Covid-19 Diary : Thursday 8 October, 2020

I’ve added a massive additional 42 pages to the released draft of my Covid book.  It now includes all the commentary on potential treatments.  A quick reminder – these are draft pre-releases.  I’ve changed some important things as the document has evolved, and indeed, new data continues to come in, changing our understanding of matters almost daily.  If you have an older copy that you’re keeping for reference, throw it away and get a new copy.

It is now almost exactly a week since the Thursday late night/Friday early morning (depending on your time zone) announcement by President Trump that he had tested positive for the virus.

As you surely know, he then went to hospital on Friday afternoon, and was discharged again on Monday afternoon.  Other than apparently needing some supplemental oxygen a couple of times on Friday, it seems that from Sunday onwards, he has claimed to be feeling well – on Monday he said he felt better than he had for twenty years.

To be blunt (and in general I’m more a Trump supporter than not) no part of the official account of his virus illness is credible or makes sense. For example, in this article, President Trump’s doctor says Trump stopped taking fever meds three days ago, which based on the time of the interview suggests Trump stopped taking his fever meds on Friday – the day he had to go to hospital and twice needed supplemental oxygen.  I rate that claim as very unlikely.

While, for sure, every person’s virus experience is different, the official account and timeline of President Trump’s experience is stunningly fast.  He went from first positive test to needing supplemental oxygen in less than 24 hours, and within 48 hours of that, was claiming to be all better.

There have been some claims that Trump may have known of his infection earlier than we’ve been told – Wednesday has been mentioned, but even adjusting for that doesn’t explain the speed of his transition from “normal” to “seriously unwell” to back to normal again.  Is it a spectacular indication of the success of some of the meds he was taking?  Probably not.  The treatment he is giving most of the credit to (although there’s no way at all he’d know which treatments worked the most or least) is the Regeneron treatment, and it has been taken by hundreds of other test subjects/patients already.  There is no mention of almost instantaneous resolution of infection in their writeups to date, and you can be sure that if there was even the hint of such an outcome, they’d be rushing to boast about it in the press.  To the contrary – the average time for symptom relief was eight days for patients taking the same (high) dose that President Trump was given.

Maybe it was the cocktail of all the other drugs too?  Possibly, no-one knows.

Or maybe, as seems possible in the two audio clips in this article, he is not yet nearly as well as he claims to be.  (Note also that in my opinion the silence after the first cough is not really a silence, it is more likely to be President Trump hitting the mute button while he coughs some more.)

Another unlikely/impossible issue is that he was given anti-inflammatory steroids on the Saturday.  The medical science is quite clear on this point – you do not give steroids during the first week of an infection.  Plus or minus a day or two, you wait until the second week before adding steroids to the medication.  Figures 1 and 2 of this document show that plainly – they refer to day 11 or 12, but that is counting from the date of infection, rather than the date of first symptoms (which is calls day 5).

So was Saturday actually 11 or 12 days since President Trump was infected, and six or seven days since he first started to experience symptoms?

There is, of course, a long and noble history of US Presidents (and plenty of other heads of state, too) being less than fully open and honest about their health.  It is not only President Trump who chooses to carefully manage what information is shared.  But we think we’d prefer the “no comment” approach to what seems at present to be a fanciful series of imaginings.

One other point that is probably relevant.  We were told of a long list of other drugs President Trump was also taking.  Will the CDC/FDA/NIH now abandon their increasingly ridiculous statement that there are no recommended treatments for people to take in the early stages of a Covid infection?  We mightn’t know what it was that caused President Trump’s miraculous speedy recovery, and we also have no idea if we know the totality of the medicines he was taking (my guess is we don’t).  But we now know, for sure, that an overweight 74 yr old male – a high/high/high triple risk combination of weight, age and gender – can go from a positive test to briefly needing oxygen to being discharged all in less than four days.

Whatever it was, we all want the same thing he had (and most of the disclosed treatments he was taking are very low cost and very plentiful).  Remember that – if your doctor gives you any pushback at all, just say “I want what President Trump had”.

Current Numbers

Montenegro puts in an appearance on the minor country list.

The US moved back up to third place in the major country list, although Brazil is very close in numbers, and Belgium, which just returned to the major list on Sunday, moved up to 8th place.

There was quite a shuffle in the death list placings.  Amazingly, Brazil, Spain and Bolivia are at almost exactly the same level, so there could be more changes between now and Sunday.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

I Am Not a Doctor, But….

One of the big nonsenses I continue to see being regularly recycled is a hope that “herd immunity” will save the day and stop the virus.

It won’t.  There are two huge reasons for that.  The first is that herd immunity probably needs over 60% of the population to have acquired immunity.  Presently, 2.4% of the population in the US has been infected.  We need 25 times more infections to get us over 60%.  And, of course, part of the 25 times more infections will be 25 times more deaths.  That could total over 5 million deaths to get us to the herd immunity level.

The second reason is that acquired immunity, after having had the disease, is increasingly seeming to be patchy, uncertain, and short lived (possibly only three months).  Indeed, a growing and alarming aspect of people who are now already on their second time around with the virus is that the second infection is proving to be worse than the first.

Six months late, the CDC has finally and grudgingly gone partway to conceding that it has been wrong all along about how the virus spreads.  All the worry about the virus on exposed surfaces?  As far as I know, there’s not a single known case of anyone catching the virus from touching a contaminated surface (although to be fair, maybe that is due to the obsessive hand sanitizing we’re all doing!).

And the “no aerosol transmission” claim?  The CDC is now accepting that the virus “can sometimes be spread by airborne transmission“.  The CDC believes the bulk of transmission is via droplets, a nonsense of a claim and almost but not quite as wrong as its earlier obsession with fomite transmission (by touching things).

But – only sometimes spread by airborne transmission?  How about “most of the time”?  Here’s an excellent online resource that makes a stunningly strong case for airborne/aerosol transmission being the major path for the virus to spread.  Well worth reading, particularly section 1.4.

Some good news – a treatment that promises to “stop the disease in its tracks” and another promising treatment too.

Well done, New Zealand.  The country claims to have successfully cleared itself of the virus again, for a second time.  A mystery infection spiraled into around 150 new cases before being stopped after just over six weeks of outbreak, and with new case numbers now down to zero, it seems to have been eliminated.

If New Zealand can do this twice, why can’t other countries do it once?  Instead, many countries are now reporting greater numbers of daily new cases than ever before.  Rather than getting better at virus control, most countries are getting worse.

This is not rocket science, it is very simple.  Why aren’t other countries doing the same as New Zealand, so their citizens too can stop wearing masks and social distancing, and have joyous and relaxing times in pubs and restaurants, at sports events and concerts, ride public transport without worry, and generally enjoy “normal” life again.

Here’s an interesting reminder that the tests for Covid are not always accurate.

Timings And Numbers

With daily new case numbers continuing to move up again for almost exactly a month now, it is not surprising that the count of states in the US with reducing case numbers is very low.  After dropping down to only 11 states last weekend, it rose to 13 on Monday, 15 on Tuesday, then eased back to 14 on Wednesday and 13 today.

The worst state is currently Montana, displacing Wyoming from that position.

As you can see, the growth in new cases in Montana is extraordinary.  We wonder when they’ll do something serious about stopping that.

WHO is at it again.  For reasons we can’t start to comprehend, WHO announced earlier this week that perhaps 10% of the world’s population has already been infected by Covid.  There’s only one slight problem with that claim.  The official count – a count they are maintaining themselves – is right around 36.7 million cases, which is 0.47% of the world’s population.

So is WHO wrong by a factor of 20?  Probably.  Details here.

Closings and Openings

Bill de Blasio, Mayor of New York, is now threatening fines of up to $15,000 on people and organizations that break the city’s social distancing rules.  We wonder how many of those fines will ever be imposed, and how many will ever be collected.

Talking about social distancing, California is refusing to even consider when, how, or if Disneyland and other major theme parks might open again.

We can see the good sense in being careful and slow to reopen the parks, but we think it only fair the park owners be told what the parameters are for when they’ll be allowed to open.  Not even having a set of conditions that everyone can understand and track the progress towards is totally unfair.

Shortages

Here’s a blast from the past.  Although surgical masks seem freely available at present, “professional” grade N95 masks and other PPE is apparently still in desperately short supply.  That’s dismaying, particularly with increasing case numbers again at present.

Logic?  What Logic?

You’ve got to love California.  The governor’s office is now telling diners they should wear their masks between bites of food.  Yes, that might be a great idea in theory, in a perfect world.  But did the people in the governor’s office actually try to eat that way before recommending it?  (Really sad thought – maybe they did try and thought it perfectly okay!)

One of the least appealing things to do at present is to go cruising.  Well, that is certainly my perception, but not so much in Singapore, where the tourist board is trying to persuade cruise lines to start offering “cruises to nowhere” so people can “enjoy” cruises again.

So a cruise that goes nowhere?  That sounds even less fun than a cruise that goes somewhere.

Other

Are you starting to wonder how you’ll manage “the holiday season” this year – large family gatherings for Thanksgiving and Christmas?  Even though they’re of very little practical value, it seems that 30% of intending hosts plan to do temperature checks of their guests prior to allowing them in the front door.

Imagine that – you and your family drive all day to attend your family event, and upon arriving, your not-favorite sibling aims an inaccurate $10 temperature gun at your head, announces your temperature is too high and you’re not allowed in!

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

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