Covid-19 Diary : Sunday 25 October, 2020

Nothing to do with the virus, but I’ve just finished a long drive east from Seattle, during the course of which I set a new personal record for coldest temperature observed in my car.  -7°F.  Brrr….  I’ll confess to being curious as to if the car will start tomorrow morning.

It is not just cold, but also slightly odd in MT – all the shops have signs on the doors saying no admission without a mask, but half the people in the stores have no masks on.  How did they get in?  There was a similar sign at the Travelodge I’m staying at tonight, but neither of the two people on the front desk had a mask on.  So I guess this chart of new cases in Montana shouldn’t be a total surprise.

Back to the usual stuff, although the lack of masks here allows for an easy segue.  Is it possible the US will soon report a single day with over 100,000 cases?  Friday saw a new record for new cases reported, and there’s no sign of the current surge abating.

No country has ever reported 100,000 cases in a single day – yet; although for a while, India looked like it might (and keep in mind that India has a population 4.2 times greater than the US, so their 100,000 count would be the same as a modest 24,000 day in the US).  But India’s case numbers are now declining again.

As you can see, India’s new case numbers are now down to a daily average of little more than 50,000.  That would be the same as 12,000 a day in the US, a number which we’ve not been anywhere near since way back in mid March.

The interesting thing about India is that it’s story is being repeated by many other countries, especially in Asia.  A single peak, and then, almost as quickly as it rose, numbers drop down again.  I find myself revisiting the puzzlement of the great differences between countries and their virus experience.  Regionally, Asia and Africa are reporting numbers much lower than most of the rest of the world, and this is an interesting article that talks about some of that.

I’d like to go one step further though, and raise a subject that somehow seems to be walled-off from most discussion.  China.  China is the country where the virus originated from, and for several months, the authorities either weren’t aware of it or chose to ignore it.  Unsurprisingly, case numbers skyrocketed in China as a result.  Do you remember the astonishment with which we watched the virus taking over the Wuhan region, with huge numbers of new cases being reported every day, and the usual panoply of articles about overflowing hospitals, crematoriums, and so forth?

Well, if you remember that, you’re mistaken.  Yes, the Wuhan outbreak was indeed described in those terms, but China’s worst day saw an official count of maybe 3,600 people being infected.  That’s little more than a rounding error compared to what is happening every day in the US.

The chart is a bit messed up because on one day China had a sudden surge of cases due to correcting the total, and Worldometers shows all those cases on one day rather than spreading them over the past few weeks.  But you can still clearly see the brevity and mildness of their virus outbreak, and the almost total lack of new cases since then.  There are about 15 new cases being reported in China every day at present, but they are from people coming into China from other countries and in quarantine, not “cases in the community”.

China is a country of 1.44 billion people – 4.3 times larger than us.  They had an uncontrolled outbreak for almost a month before any official action was taken.  But somehow, they managed two extraordinary things.  First, somehow this very mobile nation limited the outbreak almost entirely to the Wuhan region.  Secondly, they quickly eliminated the virus and it has remained eliminated ever since, even though the country has a huge and porous border with North Korea, Russia, Kazakhstan, Kyrgyzstan, Tajikistan, Afghanistan, Pakistan, India, Nepal, Bhutan, Bangladesh, Myanmar, Laos and Vietnam.  To say nothing of other places like Hong Kong and Taiwan.  Plus it has international flights coming and going every day.

How can China keep its cases at zero?

I don’t believe they had only 80,000 cases during their major Wuhan outbreak, but I find myself increasingly believing that they have no cases now.  I’ve sometimes had chances to chat with people in China, and I’ve tried to just casually work it into the conversation to ask them how they are managing with all the restrictions and virus problems, and every person has said that things are essentially back to normal now, other than for wearing masks in public.

As you can sort of see, we’re now reaching the point of having more cases, every day, than China (officially) has right since day one.

At the small end of things, we see New Zealand doing what Hawaii can not – eliminating the virus entirely.  At the large end of things, we see China doing what the entire US can not – eliminating the virus entirely.

There’s no real secret about NZ’s approach.  It had close to complete community compliance with a severe lockdown period and rapid testing/tracing to eliminate the virus in the country, and since then, has isolated itself from almost the entire rest of the world to keep the virus from re-entering.  This is clearly impossible for the US as a whole to duplicate, although for a while it looked like HI would do the same thing (alas, it gave up).

But what is China’s secret?  Sure, its official border controls are moderately strict, but its borders are only slightly less porous than our US border, and NZ’s experience has shown that if there’s even the tiniest teeniest crack in your border, the virus will come rushing back in again.

There’s some very big issue that we’re not understanding, and should be trying to identify.  It isn’t just compared to China (although China is the largest example), it is with other countries too.  The US is reporting 26,621 cases of the virus per million people, and 694 deaths per million people.  The world average is around five times lower – 5,507 and 148.  But then there are countries like Japan, South Korea, Taiwan, Thailand, and Vietnam with very much lower rates – Vietnam is 12 per million and 0.4 deaths, Taiwan is 23/0.3, Thailand is 53/0.8.

To put it another way, with 80,000 new cases in the US in a single day, that is the same as 241 cases per million.  There are 25 countries with less than 241 cases/million in total, over the 8+ months the virus has been a problem.  We are reporting about 3 new deaths per million per day; there are 40 countries with fewer deaths than that in total.

We’re not talking about countries with the world’s finest healthcare systems and healthy populations.  We’re talking about some of the poorest countries, too.  The world’s poorest country by some measures is Burundi – but they’re reporting only 46 cases per million and 0.08 deaths/million.  The second poorest is the Central African Republic with 1003/13, and the third is the Democratic Republic of the Congo, 123/3.  Not only do these countries have lower rates, but their fatality rate is lower than the US, too.

Is it too much to ask that we get our case rates down to no more than the case rates in Burundi, CAR and DRC?  Or, if you prefer, Japan (758/14) or Taiwan (23/0.3) or South Korea (503/9).

While the US situation is of most direct relevance to me, it is fair to note that we in the US are not actually suffering the worst at present.  That title probably goes to tiny Belgium, which is reporting up to 18,000 new cases a day.  That would be the same as the US reporting 543,000 cases a day.  Other stricken European countries include France, Spain, the Czech Republic, and Britain.

However, none of those countries have amassed the same total of cases as the US has, although Belgium (30% more) and Spain (8% more) have both suffered more fatalities.

Current Numbers

On the minor country front, Israel overtook Vatican City again.

The US is getting very close to passing Peru in the major country list, but is still a day or two away from achieving that.  Always assuming that Belgium, shooting up the list, doesn’t get there first!  The UK returns to the top ten list as well.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

I Am Not a Doctor, But….

There’s been a concern in the back of my mind that I’ve not wished to publicly express prior to now.  It was hard not to think, with the growing requirement for a negative test result to be shown to an airline to be allowed to board a flight, that there might be some fake test results being prepared, particularly because it can cost $150 or even more to get a “discretionary” personal test.  There’s a precedent – the fake “support animal” certificates that are for sale on the internet.

There is no process in place to confirm whatever claims to be a valid test result, and with people often getting such results by email rather than original official documents, it isn’t even possible to require a “fancy looking document” as a very basic sort of validation procedure.

Now, the kinder and gentler of readers might refuse to believe that anyone would choose to cheat the system and possibly endanger other people, just to avoid the hassle and cost of a real test.  To those people (and you too, if you’re interested) I sadly offer up this article.

I saw an article about a new HCQ study suggesting it was useless to prevent the virus, and because it was a study from the local University of Washington, a generally respected school, I went and read their report.

Inexplicably, there study contains both one relatively minor blunder and one huge blunder in the trial protocol.

The minor blunder is the trial used half the generally recommended dosage of HCQ (200 mg/day instead of 400 mg/day).  So the headline shouldn’t be “HCQ doesn’t work” but instead “Half the correct dose of HCQ doesn’t work”.  As a further point, it also didn’t seem to give patients Zinc as well as HCQ, with many experts recommending both.

But now for the really big blunder, one that is so huge as to make it almost impossible to believe it was accidental.  Usually in these “blind” studies you give people either the real drug or a placebo, and you don’t tell the people which they are getting; indeed, in the really highest quality blind studies you even make the pills (or whatever) look and taste identical so there is totally no way that either the test subjects or the test administrators know who is getting what.

One of the key elements of the placebo concept is that it should be a totally neutral inert substance that doesn’t, in and of itself, have any impact on the people taking it.  Imagine, for example, you are doing a study to see if a new pain reliever drug helps patients escape the worst of their pain sensations.  You’d not give the placebo “control group” paracetamol, would you!

In the UW study, the control group was given Vitamin C, an unusual choice of placebo (more commonly it is sugar or starch).  The thing is that Vitamin C is also suggested to have beneficial and anti-viral properties, helping people to fight off the virus.  It is well known as being helpful in fighting the “other” coronavirus – the common cold, and it seems it may impact on the new Covid-19 virus too.

Making sure the placebo truly is a neutral non-factor in a study is an essential part of a good study design.  On the other hand, it isn’t just the UW who has made a bad placebo choice, it is a long-standing problem.  Shame on the UW for such an egregious breach of best practices.

But you’ll not see a headline “Shameful UW study violates best practice guidelines and produces meaningless result”.  Instead, HCQ gets it in the shorts, albeit blamelessly, yet again.

Here’s an article that nicely traces the evolution of the exaggerated fear of catching the virus from touching something, and how that has been slowly and subtly downgraded in the months subsequently.  I’m not giving up on my hand sanitizer yet, but I’m now even more confident than I was before that I’m unlikely to run out any time soon (I bought four large containers in Feb or March, and still have 3 1/2 of them unused now).

One of the most feared government agencies in many states, and definitely so in Washington, is the State Liquor Control Board, or as it is now charmingly renamed, the WA State Liquor and Cannabis Board.  They have such a nightmarish web of obligations and restrictions on bars and the people who work in them as to almost kill all the pleasure of owning, working in, or relaxing in a bar.

They’re equally militant when it comes to mounting stings to catch hapless 7-11 stores for selling alcohol to people who are 20 yrs and 11 months old, to the point that I am still occasionally carded myself, with store clerks anxiously looking around for undercover agents and telling me they’ll lose their job if they don’t demand to see my ID.  (I’m more than three times 21 and can’t pretend to look a day younger than I truly am…..).

So I find it astonishing to read this article about how they are merely giving warnings – repeatedly – to a bar that is egregiously violating Covid-19 rules and restrictions.  They’ve a zero tolerance policy for selling alcohol to minors.  Why now the loose interpretation of the Covid-19 restrictions?  There have been 2,299 Covid deaths in Washington so far.  I’ve no idea how many minors have died from alcohol in the last eight months, but perhaps 100, maybe 1,000 times fewer.

Timings And Numbers

Last I wrote, there were only four states with dropping rates of new cases on Thursday.  There were four again on Friday (MS ME DC OR) then three on Saturday (MS ME OR) and again today (MS FL ME).

Closings and Openings

There’s one opening, for sure, that I’m eagerly awaiting.  The latest James Bond movie, which had been originally scheduled for an April release.  Its release date has been now delayed twice, and is currently expected in April next year.

There was a sudden spate of rumors that the movie’s producers were considering selling the streaming rights to it now, prior to a theatrical launch, much the way other movies are now finding themselves forced to do (most notably the second Borat movie, released on Amazon on Friday).  Currently there’s not a lot of distance, we are told, between an offer from Apple to pay $400 million and the producers’ ask for $600 million.

We’d love to see the movie, but there’s no way we’ll pay money to buy an Apple device and sign up for Apple streaming to watch it.  Let’s hope Netflix or Amazon (both being device neutral platforms that can be enjoyed any which way) beat Apple in this semi-public bidding war.

Details here.

Shortages

Just a quick heads-up comment here.  If, as currently seems likely, the virus continues to spread more rapidly in the US, and there’s a change of administration some time subsequent to November 3 (most civilized countries change governments within a few days of an election – the bonus 2 1/2 months to the losers in the US has always been inexplicable), we expect there may be more forceful requirements for wearing face masks.

While they are currently reasonably freely available, it might be a good idea to stock up on a few more boxes.  Costco, Walmart and Amazon all seem to have them for about $10 per box of 50.

Other

We’ve seem some truly outlandish full face shields in the last few months, and now we can say we’ve also seen an otherworldly one.

This reads like an April Fool’s Day Joke, but seriously out of season.  Hormel is giving away bacon-scented face masks so you can smell bacon everywhere you go.

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

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