hydrogen peroxide?  Since that time there has been growing evidence and confirmation that when you are infected by the coronavirus, it first lives in your mouth, and only after “taking root” there does it grow on down into your lungs.

Mouthwashing and gargling could make a huge difference, and stop its spread before the virus gets firmly established.  The linked article (above) provides additional information.

Timings And Numbers

The US exceeded 4 million virus cases on Tuesday, and now is at 4.17 million.

More seriously (if that is a fair thing to say), we are back to the bad old days of more than 1,000 deaths per day.

Some almost good news though.  The rt.live site went from only 8 states with declining new case numbers each day on Monday to 12 for Tuesday, Wednesday and today.

The states with the best “curves” – ie reducing numbers of daily new infections – are (from best to least best) ME, UT, OR, DE, WA, SC, SD, NC, AZ, FL, OH and TX.  It is worth noting that all these states are only very slightly reducing their daily new infections, with the last three showing rates of 0.99 (1.0 means staying the same, over 1 means growing, under 1 means shrinking).  And even the best performing state, Maine, with a 0.84 number, has that score with a wide range of confidence interval applying – it might be as low as 0.66, but it also could be as high as 1.02.

The most encouraging part of the rt.live data is looking at each individual state curve.  None of them are showing a clear rate of increase, all of them are holding their current values more or less, although none of them are showing any clear trend on their curve lines to reduce their rt number, either.

The lesson from all of this is abundantly obvious.  Abandon social distancing type measures, and the virus starts growing.  Re-introduce social distancing, and the virus starts declining.

Here’s an article that is both very true and equally tragic.  Its headline clearly tells what it is about : The crisis that shocked the world: America’s response to the coronavirus.  It has some great graphs in it.

Another good article is this one about the rate of infection around the world.  It has an excellent series of graphs, too.  The article also points to another area in which WHO is killing us off through its obstinate refusal to accept facts about the virus that show it to be dangerous.  In this case, WHO is reluctant to accept that people without symptoms can infect other people (who then might develop symptoms and even die).

Why is WHO so unwilling to admit any of the obvious truths about this virus?

It is amazing we still have absolutely no idea whatsoever about how deadly the coronavirus is.  This is a key consideration – we have come to live with regular influenza without too much worry, and much of our public health policy and response to the coronavirus was based on a belief it was very deadly.  But we really have no idea at all about this – here’s a Wall St Journal article that optimistically says researchers are getting closer to an answer to that question, but “getting closer” still means a 5-fold spread between the low end of the range of estimates (0.3%) and the high end (1.5%).  And some people argue in favor of much higher or lower numbers.  I don’t see any consensus forming around one specific number at all.

The problem in calculating this figure is at both ends.  The peculiarity of the virus and its unknown but thought to be high percentage of asymptomatic cases makes it hard to know the total number of people who get the virus.  And the extraordinary inability of our authorities to accurately and honestly report the truth on how many people die from the virus makes it hard to know the total number of truly virus-related deaths.

Closings and Openings

There’s a lot of discussion/argument at present as to if schools should re-open in the fall.  So it is good to see some helpful data based on observations at summer camps.  The conclusion – teens are the most likely age group to contract and spread the virus.  The key point for us is that an infected teen, while probably unlikely to die, themselves, becomes a risk for the older people around them, such as teachers, parents, grandparents, people in shops, and so on.

The issue of do we open our schools again would be much less contentious if we had decent teachers who did a decent job of remote teaching, allowing it to be a viable option.  In the three months my daughter’s high school was closed, she never once had any direct contact over video with any of her teachers.  They’d just send occasional mass messages assigning videos to watch, prior to, at the end of the school year, awarding all students with “A” grade passes.  This is a national disgrace and a betrayal of trust by parents and children in the teaching trade.

The business community adapted quickly to using video instead of in-person interactions.  Socially, we’ve done the same.  What is the problem – other than blithering incompetence bolstered by aggressive trades unions protecting the incompetents and incompetence in our education system – with teaching?

Some people believe the virus is part of a global plot concocted in part by Bill Gates.  I’m not one of them, and while I don’t agree with everything he says, I do think he is more on the side of the angels than not, and has fewer hidden agenda items than most.  Maybe his priorities aren’t the same as mine, but I think he’s intelligent, rational, and a good source of commentary to consider.

He is suggesting schools should remain closed for another year.  I wish he’d also turn his massive intellect and financial powers to a way to improve the quality of the education that would be given during that year in lieu of at-school teaching.

We were interested to see our good friends at Amawaterways restart some of their European river cruises, albeit on a charter basis only.  They couldn’t pay us to go on one of their cruises at present, but we did notice one huge change they’ve made to their ships which promises to massively reduce the risk on board – but it is a reduction not from “suicidally high” to “too low to measure” but from “extremely high” to “less extremely high but still of concern”.

The change is making all the a/c circuits in the ship individual units, bringing in fresh air and venting it out again with no recirculation and sharing, rather than the formerly more centralized system that could potentially share infected air.

I’m increasingly of the opinion that virus/infection risk control is mainly about air flows, and astonishingly, it is the airlines that seem to be doing things best.  Strong steady and vertical not horizontal flows from the ceiling to the floor and either no recirculating at all, or only via fresh clean effective HEPA filters, is what is needed to whisk away the aerosol particles.

We hope things go well for Amawaterways and their guests.  Details here.

Shortages

The UK government congratulated itself for investing £14 million into a company that will start making face masks, with the exact quantity unspecified, but described as being “part of a push to produce a million masks a week.

That sounds like a lot of masks, doesn’t it.  But actually, it isn’t.  With a population of 68 million people, that represents less than one mask for each person, once a year.  And, oh yes – they are single use disposable masks.  Sure, another million masks a week is great, but it doesn’t get close to the numbers needed in the UK or US or elsewhere.  The UK should be aiming for the high side of 200 million masks a week, and in the US, we need over a billion a week.

On a happier note, I noticed the local Costco selling boxes of 50 masks last time I visited.  I forget the cost, but it was very reasonable (of course – thank you, as always, Costco).  The masks aren’t shown on their website, though, so I’m not sure how universally available they are.

Logic?  What Logic?

Kentucky is “recommending” a self-quarantine for people coming into the state from other states where virus activity is high.  That sounds like a fairly weak concept, and all the more weaker because how are people to know if the state they are coming from is deemed high or not.

But not everything and all quarantining in KY is ineffectual.  A woman who tested positive for the virus was told she must self-quarantine, and when she refused to sign a formal document acknowledging her obligation, she and her husband were placed under house arrest and fitted with ankle monitors to alarm if they strayed more than 200 ft from their home.

That is the type of enforcement that is needed, all the time.

Virus?  What Virus?

Look at the pictures in this article, contrasting the passengers on a US based Niagara Falls cruise boat and the passengers on the Canadian side.

Social distancing?  Not really.  The difference in approach might help explain why the US has four times the rate of virus infections as Canada.

There is also, ahem, another reason why Canada’s rate might be only 1/4 that of the US – social distancing in, ahem, a different context.  This link is not for the easily offended.

Medical

The virus testing in the US is going from bad to worse.  While it is true the US has had more tests done than any other country, when you convert that to tests per million people (which is the only sensible measure) the US drops down to 23rd place, slightly better than Portugal and not quite as good as Cyprus.

But the count of tests per population is meaningless.  There are two essential measures.  The first is how easy it is for someone who, for whatever reason, wishes to be tested.  The second is how quickly the results come back.

By various subjective measures, it seems testing remains difficult to arrange in the US.  And by objective measures, getting a test result is taking anywhere from four days to 14 days.  That makes a test utterly useless.  As this article states, “People are most infectious both about the two days before they get sick, and maybe three or four days after they get sick. So if you’re telling someone they were infected five days after they felt sick, they’ve already infected most of the people they’re going to infect. And those people have already potentially become infected as well.”

It also means that any attempt to then contact people who the tested person may have infected happens too late.  By the time any attempt at contact tracing is initiated, the person’s contacts have had plenty of time to infect a new round of sufferers, and so it goes, with us always too late and behind the curve.

It is a national disgrace that we can’t get faster testing.  Better/faster testing would help us slow the virus down.  It is an easy thing, doesn’t require controversial medicines or anything else, just testing resources and efficiency – the sort of things the US used to excel at.

Even worse is that there is thought to be $7-8 billion of money released to be spent on improving our testing capabilities by the government, but sitting unspent!  Normally we love to see the government being frugal and saving money, but this is definitely not one of those situations.

We’d also note that WHO’s almost as evil/useless twin, the CDC, has shown its lack of common sense yet again by having a guideline that suggests test results should be promulgated in less than four days.  Do they have no comprehension whatsoever about the harm that is being caused by giving the virus four days head start on everything we do?  Why is their guideline not four hours?  Or even four minutes?

What is wrong with the CDC?

Possibly good news is on the horizon with this promise of a fast testing procedure.  But we’ve been hearing promises for fast “at-home” type tests pretty much since mid March, and we’ve yet to see any of the promised solutions actually make it to the field and start to positively impact on the morass that is out there at present.

The colossal failure by the people charged with preparing for and managing these types of challenges is a national disgrace, as is the continued ineffectual efforts to improve, and the lack of negative consequences flowing to the people who are literally responsible for tens of thousands of avoidable deaths.

I’m sorry to end today’s diary entry on such a negative point, but it is something we all need to consider and somehow pressure our politicians to change.  Can you think of anything at all to do with our response to the virus that hasn’t been appallingly bungled?  I sure can’t.

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.