Covid-19 Diary : Thursday 6 August, 2020

 

We find ourselves wondering how many more examples does the world need, proving the truth of what seems to be ultra-obvious to us, “If you relax the restrictions, the virus will return”.  It surprises us to see this repeat again and again – countries that focus on reducing their new case counts down to whatever they choose to be an acceptable level, and then, having achieved that, boast of their success and then relax their controls, only to discover, to their apparent surprise, that if they relax their controls, the virus rushes back once more.

The latest example of this is Spain.

We don’t only marvel at the naive surprise of countries discovering this simple fact.  We also wonder how stunningly uninformed and ignorant their public health officials must be to be surprised by these inevitable and predictable outcomes, and wonder what their actual objectives and goals are.  What is the point in fighting the virus if, as soon as you’ve won a battle, you then give in and allow the virus to grow back to the same levels – or even higher – as before?

When will the public health officials publicly admit and honestly tell us the truth – the virus isn’t going away by itself, and we will need to maintain social controls until or if an effective vaccine is developed.

Another example of this – I’m not sure what to call it – shortsightedness?  Incompetency?  Dishonesty?  Whatever the name, another example is this article quoting the president of the Minneapolis Federal Reserve Bank.  He says we need another lockdown for a month or longer to save the economy.  The key is in the two small words “or longer” – there’s no point in enduring another lockdown, if we then immediately give back everything we “won” in our virus battle by relaxing the lockdown, the same as we did the first time.  We either need to learn to live with the virus and accommodate it in our normal routine and daily lives, or we need a vaccine that works.

I can’t see any easy way to conveniently and safely incorporate the virus into our daily lives and normal routine – can you?  I’m also very concerned about the timeframe and possibility of a vaccine (discussed more, below).  We need to stop pretending to ourselves what the future might actually hold.

Current Numbers

The US broke through the 5 million total cases mark at lunchtime today, and as predicted, also now has more cases per million than Vatican City.  Peru is moving strongly up the death rate table, having climbed two places in a week.

Other than that, and some minor shifts of position, there have been no major changes in our three tables.

Top Case Rates Minor Countries

RankOne Week AgoToday
1QatarQatar
2French GuianaFrench Guiana
3BahrainBahrain
4San MarinoSan Marino
5KuwaitPanama
6OmanKuwait
7Vatican CityOman
8PanamaVatican City
9ArmeniaArmenia
10AndorraAndorra

 

Top Case Rates Major Countries

RankOne Week AgoToday
1ChileChile
2USAUSA
3BrazilBrazil
4PeruPeru
5South AfricaSouth Africa
6SwedenSaudi Arabia
7Saudi ArabiaSweden
8SpainSpain
9BoliviaBolivia
10Dominican RepublicDominican Republic

 

Top Death Rate Major Countries

RankOne Week AgoToday
1BelgiumBelgium
2UKUK
3SpainPeru
4ItalySpain
5PeruItaly
6SwedenSweden
7ChileChile
8USAUSA
9FranceBrazil
10BrazilFrance

 

I Am Not a Doctor, But….

Here’s an apparently stunning and overwhelming validation of Hydroxychloroquine.  To be fair and dispassionate, I don’t know who is publishing the website and associated Twitter account, and the data they’ve collated and presented is far from rigorous and fully explained, and the whole concept of their “high level analysis” of numbers is one that is fraught with uncertainty and challenges.  I also don’t understand exactly what the selection criteria is for deeming a country to be using or not using HCQ either.

But the website does show some extraordinarily strong differences between the HCQ-using and not-using countries, and a wealth of other fascinating data, too.  It is supported by 172 references, although not all the references are directly related to the main thrust of their HCQ advocacy.

The most puzzling thing of all, to me, however, is not the data on this website.  Rather it is the people who allow distorted data to be used as a reason to ignore HCQ entirely, while making ridiculous statements such as the drug being too dangerous to research further.  That doesn’t even pass the laugh test, because HCQ is the tenth most commonly prescribed drug in the US and is on the WHO list of essential (and very safe) medicines.

There is a growing abundance of evidence that tantalizingly hints at HCQ being an extreme game changer if used properly.  Why is there a huge focus on deceptively “proving” that HCQ is no good, instead of a focus on finding the use-cases where HCQ can save lives?  If I were a conspiracy-monger, this truly would have me looking for the secretive cabal that is succeeding in suppressing and distorting the possible life-saving nature of HCQ when used effectively – ie, in conjunction with zinc, and at the earliest possible point in an infection.

Instead, we get articles such as this in the mainstream media (USA Today in this case) reporting officials telling us it is time to move on from talking about HCQ because it is of no value.  We’d love to know what the five trials are that Admiral Giroir is citing in support of this astonishing claim, and also we’d love to know even more how Admiral Giroir can ignore or dismiss/disregard the trials that have shown HCQ to work almost miraculously well.

A sensible person – someone other than apparently Adm Giroir, someone truly seeking solutions to this crippling virus affliction, if faced with conflicting trial outcomes, would want to understand and amplify the successful trials, not look at unsuccessful trials and then ignore the successful trials.  Whether it is HCQ or something else, clearly in some cases, something is causing people to enjoy lower infection rates, less severe infections, and lower death rates.  Let’s find out what it is and how to use it more widely, rather than give up on the concept entirely.

Here’s another promising new almost-instant test for Covid-19 infections.  It says it takes 90 minutes to report a result.  That is great, but it would also be helpful to understand how accurate the test results are (both false-positive and false-negative errors) and also the cost and projected availability of testing.  The BBC article talks about its release in the UK – what about here in the US?

We’re also hearing reports of a new test in Canada that can give results not in 90 minutes, but in well under 90 seconds.  It is still being developed and not yet ready for commercial release, so is currently in the “good news if true” category.

Some astonishing and puzzling news from the Netherlands.  Their “top scientists” have concluded there is no evidence showing any value in wearing face masks, and go further by saying wearing masks may actually be harmful.

But, contradiction for this statement can immediately be found in the statement itself!  Their “top scientists” go on to say there is evidence that wearing face masks works on public transport such as buses, trains and ferries.

Wouldn’t you love to know how a face mask works on a train or ferry, but not in a supermarket?

Talking about face masks and their value/benefit, what about face shields?  Here’s a decent article that can be summarized as saying that face shields can increase your protection, but are woefully inadequate by themselves.

The “deus ex machina” that we’re all desperate for, to save us all from the continued depredations of the virus, is a vaccine.  But our desperate desire and indeed need for a vaccine may be coloring our perception of the reality of when/if a vaccine will appear and save us.

Here’s a good article full of disappointing reality rather than unrealistic hype about a future vaccine.  We particularly noted two key points – firstly that the concept of an “effective” vaccine doesn’t mean one that prevents people from getting the virus, but has been defined instead as one that merely reduces the severity of any such infection.  The second point is that while there are seven currently leading vaccine candidates, they are all based on the same approach to creating a vaccine.  If one fails, it is likely all seven will be failures.  We are not pursuing seven totally different approaches; we have one approach being developed by seven different companies.  That’s not nearly as encouraging as first implied.

We are also concerned not only at the breakneck speed of the vaccine development process and the lack of time for more careful testing and analysis for side effects and unexpected issues, but now we see that the big pharma companies developing these vaccines are being given waivers exempting them from liability if their vaccines end up killing us all.

So, inadequate testing, and no liability for mistakes.  What could possibly go wrong with that combination?

This article gently expresses some of the possible problems that might happen with this rushed trialing process, but doesn’t get anywhere near to worst case scenarios which of course have to be considered as extending all the way to “ends up killing us all”.

I keep thinking of thalidomide, and how it caused a totally unexpected problem that didn’t appear during the testing, and only became tragically apparent after the drug had been approved as safe.

Timings And Numbers

The excellent rt.live site showed 16 states with decreasing rates of new cases on Sunday.  This grew to 19 on Monday, and continued to 20 on Tuesday, Wednesday, and Thursday, although the specific states varied from day to day.

On Thursday, from best to barely under the 1.0 measure (where new infection rates change from decreasing to increasing), the states are AZ, NM, CA, WI, LA, VT, SC, WV, ME, NY, GA, FL, OH, ID, AK, CT, PA, DC, NC, KY.

Of passing interest is this item that reveals a huge gap between the official and apparently actual numbers of cases and deaths in Iran.  We’ve guessed at Iran downplaying its numbers for some time, but even the more likely numbers still show it as having infection and death rates very much lower than the US.

Closings and Openings

The US State Department has dropped its global “don’t travel anywhere” recommendation.  Now they are back to making country by country recommendations – we do hope they’ll fairly distinguish between countries with lower virus rates than ourselves in the US (ie just about every other country in the entire world) which are therefore desirable places to travel to, and the very few afflicted with higher rates of virus spread.

We wonder when the US will also relax its now woefully out-of-date restrictions on European visitors traveling to the US.

As we said on Sunday, it takes a special kind of stupid to go on a cruise at present.  But we’ve been surprised at the flood of reports of cruise ships with virus infections on them – for example this report and this report (not a complete list).

These outbreaks also show, very clearly, the nonsense of requiring a person to be tested for the virus, but allowing tests up to five days before the person arrives onto the ship.  What is the sense of that?  None, whatsoever!

Talking about a lack of sense, we see the annual motorcycle rally held in Sturgis, SD, will proceed this year, starting next week on 7 August and continuing on to 16 August.  The town of not quite 7,000 people is expecting more than 250,000 people to turn up for the rally.  We wonder how many will catch the virus.

Is your state on this list of 35 states with quarantine restrictions that will apply if visiting New York City?

This is a crazy concept.  First of all, the “honor system” quarantine does not work sufficiently well.  Secondly, deciding if a person needs to be quarantined or not based on their state of residence is too broad-brush an approach.  A “safe” state still likely has zones of high virus activity, and similarly, a “dangerous” state has zones of low virus activity.

It would be just as easy to make the decision based on county-level data (there are 3,141 counties – that is a much more precise control measure, and data is readily available on county levels) and that would make for a more effective, safer, and fairer system.

 Who Should Pay

The Sturgis motorcycle rally next week might be proceeding, but it seems Halloween might be greatly curtailed.  The interesting point in the linked article, at least to me, was the discovery that Halloween represents the second highest spending of any holiday after Christmas.

Last year we spent, in total, $3.2 billion on costumes, $2.6 billion on candy, $2.7 billion on decorations, and $390 million on greeting cards.  That’s a somewhat surprising average of $27 for every man, woman, and (of course) child in the entire nation.  I’ll be careful not to let my daughter know that I’ve been shortchanging her on Halloween!

Shortages

Toilet paper might be readily available again, but Clorox wipes are projected to remain in short supply until some time next year.

What I do is simply use hand sanitizer.  I never trust anything in stores, and use my own hand sanitizer on things like trolley and shopping cart handles.  Hand sanitizer these days seems relatively abundant, and can be bought in bulk for under 40c/ounce, on Amazon and elsewhere.

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.

2 thoughts on “Covid-19 Diary : Thursday 6 August, 2020”

  1. I used to read about the bias of American medicine, and how it favors technology and complexity over simplicity or common sense solutions. The focus on prolongation of life instead of quality of life, on addressing the symptom instead of the disease (it’s a more profitable pharma business), and on “spare no expense”, bill the insurance company, versus financially sound decisions. And I thought it was hyperbole.

    But with our approach to Covid, I think it’s true. I see regulatory agencies, that while seeking an extremely high level of safety, trade lives for incremental gains, and slow, inadequate bureaucratic decisions. They used to say that the Airline regulators needed bodies and gruesome crashes to take action. Well, the drug regulators have their bodies and gruesome deaths now, yet still seek the perfect as the enemy of the good; missing the former and ignoring and even banishing the latter.

    I remember, many years ago, when my Mother had end-stage cancer, and I was seeking to get her some cutting edge treatment, on a compassionate use basis, and I was denied, over and over. Not because they were worried about hurting her, but because she “didn’t fit the study admission requirements” – really, they didn’t want to treat someone who was likely to die, and screw up their results. The situation with HCQ and AZ is just that mentality multiplied by 160,000 or more.

    I don’t want to sound cynical, but if a $30 course of drugs can reduce the death rate by 50% or more, for high-risk patients, if administered early, versus a $4,000 per IV, multi-course treatment of Remdesivir, with less potential benefit, combined with many other invasive, expensive and almost medieval treatments, it makes you wonder why. And it also makes you wonder why the current standard of care is “watchful waiting”, offering nothing, while the patient gets steadily worse, until the point that hospitalization is needed with “florid” disease and far more serious and negative outcomes. How many of the 160,000 have died needlessly? It’s criminal, and it’s heartbreaking.

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David.