Covid-19 Diary : Thursday 14 January, 2021

The outgoing Trump administration agreed with the incoming Biden administration.  That’s a sentence you probably never expected to see, and might never see again.  Sadly, the agreement was on a matter that they’re both totally wrong about.  How is it that politicians only agree when they’re all wrong, and seldom/never when they’re all right?

The matter of their agreement affects us all, and could even be a literally life and death matter.  The policy for vaccine distribution.  Both sides have now agreed to distribute every dose of vaccine asap, with no hold-backs for the second dose that is required, either 21 or 28 days after the first.  Instead, they’re going to hope and trust that, by the time second doses are needed, they’ll be available.

Now that’s not an entirely stupid policy, in a case where there’s a reliable tested proven distribution channel.  “Just in time” ordering and deliveries have been a fact of commercial life for several decades.  That’s why your supermarket, if you’ve ever noticed, no longer has much space out the back for inventory – shipments come in and go almost directly/immediately onto the shelves, and if shipments don’t come in every day (sometimes twice a day) the shelves quickly empty out.  Even Boeing has a just-in-time approach to how it assembles planes – it expects the sub-assemblies to arrive shortly before they are needed, more or less one by one, rather than getting in batches of three months’ supply at a time.

But can we trust the government to get this right?  Please keep in mind this is a government and healthcare infrastructure that is still unable to ensure we all have access to tests and fast results from tests any time we wish.  Or masks – where are the N95 masks for you and me, especially now the more readily transmittable version of the virus is becoming more prevalent?

It is also relevant to note that the problem at present is not a lack of vaccine.  It is a lack of ability to distribute the vaccine, and confusing policies for who should be allowed to get shots.  Doubling the inventory of vaccine available for immediate use doesn’t mean that we’ll immediately double the number of vaccinated people.

These problems are also nothing to do with which parties controls the House, Senate, and Presidency.  These problems redound to senior and junior administrative people at every step of the policy and distribution process.  It will not get instantly better next week.  And if we have twice as many doses dispensed sooner, it is going to be twice as difficult to get second doses to those people in time.

Invoking the Defense Production Act to ensure second doses are manufactured in time seems like a laughable response to the problem.  Is anyone suggesting that Pfizer and Moderna aren’t manufacturing every possible dose they can at present?  Is there latent unused vaccine production capacity somewhere else in the US that could be instantly pressed into service in time for second doses to be ready to be injected into people’s arms in less than three weeks?  Suggesting that as a solution ignores the problem – our problem is in the distribution channel, not the supply channel.

Here’s another piece that shows the total lack of sense in the vaccine distribution process currently.  Will the Defense Production Act or a new President change any of that?  Sadly, absolutely not, and certainly, not in the three weeks or less between now and when the 3 million people with first doses will need their second doses.

And please don’t think “if I end up only getting one dose, at least it is better than no dose at all”.  There’s precious little evidence to support that deceptively reassuring but possibly totally wrong line of reasoning.

To put this all in context, there’s no more than a three week acceleration of our vaccination program with this dangerous concept.  If we’re so desperate that three weeks is worth such a risk, how is it that the FDA were so slow to approve the vaccines in the first place?  Why didn’t we lock the FDA decision makers in a room with no food or water and tell them they couldn’t emerge until they’d ruled on approving or disapproving the virus?  Their approval was a simple process, they’d been getting updates during the trialing, and the approval was almost guaranteed to be given.  But we allowed them leisurely weeks to ponder the matter at their leisure.

As another example of the ineptness of our public health professionals to manage a stunningly simple part of defending against the virus – face masks – this is a great article about how, now 9+ months into the virus pandemic, there are still no standards or guidelines about masks, and a shortage of the only officially approved N95 masks, while there continue to be an abundance of masks being promoted and sold that are almost totally useless.

As a vivid example, here’s an article wondering if wearing two masks might be twice as good as one, and a prudent thing to do with the new more infectious strain of virus out there.  That’s a fair question to wonder about.  So why is there no guidance?  Where is the public health leadership in this?  Isn’t this something the CDC should surely have already developed answers for, not just in the last nine months, but in the nine and even ninety years before?  How is it that masks seem like an alien technology to these experts?

Current Numbers

No change in the ranking of the best five US states for case rates, but the worst five saw IA leave and RI appear, and TN/UT swap places.  No changes in death rankings at all.

No change in the minor country rankings.  In the major country case rates, the Czech Republic continues to extend its lead over the rest of the field, and Belgium continues to fall further behind the US.  The UK moves up one place.

The US moved up a place on the death list, and Argentina’s place at the bottom of the list has now been taken by Sweden.

 

US Best and Worst States

RankCases/MillionDeaths/Million
A week agoNowA week agoNow
1 BestVT (13,467)VT (15,342)HI (211)HI (225)
2HIHIVT (248)VT (260)
3MEMEMEAK
4ORORAKME
5WA (35,165)WA (37,662)OR (372)OR (412)
47IA (92,475)RI (95,289)CT (1,763)CT (1,838)
48UT (92,739)TN (98,179)RIRI (1,884)
49TN (92,872)UT (99,053)MAMA
50SDSD (118,138)NYNY (2,079)
51 WorstND (123,554)ND (125,158)NJ (2,223)NJ (2,280)

 

Top Case Rates Minor Countries (cases per million)

RankOne Week AgoToday
1Andorra (107,953)Andorra (114,674)
2GibraltarGibraltar (104,168)
3MontenegroMontenegro
4San MarinoSan Marino
5LuxembourgLuxembourg
6SloveniaSlovenia
7Panama (61,862)Panama
8French PolynesiaFrench Polynesia
9LiechtensteinLiechtenstein (62,063)
10Georgia (59,092)Georgia (61,383)

 

Top Case Rates Major Countries (cases per million)

RankOne Week AgoToday
1Czech Republic (74,141)Czech Republic (80,834)
2USA (66,660)USA (71,786)
3Belgium (56,451)Belgium (57,696)
4NetherlandsNetherlands
5SwedenSweden
6PortugalPortugal (50,862)
7Spain (43,300)UK (47,890)
8UK (42,447)Spain (47,300)
9FranceFrance
10BrazilBrazil
11ArgentinaArgentina
12Italy (36,752)Italy (38,671)

 

Top Death Rate Major Countries (deaths per million)

RankOne Week AgoToday
1Belgium (1,712)Belgium (1,743)
2ItalyItaly (1,338)
3Czech Rep (1,177)Czech Rep (1,293)
4UK (1,153)UK (1,263)
5Peru (1,146)USA (1,198)
6USA (1,127)Peru (1,161)
7Spain (1,105)Spain (1,135)
8France (1,023)France (1,061)
9Mexico (1,003)Mexico (1,056)
10Argentina (972)Sweden (1,005)

 

The rest of this newsletter is for the very kind Travel Insider Supporters – it is their support that makes all of this possible, and it seems fair they get additional material in return.  If you’re not yet a Supporter, please consider becoming one, and get instant access to the rest of the Diary Entries – today and in the past, and much extra content on other parts of the website too.

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Items below include a discussion on the growing number of new strains of virus and their potential resistance to both vaccines and new treatments, will we be stuck with the virus forever, even asymptomatic sufferers risk severe lung damage, a peer review article on ivermectin, disappointing results from a Chinese vaccine, unknown results from a Russian vaccine, two promising new vaccines, improved case rates in the US, some ridiculous statements from the UK, an uncoordinated confusion in the cruise industry, difficult policies for people including US citizens traveling to the US, and yet another one month extension of the closed Canadian and Mexican borders.

SUPPORTER ONLY CONTENT

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END OF SUPPORTER ONLY CONTENT

One final item for today, passed on without comment – the Canadian lady who was fined for walking her husband on a leash like a dog, claiming she was “dog walking” and therefore exempt from lockdown requirements.

 

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

Please click here for a listing of all our Covid-19 articles.

6 thoughts on “Covid-19 Diary : Thursday 14 January, 2021”

  1. It seems that many of your columns bring up, and even shockingly document, the many and massive failures of our public health establishment, from the national to the local levels. How have so many, intelligent and highly trained people, who specialize in protecting the public health, who have devoted their careers to it, been so demonstrably and repeatedly wrong, ineffective, and misguided? Every step of the way through our Covid ordeal.

    If I may take a somewhat contrarian position to many generally held beliefs about the public health establishment, I don’t think this is surprising for a number of reasons. From my own experiences at the local level, our County public health folks seem to specialize in running VD clinics and warning us to get our Flu shots and Shingles boosters. I doubt they have spent 1% of their time until 2020 thinking about massive pandemics, managing national vaccine distribution or setting social policies. And the best and brightest in medicine, I’m sorry to say, do not go into public heath. They either go to teaching hospitals, focusing on challenging and chronic disease, or follow the money into Big Pharma and Med Tech. It’s the same reason we have so few quality GP’s left in our society. It’s not where the prestige and money is.

    At the national level, we have the NIH, the National Center for Allergy and Infectious Disease, the CDC and the FDA. These are almost purely academic and/or regulatory agencies (few of their people have treated patients or run hospitals). They mostly manage huge research budget priorities (we’ll circle back to this in a second), review research results, and hold meetings about regulation.

    The CDC essentially exists to be the canary in the coal mine. It identifies problems (often misidentifies them, remember the massively devastating Swine flu or the catastrophic H1N1? Me neither) and sounds the alarm. It doesn’t manage the national response or national policy. The canary doesn’t usually run the coal mine.

    The general medical infrastructure fares little better. Big Pharma and medical research focuses on treating symptoms, not cures. On highly expensive technologies, not simpler, less expensive, broadly available solutions. The vaccine development was a triumph, but other than that, the numbers reflect our systemic failures.

    Back to managing research budgets. If you will remember the important article in the New York magazine a week or so past, about the origins of Covid, it supports the thesis that it is very possible that it originated in the Wuhan research labs. These are the very same research labs that conducted bat coronavirus Gain of Function research (documented), supported by grants from the NIH (documented), and approved by Dr. Collins and Dr. Fauci, who until as recently as 2018 were strong proponents of this very dangerous research.

    Imagine the clenching in DC that took place when the nature and source of this virus became apparent, or the publication of this well-researched article. Our whole nightmare could have been funded, at least in part, by the US taxpayer.

    So, do we really expect our public health establishment to take charge and solve our many problems? Call me a cynic, but I think not. Our entire medical establishment is tragically structured and designed not to.

  2. Re; “We have to wonder if the potential for severe lung damage in asymptomatic sufferers might also extend to vaccinated people, who is seems are still at risk of becoming infected, and will still be capable of passing the infection on to others.”

    Really good question. And it leads to another, which I’m embarrassed even to be asking at this late stage. If vaccinated people can still be infected, what exactly does a vaccine’s 95% (or 90% or, indeed, 50%) effectiveness actually mean? What is being measured at the trial 3 stage — absence of infection or absence of symptoms?

    1. The trial is measuring symptoms not infections. It rates symptoms on a subjective scale, from mild to “on death’s doorstep”. And then says something like “95% of vaccinated people did not exhibit (any/severe/whatever) symptoms”. With that qualifier of any/severe/whatever being somewhat downplayed, it seems (or else none of us would need to be asking that question).

      That is what happened with the Chinese virus claim of 78% effectiveness, when it included mild symptoms as a negative outcome, it dropped to 50%.

  3. May one hope that this “subjective scale” is being followed uniformly by the main contenders and the regulators? Not, evidently, by China and who knows about Russia.

    In any event, this then begs yet another question. Why haven’t the various regulators demanded that the vaccine manufacturers now go a step further and test their subjects for infection too?

    1. I have no answer to the question about testing subjects for infection. The entire process of testing these vaccines has been rushed and, to my mind, done extremely poorly. Simply rushing (an understandable desire) doesn’t and shouldn’t also mean “done superficially or not at all”, but it seems there are dismaying weaknesses in much of the testing and very weak correlation between some of the ultimate claims and the underlying evidence in support of them.

      Certainly it would have been possible to have tested subjects for antibody presence at the end of the testing period; with the presence of antibodies implying an infection having occurred during the testing period (I think but am not sure that most of the trials involved antibody testing at the start of the test period).

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