Covid-19 Diary : Thursday 9 July, 2020

Reader Mark, a regular source of interesting articles, forwarded a piece about Vitamin D.  I found it interesting, and my original plan for a one line mention of the article evolved to the point that it justified becoming an entirely separate article discussing whether Vitamin D can possibly improve your chances with the coronavirus.  If you’ve not already seen the article, please do add it to your reading pile.

Talking about reading piles, have you ever clicked the link at the bottom of every one of these newsletters, leading to my page of linked resources about the virus?  There’s a lot of other good stuff on that page too, and if you’ve suggestions for more resources to add, please let me know.

The US passed through 3 million cases on Monday morning, is now almost a quarter of the way from there to four million (3.20 million), with the daily pace of new cases continuing to rise.  For the first time ever, we had over 60,000 cases reported in a single day on Wednesday, and then again on Thursday too.

Death rates are now starting to climb again, too, and Thursday saw us break through the 1,000 deaths in a single day level for the first time in a month.

With these sorts of numbers, there can be no denying the accuracy of this quote

The US response has been extraordinarily disappointing and wrongheaded.  Whenever there’s been an opportunity to do the right thing, we seem to have done the wrong thing.  The US has to recognize that it is competing for first or second position of the worst affected country in the world.

The quote is taken from this article, which starts off with the unpopular claim that we’ll be living with masks for years”.

Meanwhile, the cop-out of our elected officials and their refusal to assert leadership and to impose consequences on virus scofflaws continues.  This article points out that state governors are now stressing the need for “personal responsibility”.

Have the governors not got the message?  There is way too little personal responsibility.  Calls for us to act sensibly have massively failed – as this chart clearly shows.

We’re way past asking people to be responsible.  The “carrot” approach has failed.  Time for the “stick”.

Apropos of which, I went shopping at the local Safeway earlier today.  As of Tuesday, by law in Washington, all people must be masked in stores, and when entering the Safeway store, there were large posters pointing that out and telling shoppers that by law they’d be refused service if they had no mask.  That’s the good news.

The bad news?  As I entered, I noticed a shopper conversing happily with a checkout operator while buying his groceries.  He was not masked.

Apparently Safeway fails to understand its own posters.  What part of “we will not sell you food if you do not wear a mask” is so hard for them to understand?

Current Numbers

The US moved up one in the major countries list.  Although there have been varying other countries previously in the number one and two slots, this is the first time the US has moved up from third (or lower) to second place.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

I Am Not a Doctor, But….

There’s a lot of rubbish on the internet, but every so often, one happens across an absolutely brilliant page of very well presented information.  Here’s a great example of a brilliant page, this one all about masks.  Great reading, and helps you understand which masks are good and bad, how they work, and what benefits they provide.  Recommended reading.

Here’s another article on Quercetin – one of the various non-prescription medicines that might have anti-viral properties and help combat a Covid-19 infection.

We’ve long criticized people and businesses who place too much confidence in temperature testing as a way to determine if a person has the virus or not.  The problem is both that many people have the virus (and are infectious) without ever having a fever at all, and also, for all people who have the virus and have a fever too, they go through a several day period of high infectiousness before they get a measurable fever.

Temperature testing misses too many infectious people, while also creating false positives for people who have a higher temperature for other, non-virus reasons.

With that as background, here’s an interesting suggestion – maybe smell tests would be a better way of checking to see if a person may be infectious or not.  The downside to smell testing?  It takes longer, requires more people and skill to administer, and costs money for every test.  So, yes, it is probably a better approach – or, even better, a good supplementary approach – but due to the cost and inconvenience, is unlikely to be widely adopted.

Here’s another example of very unfair reporting on hydroxychloroquine.  While the article doesn’t actually come out and directly say it, the headline “Florida teen received unproven treatment at home before dying of COVID-19 at hospital” leaves you in no doubt that it is trying to blame HCQ for the girl’s death.

The real story?  Quite different.  The girl had so many “co-morbidities” – risk factors making her extremely at risk of dying of Covid-19 – as to make her death unexceptional and totally normal/expected (of course, not to her family, but in abstract terms).  She was overweight, had a previous rare nervous system disorder, and, most of all, had an auto-immune disorder.  The family was slow to take her to hospital, and furthermore, her family refused to allow her to be put on a ventilator when the hospital wished to do so.

We certainly understand the family’s grief, and desire to blame anything other than cruel circumstance, a merciless virus, the girl’s foolishness going to a crowded social function unmasked, and their own slowness to recognize the severity of the girl’s suffering.  But to now try and make this a negative story about HCQ is not something we can understand or agree with at all.

Why the steady drumbeat of unfair HCQ hate in the press?

Timings And Numbers

The excellent rt.live website continues to show a very depressing situation – on Monday, it listed 41 states as suffering from increasing rates of infection, and then on Tuesday/Wednesday/Thursday, it increased the count to 43.

Here’s an interesting pair of charts, showing the growth rates in states today compared to three months ago, when most states were reporting shrinking numbers (the rt site has options to click on two weeks ago, 1/2/3 months ago – all options/times show that today is worse than any of the previous dates).

Almost all of the 43 states are not only reporting growing rates of new virus cases, but are now at rates way in excess of their earlier peaks, a month or two back.

It continues to be a total mystery to me why so many states are focused on continuing to relax their restrictions.

We’ve now had a chance to see the travel numbers for the 4 July weekend.

The numbers are a bit confusing, because the TSA’s “same day last year” algorithm gets a bit scrambled with holidays like 4 July that occur on different days of the week in different years.  But it is clear that last Thursday saw the largest absolute number of passengers and the largest percentage of last year since mid-March.  The other days over the holiday weekend weren’t so strong, but overall, the steady inexorable climb back up of passenger numbers is continuing.

It seems passenger numbers are rising about 2% a week.  There’s no sign of any renewed air travel slow-down, even as the country is assailed by more new cases than ever before.

One of my other favorite sites, the IHME site, has come up with its latest projection and prediction.  It has raised the number of deaths it expects, and is now guessing 185,000 deaths by 1 October.  It has also started projecting through to 1 November, with the total rising to 208,000 by then.  Worst of all, the rate of daily deaths is shown as increasing during October, and there’s no reason to anticipate a sudden magical decline in November.

This also means that some states will see (indeed, some states are already seeing) renewed pressure on their hospital facilities and ICU rooms in particular, all the more so because we’ll be entering the annual regular-flu season too in November, which always sees hospitals move closer to full capacity.

So here we are, four months after the national emergency declared by President Trump, facing the exact same problems as four months earlier – growing shortages of PPE, growing pressure on hospitals, and soaring numbers of cases and deaths.  The only difference is the case and death numbers are very much higher than they were four months ago.

As we wallow in our mess of mismanagement, it is fascinating to see some unlikely countries that have done so very well in controlling their own virus problems.  There is a cluster of countries in SE Asia who have had amazingly low numbers of cases.  Take, for example, Vietnam.  VN has a population of 97 million people, yet only 369 cases in total, and no deaths.  Most days, it has no new cases at all.  Laos had 19 cases (and no deaths) in its 7.3 million people.  Cambodia has 141 cases and no deaths with a population of 17 million.  Thailand is doing comparatively poorly, with 3,202 cases and 58 deaths for 70 million people, but their case rate is still 211 times lower than in the US, and their death rate is 512 times lower (and, in case you missed it, infected people die of the disease nearly three times as often in the US as in Thailand).

What is the secret of their success?  These low numbers, in countries that seem to have many of the same weaknesses and vulnerabilities of New York in their big cities that would seem to encourage rampant virus spread, are orders of magnitude – many zeroes – lower than we’d expect them to be.  Is it something to do with how their people behave?  Is it mask wearing?  Is it some sort of existing immunity in the population as a result of having been infected with something else?  Is it something genetic?  Is it weather related?

There is definitely something allowing the virus to essentially pass over these countries almost completely.  We need to know, urgently, so we can copy their actions.

I’ve been mentioning in the last few diary entries our continued problems with testing availability and the time it takes to get test results.  This is another massive malfunction of our public health system, a massive malfunction that has been promised to be solved repeatedly, and which is as bad (or worse) today as it has ever been in the previous months.  This article puts it brutally and bluntly.  “Testing is a ‘Shitshow'”.

We’d probably not use that exact term, but we can’t disagree with the article’s analysis.  Isn’t it time we start firing incompetent people?  Their incompetence is causing literally thousands of deaths.  Every day.

Closings and Openings

A reader asked for suggestions on current good value mobile phones.  He pointed out that he couldn’t actually go and look at phones in his local T-Mobile store.  They’d only allow people into the store if the person already knew exactly what they wanted.

This is a very short-sighted action on the part of T-Mobile.  If they are forcing people onto the internet (or into other cellphone stores), what hope do their stores have of rebuilding their store traffic in the future?  As everyone becomes more comfortable buying everything online, will regular retail shopping ever recover?

Here’s a wonderful chart that shows the comparative risk factors of various activities.  Opening the mail is the safest, going to a bar the most dangerous.  A great chart to look at and learn from.

One of the desperate hopes of some public health officials is that of having their community achieve herd immunity.  This is a popular aspiration, because it allows them to excuse their blithering incompetence on the grounds that, okay, so millions of people are unnecessarily getting infected with the virus, but the good news is that is helping the country get closer to “herd immunity”.

I’ve always been skeptical of the reality of herd immunity, because it assumes people become immune after having had a bout of the virus.  This is far from guaranteed – remember, the virus is similar to the common cold, and we all know how easy it is to catch colds several times over a winter, maybe even again during the summer, and then more times next winter, and so on.

Here is the latest of a series of similar articles confirming the problematic concept of acquired immunity.  And an article that asks the question “Can you get the virus twice?”.  It is an interesting article and very important question, but unfortunately, the answer is “No-one really knows”.

Even if herd immunity might be possible, we’d have to have something over 200 million people who have been infected with the virus in order for the US to reach the minimum 60% level that would cause new infections to die out rather than flourish.  Currently, we have reported 3.2 million cases, with some unknown number more of unreported cases.  Imagine if we had to keep on at our present rate of painful existence for, I don’t know, another decade, before we reached the 200 million case number.  Does that really sound like a practical solution?

Here’s an article which adopts a tone of surprise at discovering that in Spain, there aren’t enough people who have been infected yet with the virus for herd immunity to become operative.  My surprise is at their surprise.  Spain has had a reported case count of 0.64% of the population (compare that to the US with 0.97%), plus unreported cases on top.

Who in their right mind, with a 60+% target, would expect Spain to be anywhere near herd immunity?

Bad news for the cruise lines, at least those operating out of Britain.  The British Foreign Office has updated its advice about going on cruises; formerly it said older people should not go on a cruise, and now it is advising against cruising for people of all ages.  There’s no mention of when the FCO (ie the Foreign and Commonwealth Office as it is quaintly called) expects it to become safe and prudent to go cruising again.

That advice is not a prohibition, of course, unlike in the US where the CDC has published a “No Sail” order prohibiting cruise ships from operating from US ports.  That order is currently set to expire on 24 July, but if we were to take a bet, we’d put our money on the order being extended.  The cruise ship operators have voluntarily suspended US operations through 15 September.

Logic?  What Logic?

What is the problem with wearing a mask?  In general, most people agree with the concept, and want to see everyone else wearing a mask too.  Retailers want the states to mandate masks, which will make it easier for retailers to insist their customers wear them.

The IHME site makes it dramatically clear how mask wearing can reduce our deaths.

But the states and their governors?  In too many cases, nothing.

To put it in stark terms, the noisy few who are refusing to wear masks are as dangerous to the rest of us as drunk drivers.  Why aren’t we throwing non-mask wearers in jail overnight, requiring them to attend health classes for weeks, fining them thousands of dollars, and only allowing them out of their home if accompanied by a responsible adult?

We’ve changed our world due to concern over passive smoking and smokers have accepted the controls on where they may smoke.  Where is the matching concern over passively inhaling the next guy’s virus particles?

Medical

Worldwide, every day another 5,000 or more people die (5,504 today) from the virus, including almost 1,000 in the US.  Every day.  Meantime, researchers are leisurely engaged in an indulgent and ridiculous bit of navel-gazing and soul-searching, wondering if it would be ethical to allow volunteers to be deliberately exposed to the virus as part of testing vaccines to see if they work.

We can understand it might be morally awkward to force people to take this risk, but if someone freely volunteers, let’s get on with it.  This is a great way of speeding up and better validating (or invalidating) the effectiveness of potential vaccines, and the sooner we can identify a vaccine that works well, the sooner we can start saving 5,000+ lives every day.

As I’ve said before, political correctness will be the death of us.

Talking about progress towards a vaccine, here’s a great reference page about possible vaccines and how far down the testing process each one is.

This article is a sobering reminder that even “mild” cases of the virus risk severe ongoing consequences.

Musical Interlude

Here’s a great feel-good video.  If you’re of the “Beatles generation” (which basically is everyone born from, I don’t know, the 40s pretty much through now, isn’t it) the chances are you’ll find it as lovely as I did.

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.